Diabetes and the Foot The Road to Amputation?

FOOT ULCERS AND DIABETES Lifetime risk 15% 2% of people with Diabetes per year (60,000 pa) 24x more likely to suffer amputation 50% mortality in 5 years 84% of all major amputations preceded by ulcer >£1 Billion per year Cost of foot complications This is what happen to 2% of people with diabetes. 60,00 in England and Wales 360 in Southampton Commonest cause of hospital admission !5% risk of ulcer during life time. Patients with diabetes significantly more likely to loose their legs

THE FUTURE FOR A PERSON WITH DIABETES AND A FOOT ULCER 45% 25% 11% 17% Jeffcoate et al, Diabetes Care 29:1784-7 2006

DIABETES AND AMPUTATION 5 Years (2003-8) 25,578 amputations 100 week 40% Diabetes National Variation Rate: 3.9 - 7.2/100,000 Mortality: 14 - 20.2/100,000 Prior Intervention 56.7% no intervention Cost £50-75 million (0.5% NHS budget) Holt P 2009 . Unpublished data

OUTCOME AFTER AMPUTATION Willrich et al, Foot & Ankle Int 26:(2)128-34 2005

WHY DO WE LET AMPUTATION HAPPEN? Common Poor outcome Costly Avoidable in up to 85% of people? International Diabetes Federation