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Rise in amputations sparks call for key diabetes funding to continue

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A leading charity has called on NHS leaders to commit further funding to diabetes care, including specialist nurses, following a “rise” in amputations linked to the condition.

According to analysis by Diabetes UK, there were 26, 378 lower limb amputations related to diabetes in England during 2014-17, compared to 22,092 between the years of 2010-13.

“The quality of footcare for people living with diabetes varies significantly across England”

Dan Howarth

The charity, which looked at regional data on foot care published by Public Health England, said the findings showed an increase in amputations, with a “significant rise” of 26.5% in minor lower limb amputations – below the ankle.

For major lower limb amputations, below the knee, the charity noted a “more gradual increase” of 4.1%.

In light of its new analysis, a spokesman for Diabetes UK told Nursing Times that there was “definitely” a need for more specialist diabetes nurses, which follows similar warnings about shortages in recent years.

Overall, the charity said it was calling on NHS England to commit to maintaining its so-called diabetes transformation fund beyond 2019.

The national body’s NHS Shared Planning Guidance for 2017-2019 set out transformation funding for supporting improvement in the treatment and care of people with diabetes.

The fund has seen more than £80m invested across England since 2017 to improve access to specialist footcare teams to help those with the condition to look after their feet and avoid amputations, noted Diabetes UK. However, it warned that progress risked stalling if the funding ended after next year.

Diabetes UK highlighted that, based on a 2014 study, diabetes was now the most common cause of lower limb amputations in the UK. It added that those living with the condition were 20 times more likely to experience an amputation than someone without it.

In addition, the charity explained that foot ulcers and amputations were “hugely costly” to the NHS, with at least £1 in every £140 of NHS spending going towards foot care for people with diabetes.

Dan Howarth, head of care at Diabetes UK and a registered nurse, said: “The shocking number of lower limb amputations related to diabetes grows year on year.”

“The chance of someone with diabetes having a major amputation is actually going down”

Jonathan Valabhji

He added that an amputation, whether it was minor or major, could be “devastating and life-changing” and highlighted that a minor amputation could ultimately mean losing a whole foot.

Mr Howarth reiterated the need for NHS England to continue the diabetes transformation fund beyond 2019, which he said would help to reduce the amount of amputations.

“Many diabetes amputations are avoidable, but the quality of footcare for people living with diabetes varies significantly across England,” he said. “Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.”

NHS England would neither confirm or deny to Nursing Times that it planned to maintain the funding past 2019. However, the government arms’-length body argued that the rise in the number of amputations was in line with the number of patients being diagnosed with diabetes.

In a statement, Professor Jonathan Valabhji, NHS England’s national clinical director for diabetes and obesity, said: “The chance of someone with diabetes having a major amputation is actually going down, with far lower amputation rates than in countries such as Germany.

“But as the absolute number of people with diabetes goes up, the number of people at risk of amputations goes up too,” he noted.


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