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Diabetic foot diseasePreventing loss of life and limb

Dr Rowan Hillson MBENational Clinical Directorfor Diabetes

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Diabetes in England (diagnosed)

2.2 million people with diabetes (1.3 million in 2003)(Retinal screening programme, 2009)

4.8% adults (QOF 2008)

2.5 million UK

Everyone with diabetes deservesthe highest standards of personalised diabetes care, no matter where, when or by whom they are cared for.

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Why do people with diabetes get foot trouble?

• Neuropathy - nerve damage 20 – 40% of people with diabetes• Peripheral vascular disease - circulation damage 20 – 40%• Ligament and joint problems – deformity• High glucose – infection

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Foot ulcers in diabetes

Following pressure or injuryBall of foot in neuropathy. Pressure sores if immobile or in bed

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Gangrene

Poor circulationAfter injuryWith infection

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Multiple foot problems. Infection. Recurrence

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Amputation

100+ major amputations a week (Diabetes UK)

Half those who have a major amputation die in the next 5 years (Robbins 2008)

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Prevention

Most diabetic foot problems could have

been prevented

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ePreventionTeach people with diabetes to look after their feetHealthcare professionals must check feet

ProcessNDA (1.4 m people)

2003 - 04 2007 - 08

HbA1c 68 91

Cholesterol 65 90

Smoking history noted 63 86

Foot exam 29 77

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Prompt, proper treatment

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Thank you rowan.hillson@dh.gsi.gov.uk