3,473 people with diabetes-related foot complications were admitted to the hospital for treatment in 2022
Between April 2021 and May 2022, Diabetes Ireland delivered and evaluated an in-depth education and support programme on foot care for newly diagnosed diabetes patients.
The risk the condition poses for lower limb health is stark. According to figures obtained by Social Democrats TD Róisín Shortall via a parliamentary question, 3,473 cases of foot ulcers associated with diabetes were admitted to hospital in 2022. Of those, 671 cases led to an amputation of the lower limb.
Despite these figures, general knowledge of diabetes-related foot care risks remains low. As part of the Diabetes Ireland programme, 42 people newly diagnosed with diabetes were asked about their knowledge of the condition before undergoing an online diabetes education session.
Individual results from the questionnaire ranged from 32% to 76%, with participants receiving an average score of just 55%.
However, after an education session, and following a programme of information and support that included podiatry appointments and a follow-up assessment after nine months, deterioration in foot health was prevented in all patients, halting any need for hospital treatment.
According to Louise McHugh, Senior Podiatrist at the Diabetes Ireland Care Centre in Dublin, spreading awareness of the need for people with diabetes to look after their feet is crucial.
“Every healthcare professional – anyone who is coming into contact with a diabetes patient who is newly diagnosed – has a responsibility to sit down and explain to them what to look out for,” “I would always tell patients that if you notice redness, swelling, or signs of infection, get on to us or their GP. It’s about constantly having it at the forefront of their minds.”
Research published in the New England Journal of Medicine in 2017 found that the lifetime incidence of diabetic foot ulceration is between 19 and 34%, with a yearly incidence rate of 2%. After successful healing, the recurrence rate of diabetic foot ulcers is 40% within a year and 65% within three years.
In 2022, people with diabetes accounted for 69% of all lower-limb amputations in Ireland. While the figures underscore the importance of preventative measures, the reality of a strained frontline health service means that the time needed for healthcare professionals to intervene with patients early is in short supply.
“It’s probably more difficult nowadays with a lack of resources and the pressures that GPs are under,” McHugh said. “That’s why our Care Centres are podiatry-focused. I write to all GPs with my assessment and findings, and they’re reassured with that because they know that it’s our area of expertise.”
Diabetes Ireland runs two care centres, in Dublin and Cork, with two podiatrists working in each. The demand for the service is high, with more than 4,000 patients travelling from across the country to attend the clinics for annual assessments, or more targeted care.
“Typically, we see a lot of newly diagnosed patients, which is great because we can give them advice and put in a care plan early on. But we would also have patients coming in that have neuropathy or circulation issues that would require more ongoing management,” McHugh added.
Foot assessments look for circulation issues, which can be damaged if blood glucose isn’t sufficiently managed. Our podiatrists will also check for feeling in the feet, as neuropathy can leave patients more susceptible to cuts that go unnoticed, and lead to complications like infection.
The risk of anhidrosis is also monitored as, with neuropathy, sweat glands can dry out, leading to decreased sweating and dried-out feet. This in turn can lead to callus, fissures or ulceration if not properly managed and treated.
The risk of foot complications is broadly similar whether the patient has type 1 or type 2 diabetes, but factors such as smoking, blood glucose management, exercise levels and even the shape of the foot can affect the level of risk.
“Some people might naturally have a broader foot,” McHugh explained, “so if they put their foot in a tighter shoe that can cause rubbing and friction. Depending on the shape of your feet, certain parts take more pressure, and as a result, if more friction or pressure is being put on that area, a person can have issues.”
As a result, the care centres carry out footwear assessments, with professional shoe-fitting where necessary. Supportive shoes and socks are also available to purchase.
While doctors and nurses often recommend the clinics to their patients, individuals themselves can contact the Care Centres directly to make an appointment. People requiring more complicated foot problems will be provided with a treatment pathway that may include hospital care.
To book a podiatry appointment at the Diabetes Ireland Care Centres,
Call Dublin on 01 8428118 or Cork at 021 4274229
or book online at https://www.diabetes.ie/book-an-appointment/.
November 2023 See the Diabetes Footcare Statistics in Ireland: National & County breakdown 2018-2022 here.
Reference: First published in Irish Medical Times by Michael McHale 16 October 2023