For many diabetes patients, amputation becomes a last-resort measure after infections, ulcers, or poor circulation worsen rapidly and leave few other treatment options.

But according to Dr. Estelle Everett, a physician and researcher specializing in endocrinology, diabetes, and metabolism at the

University of California Los Angeles (UCLA), most diabetes-related amputations can be prevented through early intervention, consistent medical care, and patient education.

For Everett, her commitment to diabetes prevention is deeply personal. Watching her younger sister navigate Type 1 diabetes exposed her early to the challenges many patients face, including barriers to advanced diabetes technologies such as continuous glucose monitors and insulin pumps due to racial disparities in patient care.

Those experiences helped shape her focus on prevention, education, and equitable access to care.

Dr. Everett spoke with California Black Media (CBM) about the warning signs of diabetic complications, prevention strategies, healthcare access, and the role of diabetes technology in improving outcomes.

What are some of the early warning signs that a person with diabetes may be developing circulation and nerve problems that could potentially lead to amputation?

Amputation is usually the final stage of diabetic foot disease. Earlier signs often involve nerve damage. Some people experience numbness, tingling, burning, or loss of sensation in their feet.

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Poor circulation is another warning sign. Symptoms can include calf pain while walking, foot pain at rest, cold feet, skin color changes, or wounds that do not heal properly. Foot ulcers, thick calluses, and untreated cuts can also become serious infections that may eventually lead to amputation if they are not treated early.

Before complications reach that stage, what are some early signs of diabetes itself that people should be looking out for?

Many people are walking around with diabetes and do not even realize it. Some patients first seek medical care only after they’ve already developed complications because they’ve had diabetes for years without knowing it.

That’s why routine screenings are so important. If you have diabetes, controlling it early can significantly reduce the risk of severe complications later on.

Many Black Californians harbor a degree of distrust in the healthcare system. What message would you send to encourage people to get regular checkups?

 Distrust is real, and there are many reasons people may avoid healthcare. Some fear discrimination or worry they’ll simply be judged instead of helped.

Personally, I realized some of the care my sister received may have been influenced by racial bias. Although she had diabetes for years, she was never offered diabetes technology like insulin pumps or continuous glucose monitors. When she finally asked about them, she was told she had to jump through many hoops.

Later, I realized her experience wasn’t unique. Research shows that minority patients and people from lower-income backgrounds are less likely to be offered diabetes technology. That inspired me to focus my research on improving access for the populations that need these tools the most.

I think building trust is important. Finding the right doctor is almost like dating. If you don’t feel comfortable with your provider, it may help to find someone you connect with and feel understands your concerns. That relationship can make a major difference in getting consistent care.

Are there newer technologies or innovations in diabetes care that people should know about?

One of the biggest advances has been continuous glucose monitors, or CGMs. These small wearable devices track blood sugar levels in real time and have really changed diabetes care over the past decade.

For providers, CGMs give a much clearer picture of blood sugar patterns throughout the day. For patients, they provide immediate feedback about how food, exercise, and other daily habits affect blood sugar levels.

Someone may notice that certain foods cause major spikes while certain exercises lower their blood sugar. That real-time information helps people make healthier decisions and improve blood sugar control. Research shows these technologies can significantly improve outcomes.

What daily habits or preventative measures can reduce the risk of complications or even amputation?

The biggest thing is controlling your diabetes. A lot of people automatically think diabetes will lead to amputations, but research shows the risk is much lower when diabetes is well managed.

That means taking medications as prescribed, making dietary changes, and working to keep your A1C below 7. Managing high blood pressure and high cholesterol is also important because both contribute to circulation problems.

People should also inspect their feet every day, especially if they’ve already lost sensation. Some patients injure their feet without realizing it because they can’t feel the damage. Catching wounds early is critical. Good foot hygiene also plays a major role in prevention.

Are there any common misconceptions about diabetes that stand out to you in your clinical work with Black patients?

One major misconception is that diabetes medications cause complications like kidney failure or amputations. In reality, poorly controlled diabetes causes those complications — not the medications used to treat it.

Those misconceptions sometimes cause patients to avoid medications or stop taking them altogether. Another issue is that some people believe diet and exercise alone should always control diabetes. While lifestyle changes are important, some patients have severe diabetes that also requires medication.

Needing medication is not a personal failure. Sometimes diet and exercise alone are simply not enough, and medication is necessary to prevent serious complications.

