Health services access and awareness reduce diabetic leg amputations
Better access to health services and more awareness of diabetes are being hailed for a 70 per cent decrease in the risk of local type 2 diabetics requiring a leg amputation.
The finding comes against a backdrop of rising diabetes rates worldwide, study author and podiatric medicine researcher Mendel Baba says
"Although the burden of diabetes is increasing… there's been some changes in the way we care for diabetic foot disease or management strategies that have been successful," she says.
The research compared people who took part in the Fremantle Diabetes Study from 1993 to 1996 (Phase I) with those who participated from 2008 to 2011 (Phase II).
One of the main changes over this time was the introduction of government funded care plans in about 2000.
The funding enabled people with chronic health conditions such as diabetes to access regular allied health services, including podiatry, Dr Baba says.
"There's been a massive uptake of these care plans for patients in the community," she says.
"That's in turn increased surveillance for foot ulceration and infection, and contributed to the early detection of any foot problems.
"There's also advice on preventative podiatric measures and appropriate footwear…in addition to more regular vascular assessment."
Dr Baba says greater awareness of diabetes and diabetic complications, and GPs checking for complications have also likely contributed to the drop in amputations.
Dr Baba, who conducted the research at Fremantle Hospital, says amputation is only a last resort for diabetics.
"Someone with diabetes who's diagnosed today won't necessarily have an amputation tomorrow," she says.
"If we think about [diabetes] in terms of the feet or lower limbs, it can affect the blood vessels or blood supply to the extremities.
"The high sugar levels can affect the nerves in the feet and how well they work… so you might not feel it if you step on a stone or if your foot rubs inside your shoe."
Dr Baba says vascular disease reduces the potential for healing and, when combined with a lack of sensation, puts patients with a foot ulcer at risk of infection.
This ultimately leads to amputation if the infection cannot be controlled with antibiotics.
"I'm a podiatrist myself and I see patients all the time with complications [from diabetes] so it's encouraging to see there's evidence that we are making some headway in saving limbs and feet."
This article first appeared on ScienceNetwork Western Australia a science news website based at Scitech.