Program Background & Results
A new program at MLK Community Healthcare in South Los Angeles has dramatically improved health outcomes for diabetic patients while avoiding painful and costly surgeries. In four years, only one high-risk patient required an amputation.
Patient Story: From Lifestyle to Comprehensive Care
Michelle Caldwell, 58, who has had Type 2 diabetes for more than three decades, says her condition is now better controlled than ever. She regularly visits her endocrinologist, primary care provider, dietitian and pharmacist at MLK Community Medical Group. She picks up weekly produce deliveries and attends cooking classes at the hospital. She has learned to read nutrition labels and developed a taste for salads and nuts.
Diabetes can damage foot nerves, making it easy for patients to miss small cuts or blisters that can lead to serious infections. Her care team gently urged her to switch to supportive, closed-toe shoes. She jokingly asked if there were options that didn't look like 'Frankenstein feet.'
Key Data: Significant Improvements
- Over 80% of participants saw significant drops in blood sugar levels (HbA1C).
- Over 70% achieved better blood pressure control.
- Amputation rates among high-risk patients dropped to near zero (only 1 case).
Why Is It So Effective?
Dr. Jorge Reyno, senior vice president for population health at MLK, explained that these results are not due to new drugs or treatments, but rather a relatively modest one-time grant. The funding enabled the hospital to provide the same standard of care for diabetic patients in its service area as what people in wealthier areas expect. MLK's service area is home to about 1.3 million people; over 90% are Black or Latino, and nearly 70% are uninsured or on public insurance. The area faces a shortage of 1,500 physicians. Last year, about 123,000 patients visited the emergency department, which was designed for 40,000 annually.
The Severity of Amputation
In the U.S., diabetes complications account for roughly 80% of all non-trauma-related amputations. In 2022, diabetes-related direct medical spending was enormous, with foot ulcer issues accounting for about one-third of that. Dr. David Armstrong from USC noted that only about one-third of patients return to work after an amputation, with an average age of just 54. Dr. Caitlin Hicks from Johns Hopkins stated that amputations not only affect the patient but also impose multi-generational economic and caregiving burdens on families.
A 2014 UCLA study found that diabetic residents in lower-income areas of California were more than 10 times more likely to undergo amputation than those in wealthier areas. The authors called this disparity 'deeply disturbing' in a society that espouses equality.
How the Program Works
The hospital secured a $2 million grant from the Good Hope Medical Foundation and officially launched the Diabetes Management Center of Excellence in October 2021. The program provides intensive management for high-risk patients, including those with Type 1 diabetes, gestational diabetes, or HbA1C levels ≥9.0%. Services include regular multidisciplinary follow-ups, dietary guidance, and foot care education.