Samantha Minc, MD, MPH, associate professor of surgery at Duke University, has been awarded a National Institutes of Health (NIH) R03 grant to support her research project, “Understanding diabetes and peripheral arterial disease [PAD]-related amputation in North Carolina.”
The R03 grant provides short-term funding for small, self-contained research projects, including pilot studies and secondary data analyses. Minc’s study will run from Aug. 12, 2025–July 31, 2027.
Minc’s research focuses on identifying and addressing disparities in diabetes and PAD-related amputations, particularly in underserved communities. Her work began in West Virginia, where she was recruited due to her interest in rural health. There, she conducted a granular geospatial analysis and led focus groups with patients and providers to understand barriers to limb preservation.
“That first step was huge for me,” Minc said, referring to her 2018 Society for Vascular Surgery (SVS) Foundation Clinical Research Seed Grant. “Once that funding came through, we conducted the analysis, published a paper in the Journal of Vascular Surgery [JVS], and it was really well received.”
Following the seed grant and further awards from the West Virginia Clinical and Translational Science Institute, Minc received a K23 award in 2022 from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the SVS Foundation and the American College of Surgeons (ACS). These funds enabled her to implement a trio of interventions in rural clinics: diabetic foot exams, multidisciplinary teleconference and timely referrals.
“Eighty-five percent of diabetes-related amputations are preceded by a foot ulcer,” Minc said. “These are highly preventable, highly morbid issues.”
Primary care doctors and limb flow teams who conduct diabetic foot exams can significantly reduce amputations, but, Minc asks, what does that mean for a place where it’s four hours to the closest quaternary center?
Piloting teleconferencing platforms and providing hotlines for nurses enabled them to effectively triage patients. Primary care doctors could then contact a vascular nurse, who would triage the patient accordingly—either for an emergency visit or within a specified timeframe—and connect them with local podiatrists, serving as the primary intervention.
Her team observed significant improvements, including a drop in foot-related hospital visits from 4% to 0.4% among 268 patients. The success of this feasibility study laid the groundwork for her current project in North Carolina, which involves a larger, more nationally representative population.
Utilizing scientifically validated behavioral change methods, the project aims to encourage clinicians to modify their practices. Throughout the project, data were collected over 12 months, comparing the results with those from the 12 months prior. The findings showed a significant increase across various metrics—including a 242% rise in foot exams and a staggering 2,716% increase in the completeness of those exams—compared to 2–12% of foot exams in other studies incorporating all four components. By the project’s conclusion, 84% of the exams were complete, compared to just 17% at the start. The identification of foot abnormalities also increased by 1,443%, and referrals significantly rose.
The project utilized a mixed-methods approach, combining quantitative findings with focus groups conducted at various clinics before, during and after the study, and individual interviews with patients, which allowed the team to understand the clinical and structural changes implemented in the clinics.
A key component of Minc’s approach is community engagement, where her team established both provider and community advisory boards to guide the research. One primary concern raised by community members was food insecurity.
“How can you expect us to get better if we’re not taking care of the food?” Minc recalled a community member saying.
In response, the group conducted a food insecurity scan across the rural county using a United States Department of Agriculture (USDA) toolkit. It revealed that most residents relied on gas stations and dollar stores for their groceries, with only two supermarkets serving an area of 8,500 square miles.
An initiative called Project FARMacy was launched as a result of the findings, which enabled the community to raise funds for a local farmer. Doctors can then write prescriptions for their patients with diabetes, allowing them to receive a box of healthy fruits and vegetables throughout the summer. This program lasts for three months, providing participants with fresh produce each week.
The diabetes support group developed an idea after hosting a month-long session on carb counting. “We decided to have members bring their favorite recipes or holiday recipes, which we would then share with our culinary medicine partners to adapt them into diabetes- and heart-healthy options,” said Minc.
Initially organized in November 2023, this idea unexpectedly evolved into a 120-page cookbook. Now completed, the cookbook has been printed and is finally ready for distribution. Minc’s team will continue to educate people about the importance of diabetic foot exams and improve the quality of care for individuals with diabetes. They are focused on disseminating their results throughout West Virginia this year and completed their first event in Pocahontas County over the summer.
“We did our first event in July,” said Minc. “We’re hosting our second event in Princeton, located in the southern part of the state. In two weeks, we’re hosting a large grand rounds session for all providers in the area, discussing vascular disease, diabetes and foot care; then we’re doing a large event in the Eastern Panhandle, which was another amputation hotspot, and plan to hit every part of the state. I have this road map that is part of our final year of our NIH grant that will take us across the state, and then we’ll hit the state capital in the spring and do a policy talk for advocacy programs that the community has identified.”
Minc added: “The plan is to take all this work and repeat it on a much larger scale. We have pilot data showing that we can improve outcomes if we do this. And so the plan is to identify hotspots across North Carolina and then do a more randomized trial where we deploy the intervention in a stepped fashion across the state, and show that we can improve outcomes by doing this.”
