'Feet first' for diabetes patients

Feet of a person with diabetes People with diabetes often develop foot problems

As a new study highlights major variations in diabetes-related foot amputation rates, Barbara Young, chief executive of Diabetes UK, explains why action is needed to cut rates of preventable amputations.

If I were to tell you about a place where thousands of feet were amputated every year as a result of poor healthcare, you would assume I was talking about somewhere in the developing world.

Well you'd be wrong. The fact is that here in the UK, thousands of people with diabetes have amputations every year.

Not only does an amputation dramatically reduce quality of life, but the likelihood of dying within five years is greater than for breast, bowel or prostate cancer.

And yet an estimated 80% of the 5,000 diabetes-related amputations a year in England could be prevented through better healthcare and improved management of the condition.

The fact that so many people are needlessly having their feet amputated is a national disgrace. And yet despite the large numbers, awareness of the problem is worryingly low even among people with the condition.

But it does not have to be like this.

The scandal of preventable amputations is one we hope to bring to an end with our Putting Feet First campaign. Over the next five years, we want the number of amputations in people with diabetes to reduce by 50%.

Raising awareness of the issue will be a big part of this.

'Insufficiently thorough'

The 2.8m people in the UK who have been diagnosed with diabetes should know how important it is to manage blood glucose levels, cholesterol and blood pressure well, as well as checking feet regularly and making sure shoes fit properly.

But they also need to know what healthcare you should expect - because all too often it falls short of what people are entitled to.

Firstly, everyone with diabetes should get an annual foot check.

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We need address the reason that large swathes of the country are doing so badly”

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These are important for identifying problems at an early stage, but many thousands of people are not getting them. And when they are being done, they are sometimes insufficiently thorough.

I have even heard of foot checks where the patient is not even asked to take their shoes and socks off!

Also, at the end of the check patients should be told what their risk status is, so if this does not happen then you should ask.

Secondly, if you have a foot ulcer then you need to be seen by a diabetes specialist foot care team as soon as possible.

It should certainly be within 24 hours, as an ulcer can deteriorate in a matter of hours.

Some areas are already doing well in terms of getting diabetes-related ulcers referred to these specialist teams within 24 hours.

But there are also poorly-performing areas where this does not happen.

Tragically, that omission can be the difference between someone keeping their foot and losing it.

If people with diabetes are not offered this level of care, they should insist on it and complain if they don't get it.

But the point is that decent healthcare is something everyone should get as a matter of course.

For this to happen, we need to address the reason that large swathes of the country are doing so badly.

We know from speaking to health professionals that many of them are desperate to give people with diabetes the best possible foot care but feel unable to do so under the existing system.

This is why the government needs to show leadership on this issue by insisting that all areas of the country offer the same standard of care that is already available in the best areas at the moment and monitoring and managing standards to ensure that they are being delivered.

This greater political will is the only way to bring an end to the tragic postcode lottery of amputations and in doing so create an NHS that really does put feet first for people with diabetes.


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  • rate this

    Comment number 64.

    Agreed Rockabilly; the level of animosity/obvious lack of understanding by some commentators beggars belief.Wish some had a modicum of knowledge on diabetes before sounding off.
    Diabetics need to be proactive in keeping their illness under control; monitoring, diet, med/insulin, observation etc however medical care could be better. Retinopathy & kidney screening is good; foot care non-existant.

  • rate this

    Comment number 63.

    Re 61: Amazing! People can be offensive to the point of crudity, just so long as it's about people who have chronic illnesses. That's clearly just fine with BBC moderators.

    But have a go back, and you get blocked! Perhaps if I accused him of racism I'd have been okay? After all, non-whites are very prone to diabetes.

  • rate this

    Comment number 62.

    I've 3 family members with Type 1 diabetes;my mum, aunt & niece (diagnosed age 5); various older relations developed Type 2 in old age.There's a strong history of auto-immune disease in my family eg 5 close relatives diagnosed with either ulcerative collitis or Crohns disease; several with endocrine probs like hyperthyroidism; arthritis & sarcoid too.I find folk who blame DM on diet laughable.

  • Comment number 61.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 60.

