MLK diabetes – At MLK Community Healthcare in South Los Angeles, an intensive diabetes management effort launched in 2021 has pushed diabetic-related amputations to zero among its highest-risk patients, while improving blood sugar, blood pressure, and appointment adherence.
When Michelle Caldwell sits down after an appointment at MLK Community Medical Group in East Compton, the worry isn’t her lab numbers. It’s her shoes.
Diabetes has been part of her life for more than three decades. and she says her condition is better controlled than ever. She attends regular visits with her endocrinologist. primary care provider. dietician and pharmacist at the outpatient arm of MLK Community Healthcare. She also picks up weekly produce deliveries in the South Los Angeles hospital’s cafeteria and joins occasional cooking classes. She’s learned to decode nutrition labels and developed a taste for salads and nuts.
But there’s one hurdle she can’t ignore: foot care. Diabetes can damage foot nerves. making it easier for patients to miss small scratches and wounds that could turn into serious infections. Caldwell’s care team gently urged her to switch to supportive, closed-toe footwear. She still loves a sandal, and even the podiatrist-approved options can feel, in her words, like “Frankenstein feet.”.
“It doesn’t have to be, like, fashion fashion,” she said with a laugh during a recent visit with primary care provider Dr. Edward Cardenas. “But were there any options that didn’t look like ‘Frankenstein feet’?”
That down-to-the-toes level of care is part of what MLK says has transformed how it treats diabetes in a region where delays in treatment can be deadly—especially for people who rely on the hospital when getting a timely appointment elsewhere is out of reach.
MLK serves a South Los Angeles service area where chronic illness is common and resources are scarce. The hospital system’s diabetes programs are aimed at a community where diabetes affects one in every six South Los Angeles residents and nearly a quarter of MLK’s outpatients.
Four years after MLK launched an intensive management program for its most at-risk patients. more than 80% of enrollees have seen blood sugar levels decline. More than 70% have brought their blood pressure under control. And diabetic-related amputations—long among the hospital’s most common surgeries—have plummeted to zero for program patients.
Dr. Jorge Reyno. MLK’s senior vice president for population health. said the results aren’t driven by new medications or novel treatments. Instead. a relatively modest one-time grant helped the hospital system provide the same level of diabetes care that people in wealthier areas often receive as a baseline.
“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,” Reyno said. “Because what we’ve created here is not necessarily incredibly innovative. It’s just what needs to be available — and is available in other locations.”.
For Caldwell, the change is tangible: she describes providers taking time to explain her disease instead of simply prescribing and moving on.
“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.”
The stakes behind that approach are stark in South Los Angeles. Some 1.3 million people live in MLK’s service area, where more than 90% are Black or Latino. Nearly 70% are either uninsured or have health coverage through Medi-Cal, Medicare or both. Medi-Cal’s low provider payment rates have contributed to South Los Angeles having only one-third of the full-time physicians needed to treat a population of its size—a 1. 500-doctor shortage. according to MLK’s research.
For many residents, MLK’s emergency department becomes the main gateway to care. Roughly 123,000 patients arrived last year at the hospital’s emergency department, which was designed to treat 40,000 people annually. About 40% were seeking primary care.
Emergency physicians often diagnose diabetes in severely ill people who did not know they had it. and they treat life-threatening complications in patients whose diabetes had gone unmanaged for years. Patients have arrived with gangrenous foot wounds that providers elsewhere might dismiss as athlete’s foot. Rates of diabetic ketoacidosis—when insulin levels are so low that cells can no longer convert glucose into energy—have been three times that of the rest of Los Angeles County.
For many, the timing is brutal. Care arrives too late to prevent one of the disease’s most serious complications: amputation. With nerve damage, small injuries can be overlooked. High blood sugar impairs immune function and narrows vessels that carry oxygen-rich blood, making it harder for skin to heal. Once infection turns serious, amputating a foot or limb can become the only option to save a patient’s life.
Across the U.S., diabetes complications account for roughly 80% of all non-trauma related amputations, according to the Centers for Disease Control and Prevention. Cardenas described how hard it is to talk about that outcome.
“Broaching amputation with a patient ‘is really tough,’” he said. “You’re taking such a big part of them away. It’s identity, it’s confidence, it’s [the] ability to walk and do things for themselves. It’s a huge, huge thing.”
He’s also seeing the cost in more than medical terms. Diabetes cost $306.6 billion in U.S. direct medical spending in 2022. the most recent year for which numbers are available. and foot ulcer-related issues accounted for about one-third of that. said Dr. David G. Armstrong, director of USC’s limb preservation program and the Southwestern Academic Limb Salvage Alliance.
Indirect costs can be even more punishing. A study of post-surgery outcomes found that only about one-third of patients were able to return to work after amputation surgery. despite an average age of 54. Dr. Caitlin Hicks. a vascular surgeon and director of research at Johns Hopkins University’s Multidisciplinary Diabetic Foot and Wound Clinic. said the economic fallout spreads beyond the patient.
