Diabetes-related amputations increasing

451 lower limb amputations in 2015
  • Deborah Condon

The number of people who need to have a lower limb amputated as a result of diabetes-related complications is on the increase in Ireland, Diabetes Ireland has warned.

Lower limb (leg) amputation is a potential complication of long-term poorly controlled diabetes, however it is preventable.

According to figures from the HSE, 451 people underwent a lower limb amputation in 2015 as a result of diabetes-related foot complications.

This represents a rise on 2014's figure when 443 people required amputation.

Furthermore, 1,948 people with diabetes required hospital inpatient treatment for foot ulcers last year, spending an average of 14.5 days in hospital. In 2014, this figure was 1,697. If poorly managed, foot ulcers can lead to amputation.

Worryingly, among the patients hospitalised for foot ulcers in 2015, almost 1,000 were under 65 years of age, i.e. still of working age.

While foot-related complications are preventable, Diabetes Ireland warned that there is inadequate early screening of this problem as a result of continued under-resourcing of podiatry services.

A National Diabetes Footcare programme was introduced by the HSE in 2010 and it currently employs 22 podiatrists. However, the number of amputations continues to increase.

"We are not even stemming the number of diabetes-related amputations and inpatient foot ulceration treatment year on year. The 2016 HSE Service Plan provided funding for nine further community podiatrists to be employed this year. Not one of those posts has been filled to date and it's simply not good enough," commented Diabetes Ireland chairperson, Prof Hilary Hoey.

Also commenting on this issue, Dr Ronan Canavan, a consultant endocrinologist at St Vincent's and Loughlinstown Hospital, pointed out that Ireland ‘still has one of the lowest manpower levels of specialist podiatrists working in diabetes in Europe'.

"There are significant parts of the country which do not have this service despite an urgent need. We require around 120 podiatrists around the country providing local screening and early intervention to the diabetes community," he explained.

A previous study on this found that it costs an average of €30,000 to treat one patient with a diabetes-related foot ulcer in hospital. Given the high number of patients who require this type of treatment, and along with the cost of amputations, this amounted to a total cost to the HSE of €71 million in 2015.

A 10% reduction of diabetes patients requiring inpatient treatment for foot ulcers would save the HSE around €7 million per year. Other savings would also be made such as long-term social welfare costs and the costs associated with house alterations that would need to take place if an amputation was required.

"We have basic grade podiatrists qualifying out of college every year looking for employment and further investment in community-based diabetes foot care will go a long way to reducing the hospital treatment cost.

"If we can identify at community level those at moderate risk of developing foot ulceration and ensure they are put under active surveillance by a podiatrist, we can reduce these costly diabetes complications," insisted Prof Hoey.

This issue was highlighted on a recent episode of RTÉ's Celebrity Operation Transformation. Paul Kenny (50) was initially tested for diabetes at a Diabetes Ireland public screening in a supermarket in Bray in 2008.

Due to his high glucose reading, he was advised to immediately go to hospital. Two days later, he was diagnosed with type 2 diabetes. He was overweight and had been displaying many typical symptoms of type 2 diabetes such as major thirst and going to the toilet constantly. However, he was unaware of the symptoms.

He admitted that the diagnosis did not lead to a change in lifestyle and he only took is medication and tested his bloods ‘on and off'. As a result, in December 2014, he lost his big toe.

He went back to work six weeks later and changed his lifestyle for three months, which resulted in a big improvement in his glucose readings, which at their worst were 27 (the normal range is four to seven).

But Mr Kenny reverted to his old ways and in late 2015, his lower limb was amputated. The reality of his situation finally hit home and he realised he needed to change his ways. He is determined to return to work and said he regrets how he did not look after himself. He is speaking out ‘so that others will not make the same mistake'.

"I am urging everyone to know the risk factors, know the symptoms, get tested if you are at risk and take diabetes seriously."

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