Diabetes amputation rates show huge regional variation
Amputation rates for diabetes patients are 10 times higher in some parts of England than in others, according to a study highlighting the postcode lottery in diabetic care.Researchers say the figures highlight the importance of ensuring the right specialist care.
The findings coincide with an NHS report putting the annual cost of diabetes-related amputations at £120m.
The study Variation in the recorded incidence of amputation of the lower limb in England, published in the journal Diabetologia, compared lower leg amputation rates for local health trusts (PCTs) across England over three years.
The paper concluded that, compared with the general population, people with diabetes were over 20 times more likely to have an amputation.
It reports a huge variation in the rates of both major (above the ankle) and minor amputations for patients with diabetes – including Types 1 and 2.
For major amputations these range from just over two each year for every 10,000 patients to 22.
In England every year there are about 6,000 diabetes-related amputations.
One of the main authors, Prof William Jeffcoate, a consultant diabetologist at Nottingham City Hospital, is wary of pinning blame on the areas with the highest amputation rates, though he says the variations are “shocking”.
He thinks the problem lies in the way services are organised.
“Foot disease is very complicated and a single professional hasn’t necessarily got the skills to manage every aspect of it.
“And that’s why I believe that only if you can gather a multi-disciplinary team and make sure that people have rapid access to assessment by such a team, it’s only in that way that we think you can provide the best service.”
Many hospitals in England still do not have these teams – which also include podiatrists, surgeons and specialist nurses.
Prof Jeffcoate says a lot of health staff are not trained to recognise the risks of foot disease.
“Maybe it’s just that people don’t like feet. Maybe it’s related to the fact that footcare tends to occur in an older population. But for whatever reason doctors and nurses have also never had specialist training in foot disease and so it means that they don’t necessarily have the skills to assess a new condition when it arises.”
The findings complement previous research suggesting that up to 80% of diabetes-related amputations could be avoided.
They also coincide with new figures on the annual cost of foot ulcers and amputations in England, published in a report by NHS Diabetes.
Its overall estimate is £650 million per year, including £120 million per year for amputations. The paper also highlights additional costs to patients and carers through lost working days and reduced mobility.
The report author, Marion Kerr, says the savings from specialist footcare teams – by reducing amputations – are six or seven times greater than the costs of setting them up.
“We believe that if the NHS were to spend to save – to introduce teams of this kind – not only would they transform the lives of many patients, but actually save money in the process.”
Tags: diabetes, diabetics, Doctors, Health Professionals, healthcare, NHS waste, preventable crisis