    Re 56: Those diets were conducted on 6 people, as in-patients, under 24 hr supervision. They are very low calorie, almost dangerous. Diabetes UK do not regard this as a cure. It was an experiment only.

  • rate this

    Comment number 59.

    9.Proletarian Revolutionary
    Some are registered blind as well, most likely difficult to see in that event, this doesn't make them "simply ignorant or just cannot be bothered" Blood testing strips have not always been available and thus not exclusively their fault.

  • rate this

    Comment number 58.

    56 Jimmy, yes some I don't doubt - especially if mild Type 2 caught at a very early stage. I'm also not denying control of diet is essential for ALL diabetics.
    However a previous poster was trying to imply that a) diet & exercise 'cures' diabetes b) 'poor diet' is the cause; giving ground to the myth that diabetes is a somehow self-inflicted illness & downplaying its seriousness.

  • rate this

    Comment number 57.

    We humans really do take our feet for granted! They are largely uncomplaining workhorses and deliberately adopting a caring attitude to your feet pays dividends! Although I have not been diagnosed as diabetic I have numb feet on the surface and the bones hurt when I walk My NHS guy recommended MBTs which are good and I am pleased to see that Crocs have now brought out a special range too!

  • rate this

    Comment number 56.

    54. Marie.
    I am a podiatrist who works with diabetics on a daily basis. Recent research carried out by Dr Sebastien Hammer has shown that a very low calorie diet over a 4 month period has been shown to vastly improve if not cure some type 2 diabetics.

  • rate this

    Comment number 55.

    I am an NHS podiatrist. What needs to be clarified is that podiatry depts are not seen as critical to the NHS and therefore are under funded. In most trusts now patients are not taken on unless they are in high risk categories as there are just not enough appointment slots. Write to your trust and inform them they need to keep funding podiatry depts or lose your diabetic foot specialists.

  • rate this

    Comment number 54.

    52 Matt, I'm a health care practitioner who works with diabetics. Most people with both Type 1 OR Type 2 are NOT 'borderline' diabetics, as you sweetly put it; they are diabetics. The majority will also need medication of some sort, aswell as controlling via diet to keep their blood sugar within narrow limits. Contrary to popular belief, diabetics tend to be slimmer than the 'normal population'.

  • rate this

    Comment number 53.

    cont Type 1 diabetes is an auto-immune disease where insulin producing cells in the pancreas are rapidly killed off; it's thought to be triggered by virus in individuals carrying a genetic predisposition
    Type 2 also associated with presence of specific genes; though risk increases with age, also weight/diet. However even being super-fit does not stop someone developing Type 2 eg Steve Redgrave.

  • rate this

    Comment number 52.

    51. marie

    Not true. Most people with borderline Type 2 diabetes can recover with exercise and diet. And that goes for most illnesses.

  • rate this

    Comment number 51.

    Some excellent comments but here's some facts for the terminally daft;
    * High blood pressure & diabetes are not 'non-illnesses'; left undiagnosed & untreated theres a strong likelihood they'll kill you
    * All Type 1/virtually all Type 2 diabetics cannot control their blood sugar 'with diet & exercise' only
    * The strongest precursor to getting diabetes is strong family history of auto-immune disease

  • rate this

    Comment number 50.

    46. The Rockabilly Red

    Not far off

  • rate this

    Comment number 49.

    30 Tempus Fugit

    No not Larwood let us just say as close to another hospital as you are to Bassetlaw. The reason I used marks out of 10 was to avoid having to use expletives about NHS podiatry care and GPs care of feet.

  • rate this

    Comment number 48.

    Perhaps we should let those two unfit sporting knights Sir Steve Redgrave (diabetes) and Sir Ian Botham (asthma) loose on matt in the uk.

  • rate this

    Comment number 47.

    matt in the uk -
    'You a doctor then?'

  • rate this

    Comment number 46.

    Re 45: You want one? A typical giraffe blood pressure is 300/200. Your statement is miles out. As is every one of your uninformed, pig-ignorant comments.

    Please, go and play with some traffic somewhere.

  • rate this

    Comment number 45.


    One thing I've said that isn't true ?


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