85 per cent of diabetes amputations

As many as 3,600 diabetes-related amputations that occur in Australia are "entirely preventable" and result from inadequate monitoring of the disease, according to new analysis by medical experts.

A national diabetes conference has been told that around 85 per cent of harrowing amputations could be avoided each year if more was done at a national level to prevent risk factors, monitor those at risk and respond to diabetes nerve and circulation damage that affects the legs and feet.

"Monitoring individuals at increased risk is crucial so early ulcer detection and treatment can occur – translating to reduced amputations," said Associate Professor Paul Wraight who heads the Diabetic Foot Unit at The Royal Melbourne Hospital.

Australia has one of the highest rates of lower limb amputations in the developed world with around 85 diabetes sufferers having a foot or part of their leg removed each week.

"Feet are often the forgotten complication of diabetes. Unlike kidney disease and cardiovascular disease, there aren’t national networks and protocols established to oversee individuals with diabetes related foot complications," A/Prof Wraight said.

Assoc. Prof Wraight believes a hospital and community-based care program focused on diabetic foot health, involving GPs, specialists, nurses and allied health professionals, may hold the key to reducing lower limb amputation among people with diabetes.

The introduction of a multidisciplinary foot care program at The Royal Melbourne Hospital has seen the number of individuals with diabetes having their feet examined rise from 35 to 100 per cent. "Amputation rates dropped immediately following the introduction of the program, with amputation rates down 60% by the end of the first year," said Assoc. Prof Wraight.

"We are working to roll-out this model of care to other hospitals around the country, but increased funding is desperately needed," he said.

"It’s a simple proposition – ignore the feet and diabetes will continue to be the leading cause of lower limb amputation. By focusing on the feet of individuals with diabetes thousands of amputations can be prevented."

Peter Lazzarini, who is a Senior Research Fellow at the Queensland University of Technology, explained that "it wasn’t until the last few years when we began to analyse the data against world standards that we realised there was a real problem with the number of amputations".

Global data indicates that men have lower limbs removed at twice the rate of women. Men are also more likely to develop nerve and circulation problems at a younger age and that these diabetes related conditions can then progress more rapidly to amputation. 2

Australia’s indigenous population is also at higher risk of diabetes-related amputation, with a ten times higher rate of hospitalisation than non-indigenous Australians.

The majority of lower limb amputations are performed on those who have had poorly controlled diabetes for more than 10 years which has led to nerve damage, poor circulation and foot ulcers and/or infection.

"The key to avoiding amputation in the first instance is blood sugar control," said Mr Lazzarini. "In addition, people should have an annual diabetes foot check-up to assess damage to the nerves and identify whether vascular disease has developed."

"For those who have developed nerve damage or vascular disease it is important that they see their doctor and podiatrist at least every few months and check their feet daily for signs of foot ulcers or infection," he concluded.

"If there is failure to respond to treatment, referral to a multidisciplinary foot team is critical," said Assoc. Prof Wraight.

The ADS is the peak medical and scientific body in Australia working towards improved care and outcomes for people with diabetes. The association’s members include medical graduates and scientist with an interest in diabetes as well as those with a primary role in professional diabetes care.

Ways in which the ADS strives to enhance the welfare of individuals who have diabetes include the dissemination of the latest developments in the treatment and management of diabetes to its members; developing in association with Diabetes Australia and other interested bodies, education methods designed to give those who have diabetes mellitus a better understanding of their condition. For further information about the ADS visit www.diabetessociety.com.au.

The ADEA is the leading Australian organisation for health professionals who provide diabetes education and care. There are more than 900 credentialed diabetes educators working across public and private practices and hospitals in Australia.

The association actively promotes evidenced-based diabetes education to ensure optimal health and wellbeing for those affected by and/or at risk of diabetes and sets standards and develops guidelines for the practice of diabetes education.

The ADEA also offers professional development programs and accredits those developed by other organisation. For further information about the ADEA visit www.adea.com.au.