Diabetes foot disease: the Cinderella of Australian diabetes management?

Abstract

Diabetes is one of the greatest public health challenges to face Australia. It is already Australia’s leading cause of kidney failure, blindness (in those under 60 years) and lower limb amputation, and causes significant cardiovascular disease. Australia’s diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that “it’s time” to fund these evidence-based strategies for diabetes foot disease in Australia as well.

Amputations in patients with diabetic foot ulcer: a retrospective study from a single centre in the Northern Territory of Australia

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Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

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Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…A lack of reimbursement for devices was suggested as a barrier in the USA and Australia. 113,114 A lack of transferability of research to the clinic population may exist due to the nature of clinical trials, whereby researchers may need to exclude the very patients who clinicians have difficulty treating. The use of practical trials, which increase the applicability of research outcomes to real world, has been proposed to address this issue.…”