Intensive Diabetes Management Program Eliminates Amputations in South Los Angeles Safety-Net Hospital
Key Insights
MLK Community Healthcare (search)'s intensive diabetes management program reduced diabetic-related amputations to virtually zero among 1,165 high-risk patients over four years, with only one amputation occurring within a month of enrollment.
More than 80% of program enrollees achieved lower blood sugar levels and over 70% brought blood pressure under control by year four, without using any novel medications.
The program, funded by a $2 million grant, deployed a multidisciplinary support team including pharmacists, diabetes educators, community health workers, and nurse care managers to address care gaps between physician visits.
A safety-net hospital in South Los Angeles has achieved what experts are calling "absolutely, positively spectacular" results: eliminating diabetic-related amputations among its highest-risk patients through an intensive, multidisciplinary care management program that relies not on novel drugs but on coordinated, wraparound support.
Four years after MLK Community Healthcare (search) launched its Diabetes Management Center of Excellence in October 2021, only one of the 1,165 patients in the high-risk intensive-management group required an amputation — and that surgery occurred less than a month after enrollment, suggesting the patient entered the program with a wound already at critical levels. Diabetic-related amputations and wound care, which had been the hospital's most common surgical procedure since its 2015 opening, have now fallen to third place.
"What we've demonstrated here is that we can get best-in-class care — we can even beat national benchmarks for care — if there's the appropriate commitment and investment. And that people's health doesn't have to be determined just by their zip code," said Dr. Jorge Reyno, MLK's senior vice president for population health.
A community in crisis
MLK's service area encompasses approximately 1.3 million people in South Los Angeles, where more than 90% of residents are Black or Latino and nearly 70% are uninsured or rely on Medi-Cal, Medicare, or both. The region faces a 1,500-physician shortage, with only one-third of the full-time doctors needed to serve its population — a deficit driven in part by Medi-Cal's low provider payment rates.
Diabetes affects one in every six South Los Angeles residents and nearly a quarter of MLK's outpatients. Before the program launched, the hospital's emergency department — designed for 40,000 annual visits — was handling roughly 123,000 patients per year, with approximately 40% seeking primary care. Emergency physicians were diagnosing diabetes in severely ill individuals unaware of their condition and treating life-threatening complications in those whose disease had long gone unmanaged. Rates of diabetic ketoacidosis (search) ran three times higher than the rest of Los Angeles County.
A 2014 UCLA study found that diabetic residents in MLK's service area and similarly economically disadvantaged parts of California were more than 10 times more likely to undergo a toe, foot, or leg amputation than diabetic individuals in more affluent areas.
The program model
The hospital secured a $2 million grant from the Good Hope Medical Foundation (search), with additional funding from the Rose Hills Foundation (search) and L.A. Care Health Plan (search). Rather than hiring new physicians, MLK used the funds to build a network of dedicated support staff operating between physician visits.
Each patient in the intensive-management program — which enrolled individuals with Type 1 diabetes (search), gestational diabetes (search), or hemoglobin A1C levels at or above 9.0% — gained access to a clinical care pharmacist who reviewed and coordinated medications, a diabetes educator providing guidance on blood sugar monitoring and meal planning, community health workers conducting home visits, and a nurse care manager serving as primary advocate and point of contact.
Through the hospital's Recipes for Health program, patients could also pick up weekly bundles of fresh produce and attend bimonthly cooking classes focused on diabetic-friendly recipes.
"We have multiple people reaching out and interacting with the patients in between physician visits," said MLK endocrinologist Dr. Megan Jacobs. "They have someone reaching out to them and talking to them about the social aspects of things — how they have to take into account their diabetes when they go out to dinner and when they're at a party."
Measurable outcomes
The clinical results accumulated steadily. By year three, 66% of intensive-management patients had lower blood sugar levels than at enrollment; by year four, that figure rose to 81%. Blood pressure control improved from 63% of patients in year three to 71% in year four. Appointment compliance reached 84%, up from a baseline of 50%. Hospitalizations for diabetes among the most severely affected patients fell to less than half the rate of the area's general population.
"This is absolutely, positively spectacular," said Dr. David G. Armstrong, director of USC's limb preservation program and the Southwestern Academic Limb Salvage Alliance. "This is life affirming stuff."
The economic stakes
Diabetes cost the United States $306.6 billion in direct medical spending in 2022, with foot ulcer-related complications accounting for roughly one-third of that total, according to Armstrong. The CDC reports that diabetes complications are responsible for approximately 80% of all non-trauma related amputations nationwide.
The indirect costs extend well beyond the patient. Dr. Caitlin Hicks, a vascular surgeon and director of research at Johns Hopkins University's Multidisciplinary Diabetic Foot and Wound Clinic, noted that only about one-third of patients return to work after amputation surgery, despite an average age of 54. "The economic ramifications aren't just the fact that you're not working. It's also that people in your family are taking off of work to be able to help accommodate this," she said.
Uncertain future
The primary grant funding the program ends next year. MLK is eligible to reapply to the Good Hope Medical Foundation (search), whose chair Howard A. Kahn said the foundation has been "very happy" with the program's outcomes. The hospital is also in discussions with L.A. Care, the largest publicly operated health plan in the U.S., about a potential partnership.
"The benefit of cost savings usually goes to the state Medicaid plan or to the insurance carrier, who doesn't have as high a cost to pay," Reyno said. "If a program like this could be replicated in other safety net communities and have a wider impact, then certainly the return on investment would be even greater."
For patients like Michelle Caldwell, diagnosed with Type 2 diabetes (search) more than three decades ago, the program's impact transcends the data. "It's an awesome experience. I've changed my eating habits, I'm learning to read labels more clearly," she said. "Even at my age, you think you know, but you don't know."