Diabetes amputation rates show huge regional variation

Amputation rates for diabetes patients are 10 times higher in some parts of England than in others, according to a study.

Researchers say the figures highlight the importance of ensuring the right specialist care.

The findings coincide with an NHS report putting the annual cost of diabetes-related amputations at £120m.

Amputation rates in some areas are too high, says the Department of Health.

The study, published in the journalDiabetologia, compared lower-leg amputation rates for local health trusts (PCTs) across England over three years.

The paper concluded that, compared with the general population, people with diabetes were over 20 times more likely to have an amputation.

It reports a huge variation in the rates of both major (above the ankle) and minor amputations for patients with diabetes - including Types 1 and 2.

Variations 'shocking'

For major amputations these range from just over two each year for every 10,000 patients to 22.

In England every year there are about 6,000 diabetes-related amputations.

One of the main authors, Prof William Jeffcoate, a consultant diabetologist at Nottingham City Hospital, is wary of pinning blame on the areas with the highest amputation rates, though he says the variations are "shocking".

He thinks the problem lies in the way services are organised.

"Foot disease is very complicated and a single professional hasn't necessarily got the skills to manage every aspect of it.

"And that's why I believe that only if you can gather a multi-disciplinary team and make sure that people have rapid access to assessment by such a team, it's only in that way that we think you can provide the best service."

Many hospitals in England still do not have these teams - which also include podiatrists, surgeons and specialist nurses.

Prof Jeffcoate says a lot of health staff are not trained to recognise the risks of foot disease.

"Maybe it's just that people don't like feet. Maybe it's related to the fact that footcare tends to occur in an older population. But for whatever reason doctors and nurses have also never had specialist training in foot disease and so it means that they don't necessarily have the skills to assess a new condition when it arises."

The findings complement previous research suggesting that up to 80% of diabetes-related amputations could be avoided.

They also coincide with new figures on the annual cost of foot ulcers and amputations in England, published in a report by NHS Diabetes.

Its overall estimate is £650m per year, including £120m per year for amputations. The paper also highlights additional costs to patients and carers through lost working days and reduced mobility.

The report author, Marion Kerr, says the savings from specialist footcare teams - by reducing amputations - are six or seven times greater than the costs of setting them up.

"We believe that if the NHS were to spend to save - to introduce teams of this kind - not only would they transform the lives of many patients, but actually save money in the process."

The charity Diabetes UK is marking the new data on amputation rates with a national campaign - Putting Feet First - urging patients, the NHS and ministers to take footcare seriously. It has set a target to reduce diabetes-related amputations by 50% within five years.

National 'disgrace'

Writing in the BBC News website's'Feet first' for diabetes patientscolumn, the charity's chief executive, Barbara Young, calls for urgent action.

"The fact that so many people are needlessly having their feet amputated is a national disgrace. And yet despite the large numbers, awareness of the problem is worryingly low, even among people with the condition."

In a statement the Health Minister for England, Paul Burstow, accepted that the problem had to be tackled.

"Amputation rates in some areas of the country are too high. Diabetics need to get their feet checked regularly and should see their local diabetes multi-disciplinary specialist or GP if they have concerns - this will prevent amputations.

"NHS Diabetes is currently carrying out an audit of footcare for people with diabetes to look at the current structure of these services. This will make sure that patients get the right care at the right time."

A spokesperson for NHS Portsmouth, which has one of the highest rates of major amputations in England, said improving services for people with diabetes was a priority:

"We are aware of the high amputation rate and are committed to reducing this."

Regional breakdown of major amputations