A new study by University of Virginia School of Medicine researchers and their collaborators found that patients with diabetes who participate in a free annual wellness visit are 36 per cent less likely to need an amputation.

The researchers analyzed data from 2006 to 2015 for Medicare-covered patients in the “Diabetes Belt,” 644 counties in the southeastern and Appalachian regions of the U.S. with elevated rates of diabetes. The Diabetes Belt includes the state of Mississippi as well as portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia. Patients living in the Diabetes Belt are 27 percent more likely to require a lower-extremity amputation compared to residents of counties surrounding the belt.

However, patients within the Diabetes Belt were 36 percent less likely to require amputation if they used their free, Medicare-covered annual wellness visit, compared to those who did not attend an annual wellness visit.

“Our results confirmed our hypothesis that annual wellness visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” says Jennifer Lobo, a researcher in the University of Virginia’s Department of Public Health Sciences.

The researchers found that diabetes-related foot complications were diagnosed less frequently in the Diabetes Belt compared with surrounding counties, which may point to delayed diagnoses that can lead to amputations. However, patients in the Diabetes Belt who participated in their annual wellness visit may have had their foot complications diagnosed sooner, helping prevent amputations.

In addition, the researchers suggest that patients who attend their annual wellness visit may also be more engaged in their own care, reducing the risk for more serious complications. Policymakers should prioritize incentives for patients with Medicare to use their annual wellness visits, the researchers conclude, to help reduce diabetes-related amputations.

The researchers also found significantly higher rates of diabetes-related amputations among Black patients compared with white patients, both inside and outside the Diabetes Belt. The researchers recommend additional resources or policy changes—such as increased diabetes education or the use of patient navigators that help guide patients through the healthcare system—to address systemic barriers that are preventing Black patients with diabetes from accessing the preventive care they need to prevent amputations.

“While Annual Wellness Visits are a free visit for qualified Medicare beneficiaries, additional incentives or resources to overcome systemic access to care barriers are needed to support patient attendance,” Lobo says. “Patient education about the value of Annual Wellness Visits and preventive care could also help improve utilization of Annual Wellness Visits, hopefully reducing the rate of major amputations.”