Footcare plan ‘can cut diabetic amputations’
HUNDREDS of diabetic patients lose lower limbs and toes every year in Ireland – but a new study suggests amputations could be reduced with nationwide footcare clinics.
With rates of diabetes expected to rise in the coming years, there is concern about the number of amputations carried out in Irish hospitals due to complications surrounding the disease.
The new research by Tallaght University Hospital and the Royal College of Surgeons has revealed Irish public hospitals registered 3,104 hospital admissions with lower-limb amputations between 2016 and 2019.
A total 68% of the surgical procedures were categorised as minor amputations, which relate mainly to toes, while 32% were major amputations below or above the knee.
The researchers discovered that three-quarters of minor amputations and just over half of major amputations are carried out on patients with diabetes.
They are at a higher risk of requiring lower limb amputation – a common procedure in patients with non-healing diabetic ulcers.
Amputations of lower limbs may save the lives of patients, but they have severe consequences for surviving patients’ health-related quality of life, according to the study.
It stated that the clinical prognosis of patients with diabetes who undergo lower limb amputation is poor with 9% to 20% of patients requiring a further amputation within a year and 28% to 51% requiring a further amputation within five years.
The two-year survival rates after major limb amputations have been estimated at 50% and five-year survival rates at 29%.
The research, which has just been published in the Irish Journal of Medical Science, said the annual number of procedures varied between 700 in 2016 and 848 in 2018.
The authors, Anna Mealy, Seán Tierney and Jan Sorensen, said it has been established diabetes is rising in Ireland.
‘Approximately 68% of all amputations were conducted on patients with a diagnosis of diabetes and 75% of amputations on patients with a diagnosis of diabetes were minor amputations,’ said the study. The researchers said analysis of the existing literature found that implementation of comprehensive footcare programmes could reduce amputation rates from between 37.5% to 50%.
In 2015, it was estimated that there were 209,000 people living with diabetes in Ireland with this figure projected to increase by 5% to 10% annually.
The HSE says current estimates are that diabetes and its complications consume 10% and 14% of the total healthcare budget, with this burden growing substantially in the future as the prevalence of diabetes increases. Along with amputation, complications of diabetes include vision loss, renal failure, and cardiovascular disease.
The study highlighted that several previous studies have recommended dedicated diabetic foot teams as a cost-effective means to improve patient care and reduce the need for amputations.
The HSE said in a statement yesterday that a new model of care for the diabetic foot is currently being finalised. ‘We would envisage it will lead to a considerable increase in multidisciplinary diabetic foot teams in our hospitals and foot protection teams in the community,’ it said.
209,000 people living with diabetes in Ireland