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National
Foot Health Week, Sunday 10th to Saturday 16th October 2004 - diabetes
Amputation
risk for people with diabetes
People with
diabetes risk serious health complications including foot or lower
leg amputation, if they don’t undergo regular foot checks,
according to the Australasian Podiatry Council.
“Diabetes
reduces blood flow and sensation in the feet,” says president
of the Australasian Podiatry Council Carol Mioduchowski, “which
can turn blisters, corns and callouses into serious problems, leading
to ulceration and even amputation, if they are not treated promptly
and appropriately.”
Diabetes-related
foot complications are the leading cause of hospitalisation for
people with diabetes, costing $48 million per year. In Australia,
an estimated 3000 lower limb amputations each year are attributable
to diabetes, while in New Zealand more than $170 million dollars
is spent each year in the public health system on diabetes –
mostly on complications.
Despite the
risks, research consistently shows that people with diabetes miss
out on foot screenings – a recent study published in Diabetes
Care showed that 50% of participants had not had their feet checked
in the past year.
During Foot
Health Week, Sunday 10th October to Saturday 16th October 2004,
the council is urging people with diabetes to get their feet checked.
“The peak
health and diabetes organisations recommend foot screening, yet
alarmingly foot checks are being overlooked,” Ms Mioduchowski
says. “Foot Health Week is the ideal opportunity for people
to visit their podiatrist which could save their feet and their
health.”
For more information
or to find a podiatrist near you go to http://www.feet.org.au
| In Australia,
new Medicare legislation entitles people with chronic health
conditions to up to five funded allied health visits per year.
People with diabetes can use this scheme to access podiatry
care upon referral from their GP. For more information go to
– www.health.gov.au
or talk to your doctor or podiatrist. |
Background
- diabetes and feet
Diabetes is
a significant, increasing public health problem, affecting over
4% of the Australian population, at least 10% of older people and
up to 30% of some Aboriginal communities. Diabetes Australia estimates
that 1.8 million Australians will be affected by diabetes by the
year 2010, already Type 2 diabetes costs Australian $3 billion a
year. In recognition of the impact that diabetes has on the Australian
community, and the potential for improved health outcomes, the Australian
Health Ministers agreed in 1996 to make diabetes mellitus one of
the National Health Priority Areas.
According to
Diabetes New Zealand, approximately 116,000 New Zealanders have
been diagnosed with diabetes (11,000 with Type 1 and 105,000 with
Type 2) but it is estimated that for every person diagnosed with
diabetes Type 2 in New Zealand there is one person with undiagnosed
diabetes. Currently one in 32 (3.1%) Pakeha adults has diabetes,
while one in 12 Maori (8.3%) and one n 12 Pacific Island adults
have known diabetes. However the Ministry of Health has forecast
a 30% increase in the incidence of diabetes by 2006, due to the
ageing population. In New Zealand more than $170 million dollars
is spent each year in the public health system on diabetes –
mostly on complications and the cost of diabetes-related amputations
was over $30 million in 1990.
In Australia,
diabetes is the most common cause of non-traumatic amputation, with
the number of amputations attributable to diabetes each year estimated
to be 3000, with 1.5% of people with diabetes having a foot ulcer
at any one time (National Diabetes Strategy, 1998)
A key factor in successful diabetes management and prevention of
complications such as cardiovascular disease, eye and kidney problems
is the maintenance of an active lifestyle. Good diabetes management
is significantly impaired when a foot problem develops – therefore
foot health is imperative for overall well-being.
The National
Diabetes Strategy and Implementation Plan (1998) identified the
prevention and management of foot disease as a key priority area
and recommended:-
“Increase
in the availability of podiatric services and specialist foot clinics
to provide these services.” and…..
“Medicare
item number for podiatry services for diabetic people with a foot
ulcer should be introduced.”
In launching
the Strategy, the Federal Health Minister, Dr Michael Wooldridge,
identified the lack of suitable access to podiatry services as a
significant barrier in the provision of quality diabetes care.
