Every 30 seconds a lower limb is amputated somewhere in the world as a consequence of diabetes, states a review in this week's issue of The Lancet. Most of the content of this week's issue is devoted to diabetic foot disease, coinciding with World Diabetes Day today (Friday November 14, 2005), which is this year focusing on foot complications.
The world is facing an epidemic of type 2 diabetes and the incidence of type 1 diabetes is also increasing. The lifetime risk of a person with diabetes developing a foot ulcer could be as high as 25%. If left untreated patients with the condition may have to have their leg amputated. In one of three reviews in this week's issue Andrew Boulton (Manchester Royal Infirmary, UK and University of Miami, Florida, USA) and colleagues note that diabetic foot ulceration and amputations were estimated to cost US healthcare payers $10.9 billion in 2001. In the UK, the cost of diabetes-related foot complications is estimated to be £252 million. However, foot ulcers and amputation are preventable. Provision of foot-care services can be associated with a reduction in amputations and simple clinical tests can predict those at risk of ulceration, state the authors.
Professor Boulton comments: "Identification of the at-risk foot does not require any expensive equipment: a tuning fork, pin, tendon hammer, and a 10g monofilament should suffice."
In a comment to accompany the issue Vilma Urbancic-Rovan (University Medical Centre, Ljubljana, Slovenia) writes: "One of the basic messages for the patient should be to seek professional advice as soon as possible, to minimise the risk of toe or limb amputation. One of the basic messages for health-care professionals is to always examine the feet of patients with diabetes who are at risk."
Unfortunately, however, this simple advice is ignored in many countries. In an accompanying editorial The Lancet comments: "The worldwide prevalence of diabetes now exceeds 200 million, and is predicted to rise to more than 300 million in the next 20 years. Up to 15% of patients with diabetes have a foot ulcer at some stage, and over 1 million amputations for diabetes-related complications occur every year…It is high time for health-care planners and health-care professionals to turn their attention to a condition that is a source of major morbidity and mortality, and that often afflicts those who are least able to cope. Someone, somewhere, loses a leg because of diabetes every 30 s of every day. To reduce this burden of disability by even a small amount would represent a major advance."
Contact: Professor Andrew JM Boulton, Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. T) 001 305 389 9543 / 07814 936236 ABoulton@med.miami.edu
Comment: Dr Vilma Urbancic – Rovan, University Medical Centre Department of Endocrinology, Diabetes and Metabolic Diseases, Zaloška 7, 1525 Ljubljana, Slovenia. T) +386/1 522 27 38 vilma.urbancic@kclj.si
The Lancet press office 0207 424 4949/4249 pressoffice@lancet.com
Notes to editors This week's print issue contains one personal account from a patient with diabetic foot disease in Iraq. There are four other personal accounts from people in Brazil, Moscow, Tanzania, and Barbados that will be published online at http://www.thelancet.com/collections/diabetic_foot
Journal
The Lancet