Monday 20 November 2017

Record eight diabetes patients a week lose a lower limb to amputation

More than 225,000 people are living with diabetes here
More than 225,000 people are living with diabetes here
Eilish O'Regan

Eilish O'Regan

A record eight people a week with diabetes are having lower limbs amputated despite most of the life-changing operations being preventable.

Figures show 440 diabetes-related amputations were carried out last year, up from 393 in 2013.

More than 225,000 people are living with diabetes here.

The lack of footcare specialists, known as podiatrists, who could detect problems early in patients is said to be contributing to the worrying statistics.

Angela Fitzgerald, deputy national head of the acute hospitals in the HSE, said since 2009 an additional 14 podiatrists have been appointed, with eight more due to be hired this year.

"A reduction in diabetes-related amputations has not been seen due to increasing diabetes numbers and improved expectations of patients who are now living longer and have a better quality of life," she said in a parliamentary reply to Independent TD Tom Fleming.

She also suggested that more patients are presenting with increasingly complex conditions.

Ms Fitzgerald said that an audit of the current model of care for diabetic foot is underway and is due for completion shortly.

"The findings of the audit will be used to inform the review of the current model of care for diabetic foot," she added.

The number of diabetes patients undergoing amputations spiralled from 354 in 2009.

This is despite the introduction of a National Diabetes Footcare programme by the HSE in 2010. Additional podiatrists who could detect foot problems were also hired.

People with diabetes are at higher risk of amputation because the illness can lead to nerve damage in the limbs, making the sufferer less aware of any minor injury or wound, particularly affecting the feet.

Diabetics are also more prone to develop arterial disease, which means any wound is less likely to heal. However, in most cases, early recognition of the problem and early treatment of the wound can avoid the need for amputation.

Type 1 diabetes tends to occur in childhood or early adult life when the body's own immune system destroys the insulin-making cells, while Type 2, which usually develops slowly in adulthood, may be associated with diet and exercise.

A study showed the average inpatient hospital treatment of a diabetes-related foot ulcer is €30,000, so based on treating 440 diabetes-related lower limb amputations, the cost was over €13.2m in 2014.

Treatment for a further 1,697 diabetes patients admitted to hospital for foot ulceration treatment brought the total cost to the HSE of over €63m in 2014. Experts say a 10pc reduction of diabetes patients requiring inpatient foot ulceration treatment would save the HSE around €5m per annum.

Dr Anna Clarke, of Diabetes Ireland, said lower limb amputation is one of the preventable potential complications of long-term poorly controlled diabetes.

"Due to continued under-resourcing of podiatry services, there is inadequate specialised early screening and thus the lack of early intervention in patients who require it," she said.

Medics claim the National Diabetes Footcare programme only has the capacity to see patients who have developed a serious foot problem.

"For many it is far too late to save a limb," said Professor Seamus Sreenan, an endocrinologist at Connolly Hospital in Dublin.

In 2014, there were 101 amputations in Dublin, followed by Cork (44), Kildare (35), Limerick (29), Wexford (21), Wicklow (20), Westmeath (19), Clare (15) and 13 in Galway and Louth.

Irish Independent

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