Despite the
recognised need for appropriate professional foot care for people
with diabetes, studies consistently demonstrate that feet are overlooked.
A recent study published in Diabetes Care reported that eye screening
for retinopathy is performed more frequently than foot screening
in Australia, with only 50% of participants reported to have had
their feet examined in the past year.
The National
Association of Diabetes Centres (NADC) and Australasian Podiatry
Council have established foot screening guidelines to assist health
professionals to identify those people with diabetes and an active
foot problem.
References:
Beilby J,
Steven ID, Coffey G, Litt JC, Marley JC. Reported diabetes mellitus
management among South Australian GPs. Australian Family Physician.
1994; 23: 611-3.
Kamien M,
Ward AM, Mansfield B, Fatovich B, Mather C, Anstey K. Management
of type 2 diabetes in Western Australian metropolitan general
practice. Diabetes research & Clinical Practice. 1994; 26(3):197-208.
Tapp RJ,
Zimmet PZ, Harper CA, de Courten MP, Balkau B, McCarty DJ, Taylor
HR, Welborn TA, Shaw JE; Australian Diabetes Obesity and Lifestyle
Study Group. Diabetes care in an Australian population: frequency
of screening examinations for eye and foot complications of
diabetes. Diabetes Care 2004; 27(3):688-93.
How
diabetes affects feet
The foot complications
arising from diabetes are serious and often difficult to treat and
may predispose people to further complications. When it comes to
diabetes and feet, prevention is the goal.
If diabetes
is poorly controlled for a long period of time, this may lead to:
- nerve damage,
or ‘peripheral neuropathy’, which impairs sensation
to the feet; and/or
- reduced
blood supply, also know as ‘poor circulation’.
Nerve damage
may mean a person loses full sensation in the feet. If a person
has poor circulation, any injuries or infections to the feet (i.e.
cuts, burns, or scratches) will take longer to heal. This is due
to less blood flowing into the arteries in the feet. Blood provides
energy to working muscles and aids in healing any tissue damage.
People with poor circulation need to take extra care to protect
their feet from injury.
Most foot problems
in people with diabetes occur when injuries – and often infections
– go unnoticed and untreated, or when healing is delayed due
to poor circulation.
To prevent problems:
- Protect
your feet from injury.
- Inspect
your feet every day (your podiatrist can show you how).
- See your
podiatrist or doctor immediately if a cut or wound is not healing.
(National Diabetes
health care guidelines recommend people with diabetes have their
feet checked by a podiatrist at least every 12 months.)
Fact
sheet: diabetes and feet
The problem
- Diabetes
affects 1.2 million Australians. By the year 2010, Diabetes Australia
expects that number to increase to 1.8 million.
- Diabetic
Foot Disease is common, is associated with increased mortality,
is a major cause of hospitalisation, and is expensive to manage.
- According
to Diabetes New Zealand, approximately 116,000 New Zealanders
have been diagnosed with diabetes (11,000 with Type 1 and 105,000
with Type 2) but it is estimated that for every person diagnosed
with diabetes Type 2 in New Zealand there is one person with undiagnosed
diabetes. Currently one in 32 (3.1%) Pakeha adults has diabetes,
while one in 12 Maori (8.3%) and one in 12 Pacific Island adults
(8.1%) have known diabetes. However the Ministry of Health has
forecast a 30% increase in the incidence of diabetes by 2006,
due to the ageing population. In New Zealand more than $170 million
dollars is spent each year in the public health system on diabetes
– mostly on complications, and the cost of diabetes-related
amputations was over $30 million in 1990.
- The two main
risk factors for the feet of people with diabetes are peripheral
vascular disease which impairs circulation and delays the healing
process, and neuropathy – nerve damage which causes individuals
to lose sensation to their feet, increasing the risk of ulceration
and infection.
- Approximately
50% of people with diabetes are affected by peripheral neuropathy
after 15 years of living with the disease. (Vinik Al et al. Diabetic
Neuropathies. Diabetes Care, 15: 1926-75, 1992).
