Diabetes-related amputations on the rise

Tuesday, 23 August 2022 06:08 Written by

The number of people with diabetes who had to have lower limbs amputated as a result of the condition increased last year, despite the fact that such amputations are almost completely preventable, Diabetes Ireland has warned.

According to figures from the HSE, 440 people with diabetes had lower limbs amputated last year compared to 393 in 2013.

Last year also saw almost 1,700 people with diabetes requiring hospital inpatient treatment for foot ulcers, which if poorly managed, can lead to amputation.

Diabetic foot disease is currently the most common cause of hospitalisation among people with diabetes. It includes ulcers, infections, deformities and amputations.

Diabetes Ireland, the national charity for people with the condition, expressed concern that despite the introduction of a National Diabetes Footcare Programme by the HSE in 2010, the number of amputations is continuing to rise.

"We are not even stemming the number of diabetes related amputations and inpatient foot ulceration treatments year on year," commented Dr Anna Clarke of the charity.

Lower limb amputations are one of the most preventable potential complications of long-term, poorly controlled diabetes. But research has shown that foot complications, including amputations, are almost entirely preventable if patients are regularly screened and are subject to early intervention by podiatrists when required.

However, the charity insisted that the continued under-resourcing of podiatry services here means that there is not enough specialised early screening. This means that people who would benefit from early intervention are simply not getting it.

Commenting on this issue, consultant endocrinologist, Dr Seamus Sreenan of Connolly Hospital in Dublin, pointed out that the National Diabetes Footcare Programme ‘currently only has the capacity to see patients who have already developed a serious foot problem, which for many is far too late to save a limb'.

"Despite the appointment of 22 podiatrists under the programme, 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," he said.

In fact, the figures show that last year, Westmeath and Kildare saw the biggest increases in lower limb amputations and there are no diabetes podiatry services in these counties.

The number of people who required a lower limb amputation in Westmeath jumped from seven in 2013 to 19 in 2014, while in Kildare, it jumped from 24 to 35.

The charity pointed to an Irish study which found that the average cost of treating an inpatient in hospital for a diabetes-related foot ulcer is €30,000. Based on these figures, the cost of treating 440 diabetes-related lower limb amputations in 2014 was more than €13.2 million.

When the cost of treating foot ulcers in hospital is added to this, Diabetes Ireland estimates that the total cost to the HSE last year was €63 million.

"A 10% reduction of diabetes patients requiring inpatient foot ulceration treatment would save the HSE around €5 million per annum. Other costs savings such as long-term social welfare costs, housing alteration costs etc..., also need to be added to this figure making further cost savings for the Exchequer," Dr Clarke said.

She pointed out that podiatrists are graduating from 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'.

"The cost of employing the full podiatry class qualifying out of Galway University this summer would be approximately €700,000 per annum and would lead to huge savings within five years," she added.