Diabetes‐related major lower limb amputation incidence is strongly related to diabetic foot service provision and improves with enhancement of services: peer review of the South‐West of England

Abstract

AimsTo investigate the relationship between high diabetes‐related lower limb amputation incidence and foot care services in the South‐West region of England.MethodsThe introduction of 10 key elements of foot care service provision in one area of the South‐West resulted in stabilization of foot ulcer incidence and sustained reduction in amputation incidence from 2007. Services introduced included administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthotist and audit. Peer reviews of the region's diabetes foot care services were undertaken to assess delivery of these service provisions and compare this with major amputation incidence in other regions with data provided by Yorkshire and Humber Public Health Observatory Hospital Episode Statistics. Recommendations were made to improve service provision. In 2015 changes in service provision and amputation incidence were reviewed.ResultsInitial reviews in 2013 showed that the 3‐year diabetes‐related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services (P=0.0024, adjusted R 2 =0.51). Repeat reviews in 2015 found that two or more foot care service improvements were reported by six diabetes foot care providers, with improvement in outcomes. The negative relationship between major amputation incidence and service provision remained strong both in the period 2012–2015 and in the year 2015 only (P ≤0.0012, adjusted R 2 =0.56, and P= 0.0005, R 2=0.62, respectively).ConclusionsMajor diabetes‐related lower limb amputation incidence is significantly inversely correlated with foot care services provision. Introduction of more effective service provision resulted in significant reductions in major amputation incidence within 2 years. Failure to improve unsatisfactory service provision resulted in continued high amputation incidence.

Regional variations in amputation rates: are regional diabetic foot services the reason?

“…A study by Paisey et al . sheds some light on this when they recently audited 14 UK regions for 10 key evidence‐based elements of regional diabetic foot services and their amputation rates . They found a strong correlation between higher numbers of these key elements and lower amputation rates and vice versa .…”

“…sheds some light on this when they recently audited 14 UK regions for 10 key evidence‐based elements of regional diabetic foot services and their amputation rates . They found a strong correlation between higher numbers of these key elements and lower amputation rates and vice versa . The 10 key elements included patient and clinician education; regular multidisciplinary diabetic foot clinics including podiatry, orthotist and vascular services; adequate podiatry services in community; foot examinations of all diabetes inpatients; use of evidence‐based clinical pathways and data collected on each patient; and administrative support …”

Diabetes‐related lower‐extremity complications are a leading cause of the global burden of disability

“…Thus, if anything, our DRLEC estimates are likely to be an underestimate. In the meantime, these findings highlight the need for policymakers to prioritize policies that improve evidence-based care for people with DRLEC [6,7], and thus, potentially reduce a large cause of the global burden of disease. In the meantime, these findings highlight the need for policymakers to prioritize policies that improve evidence-based care for people with DRLEC [6,7], and thus, potentially reduce a large cause of the global burden of disease.…”

Corrigendum

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CorrigendumIn an article by Paisey et al [1], the cost per annum mentioned in the sentence below on page 60 of the issue should be listed as bn (for billion) instead of m (for million):The recent economic analysis of the cost of diabetic foot ulcers in England has estimated the cost of treatment of diabetic foot ulcers in the community to be £0.97-1.1 m per annum in England.Therefore, the correct sentence should be:The recent economic analysis of the cost of diabetic foot ulcers in England has estimated the cost of treatment of diabetic foot ulcers in the community to be £0.97-1.1 bn per annum in England.

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