Reversing Trends in Diabetes-Related Disability

An estimated 265 million people worldwide suffer from diabetic polyneuropathy (DPN), a type of nerve damage caused by diabetes. While many patients with DPN lead normal lives, a subset experiences severe complications related to foot infection, gait disruption, and lower extremity amputation. In the United States, the complications associated with DPN account for more than $13.7 billion in healthcare costs annually, and disproportionately affect low-income, rural, and minoritized communities. Given rising rates of DPN worldwide, by 2060, lower extremity amputation is projected to increase by 260%, impacting approximately 3.8 million people in the U.S. alone. 

While DPN has no cure, its complications may be delayed or avoided through strict blood sugar control, continuous symptom monitoring, and appropriate pain management, annual foot exams, and timely referral to specialty care. Despite the known risks associated with DPN, it is often inadequately addressed in clinical settings, largely because clinicians cannot know which of the many patients with DPN are at highest risk for complications and warrant more intensive monitoring and intervention. Consequently, health systems face a critical dilemma: how to provide optimal DPN care given growing prevalence and limited resources to address it.  

Our research team at the HIPE (Healthcare Innovation, Policy, and Engagement) Lab is working to fill this evidence gap through collaborative, partnership-driven research with The Queen’s Health Systems, the largest health system in Hawaii, as well as patient advocates and policy makers, including guideline developers and payers. We will leverage rigorous, interdisciplinary, mixed methods research designs to generate critical evidence, inform and evaluate policy options, and design innovative solutions. By grounding this work in established partnerships, our aim is to ensure that findings translate directly into clinical practice and produce sustainable change, particularly for communities most burdened by DPN.