Diabetic foot disease a ‘significant’ public health problem – Beaumont symposium

Patient education, a focus on prevention,and multidisciplinary care are fundamental to addressing diabetic foot disease, a leading specialist has highlighted.

Diabetic foot disease is a “significant” public health issue that must be addressed “more seriously”, said Mr Elrasheid Kheirelseid, Consultant Vascular and Endovascular Surgeon, Beaumont Hospital, Dublin.

Mr Kheirelseid was speaking to the Medical Independent (MI) from the Beaumont Multidisciplinary Diabetic Foot Symposium on 18 June. The event brought together leading Irish and international experts to highlight the prevalence of diabetic foot disease in Ireland and the importance of taking a multidisciplinary approach to management, leading to a reduction in amputation rates and healthcare costs.

The programme highlighted how closer coordination between hospital and community services, and across specialties, can improve the consistency of care.

Diabetic peripheral neuropathy is a common complication of diabetes. It can lead to an insensitive and sometimes deformed foot, resulting in abnormal loading. This can cause skin injury and ulceration. Many people with diabetes also have peripheral artery disease, which is an important risk factor for impaired wound healing. It is estimated 19–34 per cent of people with diabetes develop a diabetic foot ulcer in their lifetime.  People living with diabetes are up to 22 times more likely to undergo a major lower-limb amputation than those without the condition.

Mr Kheirelseid told MI that most cases of diabetic foot disease could be prevented through patient education, regular check-ups, and well-controlled blood glucose.

He emphasised the importance of prevention and patient education. He said self-assessment techniques, such as regularly examining the soles of feet using a mirror, help with early detection.

Mr Kheirelseid also noted that “constraints” within the health system can manifest in delayed patient presentation and review. 

“Unfortunately, at the hospital level, patients come to us with an ulcer there already, and we have to help them to heal that ulcer in order to be able to prevent an amputation, which is a high risk, and also to be able to maintain their mobility and productivity in the community.”

Diabetic foot disease is associated with a higher five-year mortality than that of breast cancer, for example. The five-year mortality rate after amputation is higher than that for all cancers except lung cancer.

The evidence has shown that a multidisciplinary approach is the most effective strategy to reduce the rate of amputation and mortality. Mr Kheirelseid said specialist care for diabetic foot disease needs to be organised in a similar way to cancers – with designated multidisciplinary centres. “It is not only about treatment, but it is also about prevention of reoccurrence,” noted Mr Kheirelseid.

“We have a service in Ireland – it is a fragmented service, unfortunately – we need to conjoin that service into centres to look after these patients.”

Beaumont has one of the longest established programmes nationally, but faces challenges with space and staffing levels. Mr Kheirelseid said the shortage of podiatrists in Ireland is a particular concern. 

An estimated 6 per cent of the population has diabetes and this is expected to rise to 8 per cent in 2030. Therefore, the system needs to be “very well prepared” for an increase in diabetes-related presentations.