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Decrease in major amputations for people with diabetes across the north


Oct 23, 2018

Amputation rates for people with diabetes in the region have fallen by almost a quarter, according to new figures from Public Health England.

The North East and North Cumbria region still has a rate slightly higher than the national average but work is continuing to ensure the number of amputations are further reduced.

Rates in the region were 11.4 per 10,000 people with diabetes in 2010. These have now fallen to a rate of 8.9 per 10,000 people with diabetes, with the England average being 8.2; a reduction of almost 25%.

An estimated 191,000 people have diabetes in the North East and North Cumbria.

Diabetes is a serious, lifelong condition and new analysis by Diabetes UK shows that 500 people living with diabetes die prematurely every week in England and Wales, with many of these deaths being caused by avoidable complications.

The hallmark of diabetes is high blood glucose or ‘sugar’ levels which can lead to organ and tissue damage if not treated correctly. People with the condition are at a higher risk of a diabetes-related injury to a foot which has reduced feeling or reduced blood circulation.

Amputations are over 20 times more common in people with diabetes and regional groups are working through the Northern England Footcare Network to reduce the number of amputations that have been done.

NHS expenditure on diabetes related to foot ulceration and amputation was estimated in 2014/15 to be between £972m and £1.13bn (£1 in every £140 of NHS budget)3, and it is estimated by Diabetes UK that many of the 6,000 diabetes-related amputations4 a year in the UK are a result of variation in services and a lack of awareness, leading many people to delay seeing their doctor for months and therefore missing the chance to save their foot.

At the launch of the Putting Feet First campaign by Diabetes UK in March 2012, it was estimated that in 2009/10, eighty percent of the 6,000 lower limb amputations carried out could potentially have been prevented through access to good quality, structured care and improved awareness among people with diabetes about their risk status and the actions they should take. Across the UK, there are now more than 8,500 leg, foot or toe amputations every year.

The Northern England Footcare Network, which includes consultants in diabetes, vascular surgery, microbiology, specialist podiatrists, specialist diabetes nurses and other allied healthcare professionals and patient representatives, have been working together to reduce the high rate of amputations in their area since 2012. They meet regularly to share ideas on improving footcare practices across the region.

Dr Rahul Nayar, Chair of Northern England Diabetes Footcare Network, Diabetes Clinical Lead for Northern England Clinical Networks, NHS England & Consultant Diabetologist at City Hospitals, Sunderland, said: “This sustained reduction in major amputation rates across our region has been achieved through the collective vision of highly dedicated and knowledgeable healthcare professionals. Building upon this success will ultimately eliminate variation and inequality by continually embedding better care pathways, streamlining systems and implementing new research technologies to benefit all.”

The Network is reducing rates by supporting development of multidisciplinary foot clinics and protection teams as well as raising awareness of diabetes amputations and promoting timely referrals.

Clare Howarth, Head of the North at Diabetes UK said: “It’s encouraging to see the hard work being done in the region to reduce diabetes-related amputations, but it is still vital to remind people to get their feet checked regularly. When you have diabetes even something small like a blister can lead to an amputation, so if you notice anything out of the ordinary, no matter how small, get it checked by a healthcare professional immediately. With the right care and swift action most amputations can be avoided.”

Significant variation exists in key aspects of diabetes footcare both in out-patient and in-patient care. The Network’s role will be to identify gaps, share best practice and support teams or units in the implementation of effective clinical guidance with the ultimate aim to eliminate variation and inequality and continue driving down amputation rates.