This article is supported by the California Health Care Foundation (CHCF). Visit www.chcf.org 

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By Charlene Muhammad, California Black Media

Crystal Lambert knew something was terribly wrong with her three-year-old granddaughter as she sped down the street trying to get her to the hospital.

“I thought she got a hold of some poison,” Lambert recalled.

Doctors found Lambert’s granddaughter had a blood sugar level over 800, diagnosing her with Diabetic Ketoacidosis(DKA), a state in which the body, starved of insulin, begins to shut down.

Lambert said she was born with a pancreas that was not fully functioning — it lacked the specialized cells required to produce insulin.

Her granddaughter survived and is five years old today.  Now, she gives herself insulin shots, asks endless questions about her condition, and runs like the spirited child she is. But the terror of that night transformed Lambert — and ultimately inspired her to launch the We Fight Back Organization, a mobile health and food access initiative serving underserved communities across California. Lambert is the executive director.

The Crisis by the Numbers

According to the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System data, nearly 17.9% of Black adults in California have been diagnosed with diabetes — above the national Black adult average of 16.8%, and nearly five points higher than California’s overall adult rate of 12.6% across all races. California ranks 24th out of 39 states with available data for Black adult diabetes rates.

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Nationally, according to the U.S. Department of Health and Human Services, Black Americans were 24% more likely than the overall U.S. population to have diabetes in 2024. They also died from diabetes 78% more often than the general population in 2022. Black Americans are also more than twice as likely as the overall population to develop kidney failure caused by diabetes.

According to the California Health Care Foundation’s 2024 Health Disparities Almanac, Black Californians have the shortest life expectancy in the state at just 74.6 years — due in part to chronic conditions like diabetes and its devastating complications.

Leon Rock, co-founder of the African American Diabetes Association, believes statistics, though revealing, only tell part of the story.

“There are a whole bunch of Black folks that don’t tell you that they have diabetes — or don’t know,” he said.

And the disease itself, Rock is careful to note, is not what kills. “They die from the complications. That’s heart attack, that’s stroke, that’s amputations of legs, of feet. Going blind. All those complications are inherent in a system that has impacted Black folks with diabetes in California and across America.”

Crystal Lambert, creator and executive director of the We Fight Back Organization, started out of a need to learn more about diabetes on behalf of her granddaughter. Now she is looking to spread her organization to the valley, on Friday, June 6, 2026 Photo by Solomon O. Smith/ California Black Media

An Information Gap Fuels the Crisis

For Rock, part of the solution is diagnosis. He says the medical and public health systems are failing Black Californians by the absence of information designed for them.

“That is the bottom line. We need good information. Information that is culturally specific,” said Rock.

Telling people to eat healthy or exercise, he added, falls short when culturally specific alternatives are not provided, and when many residents of urban communities do not feel safe exercising in some neighborhoods – or outside at night.

Dr. Khadijah Lang, a family medicine physician and president of the Golden State Medical Association, agrees that the roots of the crisis run deeper than individual behavior — and blaming patients misses the point.

“We are not genetically predisposed to diabetes,” Lang said. “But the system under which we live increases the likelihood that we will develop it.” 

What the Body Needs — What Communities Are Denied

Type 2 diabetes, which accounts for 90 to 95% of all diabetes cases, according to the CDC, develops when the body can no longer use insulin effectively to regulate blood sugar. Left unmanaged, it damages nerves, kidneys, eyes, and the cardiovascular system. The hemoglobin A1C test is a blood draw that reveals how the body has processed sugar over the previous three months — not just at the moment of the test. It is the standard tool for both diagnosis and ongoing monitoring.

That distinction matters, Lang emphasized, because patients cannot manipulate three months of blood sugar history the way they might fast for a day before a single blood draw.

“The pill is not meant to undo or control a sugar level that’s being constantly stressed,” Lang said. “It’s meant to work in conjunction with a low-carbohydrate diet and exercise.” She recommended at minimum 30 minutes of physical activity five days a week — breakable into 10-minute sessions for those who need it.

Lang stressed that education must be delivered in language people recognize and can relate to. The goal is to inform them of the choices that serve their health best, she said.

But for many Black Californians, even those informed choices remain out of reach, Lambert said.

“They need access to healthy foods and medication, too” she said.

