Rates of amputation for people with diabetes are 10 times higher in certain areas of England that they are in others, a study found.
According to researchers, the statistics show how important it is for people to get the correct specialist care.
The figures come at the same time an NHS report into amputations connected to diabetes revealed the annual cost of procedures is £120m.
And the Department of Health said that in some areas, rates of amputation are too high.
Patients in the South West, parts of the North East and East Midlands have a significantly higher risk of lower leg amputation than in other areas of England.
The Diabetologia journal published the research and made comparisons with the rates of lower-leg amputation across England’s local health trusts during a three-year period.
Concluding, the paper said that those who lived with diabetes were more than 20 times more likely to need an amputation, in comparison to the general population.
A massive variation was reported in the incidences of major (above the ankle) and minor amputations for those who have type 1 or type 2 diabetes.
The number of major amputations range from two per year for every 10,000 patients, to 22.
Each year, there are nearly 6,000 amputations in England which relate to diabetes.
Report author Prof William Jeffcoate, a consultant diabetologist at Nottingham City Hospital, said: “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.”