“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. or having to provide extra resources that they previously weren’t having to. so it has sort of a multi-generational effect. ” she said.
In California, those most likely to bear that burden are households that can least afford it. Diabetic residents in MLK’s service area and other economically impoverished parts of California were more than 10 times more likely to have a toe. foot or leg amputated than diabetic people in more affluent areas. according to a 2014 UCLA study.
The paper’s authors wrote that the finding—that residents in lower income areas bear a disproportionate share of disability and disfigurement from amputations—was “deeply disturbing in a society that espouses equality and outspends all other nations on health care for its more affluent citizens.”
MLK decided to do something about that gap.
The hospital secured a $2 million grant from the Good Hope Medical Foundation, a private foundation based in Pasadena, with additional funding from the Rose Hills Foundation and L.A. Care Health Plan.
In October 2021, MLK began officially enrolling patients in its Diabetes Management Center of Excellence. Within that was an intensive-management program for a subset of high-risk patients. including people with Type 1 diabetes. gestational diabetes. or hemoglobin A1C levels—an indicator of blood sugar—at 9.0% or more. For people without diabetes, a level below 5.7% is considered normal.
For the most part, the system already had the endocrinologists, nephrologists and primary care physicians it needed. The money allowed MLK to build a network of dedicated support staff who could care for diabetic patients outside the exam room.
Between visits. patients in the intensive-management program had access to a clinical care pharmacist who reviewed and coordinated medications; a diabetes educator who walked them through blood sugar monitoring. meal planning and other daily concerns; community health workers who could make home visits; and a nurse care manager who served as their primary advocate and point of contact.
Through the hospital’s Recipes for Health program. participants could pick up weekly bundles of fresh produce and take bimonthly classes on diabetic-friendly recipes. The hospital says that structure helped patients stick to their treatment plans and gave them more time during appointments to discuss medical issues.
Dr. Megan Jacobs, an MLK endocrinologist, said the support network mattered because it wasn’t limited to clinic walls.
“We have multiple people reaching out and interacting with the patients in between physician visits,” she said. “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.”.
Over time. the hospital tracked multiple outcomes: by year three. 66% of patients in the intensive-management program had lower blood sugar levels than they did at enrollment; by the fourth year. 81% did. In the third year, 63% of patients had brought their blood pressure under control, rising to 71% the following year.
Appointment compliance rose to 84% four years after the program started, up from 50% at baseline. The hospital also said its most severely diabetic patients were hospitalized for diabetes at less than half the rate of the area’s general population.
Most importantly, amputations among the intensive-management group dropped to virtually zero. Over the course of four years, only one of the 1,165 patients in the high-risk group required an amputation. The surgery took place less than a month after their enrollment. suggesting the patient likely entered the program with a wound at critical levels.
Diabetic-related amputations and wound care are now MLK’s third-most common type of surgical procedures, after holding the top spot since the hospital’s 2015 opening.
Armstrong of USC called the results striking.
“This is absolutely, positively spectacular,” he said. “This is life affirming stuff.”
Not everyone measures success only through charts. Nurse care manager Monica Garcia said patients’ day-to-day improvements show up in ways the data can’t fully capture.
“I hear [patients] say. ‘Oh. I walked to the park with my grandchildren. ’ or ‘I was able to move around because I’ve lost the weight’ … maybe they had a sore on their foot that was kind of questionable. [and] ‘Now it’s healed because my sugars are under control. ” she said. “Just seeing the benefits when they are compliant is the satisfaction.”.
In the exam room, Cardenas is now focused on the immediate: he examined Caldwell’s feet and lower limbs. He was optimistic that her recent discomfort came from tight muscles rather than nerve damage, and he recommended a stretching and strengthening regimen.
“It shouldn’t be painful, just like a tug,” he said, demonstrating a standing calf stretch. “If you like, I can refer you to physical therapy as well.”
The program’s future, however, is not secure. The primary grant ends next year. MLK is eligible to reapply to the Good Hope Medical Foundation, which has been “very happy” with the program’s outcomes, according to Howard A. Kahn, the foundation’s chair.
Reyno said the hospital is also talking to L.A. Care, the largest publicly operated health plan in the U.S., about a potential partnership. He framed it as something that could benefit both sides.
“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.”.
Back in East Compton, Caldwell’s next steps are practical. Her care team still nudges her toward safer shoes, but she’s learned how to talk through those choices instead of treating foot care as a lecture.
She jokes about sandals, listens to guidance, and—at least for now—doesn’t have to fear that a small wound will go unnoticed. For MLK, that’s the point of the program. For Caldwell, it’s the difference between living with diabetes and getting ready for what diabetes might take.
MLK Community Healthcare diabetes amputations South Los Angeles Medi-Cal hemoglobin A1C foot care endocrinologist nurse care manager health disparities