California has made some critical policy advances. The state has expanded access to the Continuous Glucose Monitor (CGM), which has transformed diabetes care for state residents. Assembly Bill 365, introduced in 2024, proposed requiring Medi-Cal to cover the costs of CGM and other related medical equipment but it failed in the State Senate. Since then, the California Department of Health Care Services (DHCS) reports that the core Medi-Cal CGM benefit now available to eligible patients was solidified through previous budget actions and pharmacy policy updates.

These measures, while meaningful, have not closed the gap for the communities most at risk, according to advocates.

Control Through Community

Health care advocates conclude that the solution must be communal, culturally grounded, and sustained — not a fad, not a celebrity moment, not a single clinic visit. For example, observed Lang, lifestyle shaped by shared values and collective accountability can move the needle where individual prescriptions have not.

Rock is building infrastructure to match the urgency, establishing local chapters of the African American Diabetes Association across the country, with California next.

“We have to do for self, period,” he said. “Health is wealth. We have to eat to live.”

And Lambert, whose granddaughter unknowingly started all of this for her, keeps showing up.

“Diabetes advocacy is about dignity, education, prevention, and hope,” she said.

Video: Diabetes Disparity Exposed in California

This article is supported by the California Health Care Foundation 

(CHCF). Visit www.chcf.org 

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By Stacy M. Brown

Doctors across the United States say they are treating children for illnesses that routine vaccinations once made increasingly uncommon, raising concerns that years of declining immunization rates are beginning to reverse decades of public health progress.

Pediatricians have described seeing more cases of whooping cough, rotavirus infections, bacterial pneumonia and other potentially life-threatening illnesses that vaccines have long helped suppress. Some physicians reported treating conditions they had rarely encountered during their careers, while others said that growing vaccine hesitancy is changing how emergency rooms and hospitals care for children.

The reports come as measles outbreaks continue to spread across multiple states and vaccination coverage remains below federal public health targets.

Johns Hopkins University’s International Vaccine Access Center reported 2,077 confirmed measles cases nationwide as of May 29. Researchers warned that outbreaks reported across the country have raised concerns about continued transmission, additional hospitalizations and deaths, and the possible loss of the nation’s measles elimination status.

Public health experts have long viewed measles as a warning sign because of its ability to spread rapidly through communities with lower vaccination coverage. The New York Times reported that physicians increasingly fear the resurgence of measles may be followed by the return of other vaccine-preventable diseases.

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Doctors say that is already happening.

Dr. Meghan Hofto, a pediatric hospitalist at the University of Alabama at Birmingham, said she has already treated roughly as many children with rotavirus this year as she saw during the previous decade. Rotavirus once caused tens of thousands of hospitalizations annually before vaccines sharply reduced its spread. None of the children she treated this year had been vaccinated.

Hofto also described caring for infants with pertussis, commonly known as whooping cough.

“It’s hard to know when they’re safe to go home,” Hofto told The Times.

The rise in whooping cough cases has been particularly striking. More than 28,000 cases were reported nationwide last year, compared with approximately 7,000 in 2023, according to figures cited by The Times. Many of the affected infants were too young to receive vaccinations themselves and relied on broader community protection to reduce their exposure.

Other doctors described similarly troubling cases.

Dr. Jessica Kirk, a pediatric hospitalist in Alabama, recently treated an unvaccinated toddler hospitalized with pneumonia caused by simultaneous infections of Haemophilus influenzae and Streptococcus pneumoniae. Vaccines exist to protect against both illnesses. The child required oxygen and antibiotics to recover.

Researchers at Johns Hopkins have been tracking vaccination trends nationwide and found continuing signs of vulnerability.

At the same time, vaccine policy has become increasingly contentious in state legislatures.

Johns Hopkins researchers reported that lawmakers across the country continue to introduce bills affecting childhood vaccination requirements, vaccine access and non-medical exemptions. Researchers also noted that state policies governing exemptions remain a significant factor in vaccination coverage and disease transmission risks.

Physicians have said vaccine skepticism has expanded beyond childhood immunizations. Doctors also reported growing resistance to other preventive treatments.

For doctors confronting the return of illnesses that vaccines once pushed to the margins of American medicine, the challenge is becoming increasingly personal.

“It just feels like you’re a tiny little boat with a giant tidal wave coming at you,” Dr. Erin Charles, a regional pediatric hospitalist at Seattle Children’s Hospital, told reporters. “And you might convince one family here and there.”

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