Each week in England there are around 120 amputations in people with diabetes. The majority of diabetes-related amputations are caused by a “foot attack” – a foot ulcer or infection failing to heal. When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives. Amputation is not only devastating in its impact on the person with diabetes and their family, leading to loss of independence and livelihood, It is also expensive for the NHS.
Over £119 million is spent each year in England on diabetes-related amputations. Currently the numbers of amputations are rising from 5,700 in 2009/10 to over 6,000 in 2010/11. It is projected that there will be over 7,000 amputations in people with diabetes in England by 2014/15 if urgent action is not taken to reduce these¹. Only 50 per cent of people with diabetes who have an amputation survive for two years. The relative likelihood of death within five years following amputation is greater than for colon, prostate and breast cancer. The most shocking fact of all, however, is that most of these amputations are preventable. In areas where foot care for diabetics is in place there are fifty percent less amputations. Foot care for diabetics changes on a daily basis and diabetics have to be able to have immediate access to foot care clinics.
This is why Diabetes UK, the Society for Chiropodists and Podiatrists and NHS Diabetes are promoting the commissioning of an integrated foot care pathway through the Putting Feet First campaign. The pathway would ensure that in the event of a “foot attack”, those people with diabetes who are at increased risk of foot problems get identified and then fast-tracked to the specialist team that can expertly assess and treat them.
Last year a group of diabetes specialists met to pool their expertise and concluded rapid access to specialist assessment and treatment for all those with a foot problem would make all the difference in achieving the goal of reducing amputations by 50% over the next five years.
Improving diabetes foot care and reducing amputations saves lives and saves money. It also impacts considerably on health outcomes:
• preventing people from dying prematurely
• enhancing quality of life for people with a long-term condition
• helping people recover from episodes of ill health or injury
• ensuring a positive experience of care
• protecting people from avoidable harm.
A root cause analysis of every amputation across 13 London hospitals was conducted in April and May 2012 and examined 27 patient data sets. The results suggested a lack of integration of the pathway across primary and secondary care – only 54% of those having a diabetologist with expertise in lower limb complications
• a surgeon with expertise in managing diabetic foot problems
• a diabetes specialist nurse
• a specialist podiatrist
• a tissue viability nurse.
There had been no improvement from the previous year.
Recommended Daily Foot care for Diabetics
Check their feet every day
Be aware of loss of sensation.
Look for changes in the shape of their foot
Get your toenails cut properly and safely
Wear shoes that are comfortable and a good fit, shoes should not rub.
Keep an eye on your blood sugar
At least once a year have your feet professionally checked
Do not try and get rid of corns yourself the plasters that remove corns are not good for diabetics and never use a knife with a blade to remove corns.
These shocking Facts illustrate that diabetics have to be aware of basic foot care. This applies not just to type 1 diabetics who are at risk of amputations because in the long term injected insulin lodges in the extremities, ie the toes.
Even something as simple as hard skin can lead to an infection because if it is not removed the skin can crack and lead to an infection. What makes these foot care figures so appalling is the fact that it has to be cheaper for the local authorities to provide foot care for diabetics, than the surgical costs of an amputation.
For more information about diabetic complications see our other articles.
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