Common cause of amputation
Diabetes is the most common cause of lower limb amputation in the UK, and 100 people with diabetes lose a toe, foot or lower limb every week. “For someone with diabetes, even a blister caused by a rubbing shoe can lead to a foot ulcer. Some turn into chronic wounds that do not heal. Slower healing increases the chances of infection, which can lead to gangrene and amputation,” says Dr Paul Chadwick, principal podiatrist at Salford Royal NHS Foundation Trust.
A common complication in diabetes (both Type 1 and 2) is peripheral neuropathy, which reduces patients’ sensitivity to pain, so minor wounds may not be felt. “One patient arrived at my clinic for a routine check with a four inch nail through his foot — he had not even noticed,” says Dr Chadwick.
People with diabetes should have annual foot health checks. Those showing symptoms of neuropathy or poor blood flow should access a preventative foot care programme, which includes regular podiatry, health education and protective footwear. People who develop a foot ulcer should have access to a multi-disciplinary diabetic foot care team. The latter is not yet available everywhere, though a team can more than pay for itself, according to a 2012 NHS report. Classic strategies for treating chronic wounds include debridement of dead tissue, wound dressings designed to modulate wound exudates and kill bacteria, antibiotics if required, wound pressure reduction, careful diabetes control, or surgery to improve blood ﬂow.
New treatments are appearing, such as negative pressure wound therapy, which creates a vacuum around wounds to extract exudates and promote healing. A new test to detect elevated pro- tease activity (EPA) is gaining momentum. One in three cases of chronic wounds shows evidence of EPA, so the test could help clinicians target treatments such as protease modulating dressings more effectively.
What to do if you have wounded feet
Meanwhile, people with diabetes can help themselves. “Check your feet for wounds daily. If they show any damage, contact your podiatrist urgently,” says Dr Chadwick. Tackling the complications of diabetes could prevent suffering and save the NHS money. It seems to make perfect sense “The rate of complications is growing. Diabetes is the leading cause of blindness among working-age people in the UK and rates of diabetes-related stroke and kidney failure are at a record high.
How to reduce risk of complications
Around 100 amputations take place a week as a result of the condition and up to 80 per cent of these could be preventable,” says Baroness Young, chief executive of the charity Diabetes UK. “Around 10 per cent of the NHS budget is spent on diabetes and £8 of every £10 goes on dealing with complications rather than their prevention and reduction.” Reducing the risk of complications Good diabetes management, including keeping blood glucose and blood pressure at a healthy level, has been shown to reduce the risk of complications.
Don’t ignore the signs
Early diagnosis means that people with the condition can begin to look after their diabetes. Currently, by the time they are diagnosed, half of the people with Type 2 diabetes show signs of complications. Taking care of yourself Diagnosis should be followed up by the right care and support.
Diabetes UK campaigns to ensure that people with diabetes receive 15 Healthcare Essentials annually in order to keep their condition well managed and reduce the risk of devastating complications. The Diabetes UK website provides information on reducing your risk of developing diabetes, spot- ting the signs and symptoms and protecting yourself from complications. For more information visit www.diabetes.org.uk