Health leaders’ warn diabetes patients over amputation risk

Health leaders in Mid Nottinghamshire have called on people with diabetes to manage their condition to prevent the prospect of an amputation.

Health commissioners have welcomed a drop in the number of diabetes-related lower limb amputations since 2012, but pledged more action to reduce this further as figures show the number is still above the average for the UK.

People with diabetes have an increased risk of ulcers and damage to the feet because blood glucose levels are too high over a long period of time. Symptoms can include swelling, redness and blisters which if not treated properly can cause serious infection that can lead to amputation.

In the period 2010-2013 there were 3.3 lower limb amputations per 1,000 diabetics each year in Newark and Sherwood. In Mansfield and Ashfield there were 4.3. The UK average is 2.6 per 1,000. In 2009-2012 – the figures were 3.6 and 4.6 per year respectively.

The GP-led groups, which took over responsibility for securing the healthcare for people in these communities are renewing their call to people who have diabetes to seek help early if they recognise symptoms in their feet and lower limbs, that may lead to complications.

Dr Judy Jones, clinical chair of NHS Mansfield and Ashfield Clinical Commissioning Group “We accept that the numbers of amputations are still too high. Diabetes is one of our priorities and we’re working hard to identify all diabetic people, especially those with foot problems. It is a sign that not enough people are presenting their symptoms early enough and our local practices are committed to seeing this improve.

The Mansfield GP called on hospital and care home staff, as well as GPs, to continue to look out for the signs and symptoms of problems common to diabetic patients.

“It is essential to act quickly to prevent the prospect of an amputation. GPs are already working hard to identify people with diabetes at an early stage and to help those living with the condition to manage their diabetes well. It is critical that people with diabetes maintain appropriate foot care, a good diet and exercise, and take their medication as directed.”

The latest figures come as Public Health England were inviting people over 40 to seek advice about a free health check at their GP practice even if they don’t have any underlying conditions. It coincides with a report in the BMJ that shows that more 1 in 3 of the adult population are living on the cusp of diabetes.

Dr Mark Jefford, clinical lead for NHS Newark and Sherwood CCG said: “I am encouraged by the fall but the figures are still too high which is why it remains a major priority for the CCG with a focus on foot care. It’s important to educate our health professionals and to ask patients to take better care of themselves.

“As a relatively new NHS organisation we are doing everything we can to ensure that patients with diabetes receive the highest quality of foot care and we are working with the hospital trust and our GPs to prevent the devastating consequences of the condition.

“These plans include actively identifying diabetic people showing symptoms so we can get them treatment as soon as possible and help avoid a hospital admission. We are making use of innovative assistive technology (FLO) that allows GPs and health professionals to send text reminders to diabetic patients to help keep their blood glucose levels under control.

This is having a real impact on the way people manage their condition. We are also investing in training in all elements of diabetes foot care and we are doing closer assessment of diabetic patients who are admitted to hospital.

“People with diabetes should also see a podiatrist at least once a year, keep feet clean and free from infection, and see their doctor urgently if they have ulcers, swelling or redness.”

In 2012-13, 6,252 people, over 17 from Newark and Sherwood, were diagnosed with type 1 or type 2 diabetes. In Mansfield and Ashfield, 9,536 people were diagnosed with a form of the condition. A total of 15,788 people diagnosed with either type 1 or type 2 diabetes across Mid Nottinghamshire - 5.0 per cent of the combined population.

The percentage numbers are expected to rise to 9.1 per cent by 2030. From 2010 – 2012 there were 706 diabetes-related hospital admissions costing the NHS in Mid Nottinghamshire £1.6m.

Type-2 diabetes is a major cause of blindness in working age people, kidney failure, stroke and lower limb amputation.

In the UK, diabetes affects approximately 2.9 million people with an estimated 850,000 people with undiagnosed diabetes.