In honor of National Diabetes Awareness Month, I would like to shed some light on one of the complications with the highest amputation rates: diabetic foot ulcers. Type 2 diabetes occurs when body cells are resistant to insulin, which results in high glucose levels in the blood. The high blood sugar leads to less feeling and slower blood circulation, which can make it hard to notice cuts and leave small injuries susceptible to infections and ulcers.
The CDC states that diabetes affects 40.1 million people in the United States, and that 12% of those people will develop a diabetic foot ulcer at some point in their life. The National Library of Medicine states that people who go through foot and/or leg amputation have a significantly increased long-term mortality rate.
Nursing home patient with her caregiver
(Maria Alejandra Cardona / Los Angeles Times)
I had the opportunity to work face-to-face with some nursing home patients this year. One day, while I was preparing to give a footbath to one of the residents, I noticed his right foot missing. When I asked him about it, I learned that he had gotten his foot amputated due to a foot ulcer. Having had high cholesterol all through his life and being diagnosed with type 2 diabetes when he was 49, he always knew at some point he’d have to start taking insulin shots and adapt to a low-cholesterol diet. What he didn’t expect, however, was that a small blister he didn’t notice would severely impact his mobility.
But what if there was hope? In 2025, an article was published in the American Diabetes Association comparing the effects of two common diabetic treatments in foot ulcers: GLP-1 receptor agonists and SGLT2 inhibitors. GLP-1 receptor agonists mimic incretin hormones that stimulate insulin release whereas SGLT2 inhibitors block the SGLT2 protein transporter re-absorbing glucose into the kidney.
A recent cohort study on the TriNetX Platform has shown that while GLP-1 receptor agonists and SGLT2 inhibitors are associated with a decreased risk of progression to foot ulcers and amputations, GLP-1 receptor agonists have a modestly lower hazard ratio than SGLT2 inhibitors for foot ulcers. SGLT2 inhibitors generally benefit people with diabetes-related kidney and heart diseases more.
Although the possible consequences of diabetes may seem far away, major preventive measures can be taken to lower your risk starting from a young age. For example, consulting with your doctor about blood sugar screenings are recommended by the CDC if you have two or more risk factors, such as high blood pressure or a family history of diabetes. Avoiding heavily processed foods and maintaining a balanced diet can also help stabilize glucose levels. Even though diabetes-related complications may seem distant when you’re a teenager, the ways you choose to take care of your body now can make an impact down the line.
