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Sheffield foot clinic reduces diabetes-related amputations by almost half

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According to diabetes suffer Leonard Reynolds, it is not the disease that is hard to live with, but the complications that come along with it.

The 71-year-old is one of the many people in Sheffield who have avoided a major amputation as a result of diabetes, thanks to the foot clinic at the city’s Northern General Hospital.

The department, located in the Huntsman building of the Fir Vale hospital, has almost halved the number of diabetes-related amputations in the city in the past four years, following the introduction of an innovative diabetes footcare programme by Sheffield Teaching Hospitals NHS Foundation Trust.

Leonard, from Shiregreen, Sheffield, has benefited hugely from the pioneering programme, having been diagnosed with diabetes in 2006.

He says: “I’ve been coming to the clinic since 2004, when I injured my leg on my motorbike and developed cellulitis which has returned more than 20 times.

“I suffered further foot and leg problems when I was diagnosed with diabetes as it affected the feeling in my legs and feet, so I wouldn’t know when they became injured or infected.

“A bone infection meant I had to have all the toes on my right foot removed one by one.

“I practically had to learn to walk again as it affected my balance.

“The infection then spread to the bone in my leg and they thought they might have to amputate it above the knee, but thankfully the clinic was quick to react and I’m still on my feet, even though I can’t walk too far.

“Without the care I’ve received through the clinic, I would have most certainly lost my leg by now.”

Dr Rajiv Gandhi, a diabetes consultant at the hospital’s diabetes centre, says those who have diabetes often suffer foot problems, due to a lack of feeling in their legs and feet and a lack of blood supply to the lower body, which hinders the heeling of injury or infection in such areas.

He says: “Amputation is one of the most feared complications of diabetes and has an enormous impact on patients’ lives, including loss of occupation and status, disfigurement, reduced mobility and depression.

“It also has a bleak survival rate at just 50 per cent two years after the amputation.

“It’s therefore imperative that someone with diabetes who injures their feet seeks medical help straight away, as just a small cut or blister can quickl escalated into a much more serious health problem.”

In 2007, Sheffield had one of the highest diabetes-related amputations in the country, but rates have dropped significantly – with 18 fewer people with diabetes losing a limb in the city every year.

This is at a time when national amputation rates have remained static and the number of appointments at the Sheffield diabetes foot clinic have increased by 80 per cent.

Dr Gandhi says: “Reacting quickly has been the key to our success.

“The treatment pathway for diabetes-related foot problems is a complex one, with many different health professionals involved, including GPs, podiatrists, microbiologists, vascular surgeons and nursing staff. We restructured our footcare pathway to enable rapid access to a specialist team.

“Improved training for GPs and other healthcare professionals has meant they can spot problems more quickly and fast-track the patient, so they can see a consultant in 24 to 48 hours, if required.

“We’ve also introduced a diabetes foot hotline, run by a consultant diabetologist, which provides advice to any community healthcare professional on diabetes-related foot disease.”

Further measures introduced at the hospital include closer liaison with microbiologists, which has led to the development of more stringent protocols for the collection of wound specimens and appropriate antibiotic prescribing, as well as improved education for patients, highlighting specialist services can be accessed without the need for a GP referral.

Feedback of the service has been positive, with 90 per cent of patients like Leonard saying they were satisfied with the services.

Leonard says: “I visit the clinic about once every three weeks for them to keep an eye on my condition. I also have regular X-ray scans to see if the bone has become infected and, if so, MRI scans to identify where the infection is.

“I also come to the hospital for dialysis three times a week, as I have kidney failure due to my diabetes – it’s not the disease that’s hard to live with, but all the complications that come along with it. That’s why it’s reassuring to have departments like this on the doorstep.”

In recognition of their achievements, the Sheffield diabetes footcare team has been shortlisted for a national Health Service Journal Patient Safety and Care Award in the diabetes care category. The winners will be announced in a ceremony in London on Tuesday.

Dr Gandhi says: “We are delighted that, despite a dramatic increase in the number of people developing diabetes and diabetic foot problems in Sheffield in recent years, the changes we have made have led to this astonishing drop in the number of amputations in such a short period.”

 

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