Better ways of preventing foot problems in dialysis patients with diabetes could reduce the 100 or so associated amputations that take place every week in the UK, according to Diabetes UK-funded research being presented this week at the European Association for the Study of Diabetes (EASD) in Lisbon.
Led by Dr Agbor Ndip and Professor Andrew Boulton of the University of Manchester, the cross-sectional study discovered kidney dialysis increases the risk of nerve damage, foot ulcers and amputations among people with diabetes. The research 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 percent). 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.
“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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Notes to editor:
1 Department of Health (2007). Improving diabetes services: the NSF four years on www.dvh.nhs.uk/downloads/documents/B81F82BI76_the_way_ahead_the_local_challenge.pdf
2 Morrish NJ, Wang SL, Stevens LK et al (2001). Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 44, suppl 2; s14–s21
3 Diabetes UK is the leading charity for over 3.5 million people in the UK with diabetes In 2011, Diabetes UK aims to spend over £6 million on diabetes research to investigate the causes and prevention of diabetes, to improve care and treatment of diabetes and ultimately to work towards a cure. For more information visit www.diabetes.org.uk. In the UK, there are currently 2.8 million people diagnosed with diabetes and it is estimated that 850,000 people have Type 2 diabetes but do not know it.
4 Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes, usually affects people over 40 (over 25 in people from South Asian and Black backgrounds) and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required. In most cases the condition is linked with being overweight and can go undetected for up to ten years meaning around 50 per cent of people show signs of complications by the time they are diagnosed.
5 Type 1 diabetes develops when insulin-producing cells in the pancreas are destroyed. This type of diabetes usually appears before the age of 40 and is the least common of the two main types and accounts for around 10 per cent of all people with diabetes. Type 1 diabetes cannot be prevented, it is not known why it develops and it is not connected with being overweight. People with Type 1 diabetes have to take insulin either via a pump or by injections several times a day to stay alive.
6 One person is diagnosed with diabetes every three minutes in the UK. Diabetes is a serious condition that can lead to heart disease, stroke, kidney failure, blindness and amputation if not managed in the correct way. Diabetes, whether Type 1 or Type 2, is a serious condition. Diabetes costs the NHS £1 million pounds an hour. Almost one in 20 people in the UK have been diagnosed with diabetes. Diabetes causes more deaths than breast and prostate cancer combined.
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