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Research discovery could reduce numbers of diabetes-related amputations

Improvement of foot care in people with diabetes undergoing dialysis treatment could reduce the 100 or so associated amputations that take place every week in the UK, according to Diabetes UK-funded research.

The research findings will be presented this week at theEuropean Association for the Study of Diabetes(EASD) in Lisbon.

Risk factor for amputations

The cross-sectional study discovered kidney dialysis increases the risk of nerve damage, foot ulcers and amputations among people with diabetes. The research led by Dr Agbor Ndip and Professor Andrew Boulton of the University of Manchester analysed 326 patients with diabetes and late-stage chronic kidney disease.

In comparison to patients not undergoing dialysis, people receiving the treatment had a higher prevalence of diabetic nerve damage (79 per cent to 65 per cent) prior amputations (15 versus 6.4 per cent) prior foot ulcers (32 versus 20 per cent) and prevalent foot ulcers (21 per cent versus 5 per cent). More so, significantly fewer patients on dialysis received regular foot care compared to their counterparts who were not on dialysis treatment.

Diabetes is the single most common cause of kidney disease, and people with diabetes are already at risk of damage to the nerves (neuropathy) and blood supply (ischaemia) to their feet.  Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation. 

There are an estimated 100 amputations a week among people with diabetes in the UK, yet it is thought between 49 per cent and 85 per cent could have been prevented.

Targeting dialysis patients for better foot care

“The lifetime risk of an individual with diabetes developing foot ulceration has been estimated to be 25 per cent. Foot ulceration is a serious problem for people with diabetes, which also results in huge economic costs,” said Dr Agbor Ndip.

“We hope our research findings will lead to updated guidelines for doctors and nurses which highlight dialysis as an important risk factor for foot ulceration requiring intensive foot care. Patients on dialysis can easily be targeted for preventive intervention by implementing foot care services within dialysis units.”

As a result of work supported by Diabetes UK, Dr Agbor Ndip has been awarded the prestigious Rising Star Lecture at this week’s annual EASD meeting in Lisbon, Portugal.

Dr Victoria King, Head of Research at Diabetes UK, said: “Diabetes is the leading cause of lower limb amputations in the UK so research like this is crucial in helping us understand the factors which need to be considered when trying to prevent and reduce the prevalence of this devastating complication.”

Diabetes UK is calling on the Government and commissioners to tackle the challenge of prevention now – through raising awareness, education and improving access to specialist services. People need help to reduce their risk of developing life-threatening complications which have such a significant impact on the individual and society as a whole. 

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