- Foot ulceration
is one of the most common complications associated with diabetes
and can affect about 15% of people with diabetes. (source: Reiber,
G. E., 1993, ‘Epidemiology of the diabetic foot’,
In: The Diabetic Foot, Levin, M.E. O’Neal L.W., Bowker J.
H., 5th Edition, St Louis, p.p. 1-16).
- Diabetic
foot complications are the single most common cause of non-traumatic
lower limb amputations in the industrialised world. (Armstrong,
D., Lavery, L. and Harkless, L. (1998) Who is at risk for diabetic
foot ulceration? Clinics in Podiatric Medicine and Surgery., 15.
11-19).
- Shoes are
predicted to initiate up to one-third of diabetic foot ulcers.
(Jillian Hosking & Susan Nancarrow. Abstract to conference
presentation “Pumps, platforms, plimsoles….and public
health?”, APC Diabetes conference, 2000.)
The
health costs
- Diabetes
costs Australian health care an estimated $1.2 billion per annum,
which has been predicted to increase to $2.3 billion per annum
by 2010. (Bower, V and Jagiello, P. 1999, Diabetes Foot Care Module.
Podiatry Department, Royal Perth Hospital, Western Australia (Unpublished).
- The annual
cost of diabetic lower limb complications, including amputations,
is approximately A$48 million.
Diabetic
foot disease and amputation
- Diabetic
foot diseases account for an estimated 3,000 amputations in Australia
each year. (Information from the National Hospital Morbidity Database
1995-1998).
- People with
diabetes mellitus have been estimated to be 15 times more likely
to require a lower extremity amputation than those without the
disease. (Most, R & Sinnocl, P. 1983. The epidemiology of
lower extremity amputations in diabetic individuals. Diabetes
Care 6, 87.
- Foot problems
are the most common reason for hospital admissions for people
with diabetes and approximately 50% of all amputations are attributable
to diabetes. (National Report to Health Ministers on Diabetes
1998, p.124 and ABS 1997).
- It has been
suggested that as many as 75% of amputations due to diabetes could
be prevented by appropriate footcare. (Larsson, J., Apelqvist,
J., Agardh, C. & Stenstrom, A. (1995) Decreasing the incidence
of major amputation in diabetic patients: a consequence of multi-disciplinary
foot care team approach? Diabetic Medicine 12, 770.)
- A contagious
spread of infection from an infected foot ulcer represents an
increase in the likelihood of amputation.
Podiatrist’s role in diabetes management
- The role
of podiatrist in providing appropriate foot care assessment, education
and management, and the prevention and treatment of more serious
foot problems for people with diabetes is well-recognized by all
health care professionals.
- National
Diabetes Health Care Guidelines recommend podiatric assessment
at least every 12 months for people diagnosed with diabetes.
- The National
Diabetes Strategy recommends that a Medicare Number for podiatry
services for diabetic patients with foot ulcers should be introduced.
The strategy also calls for a 50% reduction in diabetes-related
lower extremity amputations and has targeted a reduction of amputations
and foot ulceration’s through a number of ‘care’
components, these include ‘specialist treatment of active
foot problems’ by a multi-disciplinary team and access to
education and preventative footcare tailored to individuals in
a high-risk category. (Colaguiri, S., Colaguiri, R., et Ward,
J., National Diabetes Strategy and Implmentation Plan, Diabetes
Australia, Canberra, 1998.)
- The management
of neuropathic foot ulceration by podiatrists includes: regular
removal of calluses, the use of various devices to redistribute
excessive pressure, good glucose control, the role of appropriate
footwear, suitable wound care, and decreasing weight-bearing activities
to help lessen pressure.
- Several studies
have demonstrated that between 50%-70% of diabetes related foot
problems can be prevented if a multi-disciplinary team (of which
podiatrists are considered an integral part) provides an appropriate
intervention. (James Walker and Susan Nancarrow, abstract for
presentation “The Footpath”: An integrated model of
care for the prevention and management of diabetic foot complications,
2000).
©
Australasian Podiatry Council 2004 |
