Diabetic amputation rate; increase or decrease?

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An interview on Diabetes, ABC radio, l dont know how old the figures are that have been quoted.

But this statement seems to be direct conflict to what Newsbot has posted up on a decline of amputation rates?

So who is right??????

Peter Lazzarini: Australia's amputations are on the rise, aligning with the global increase as well, and unfortunately globally we have an amputation every 20 seconds, which is 1.5 million amputations each year. In Australia we have one about every 2 to 3 hours. In fact the statistics bear out that we've had a 30% increase in not only numbers but rate of amputations over the recent decade.

Copy of the full transcript can be found here
http://www.abc.net.au/radionational...iabetes-related-amputation/4785250#transcript

 

David,

I think a number of the individual studies (including one in the link by Pete) look at the effect of individual programs on amputation rates, whereas in the radio broadcast he was reporting on total figures for Australia / USA and globally.
The AIHW reports the discharge data provided by the states by DRG for Australia, which is easily searchable, but runs a few years behind.

What Pete was saying, is that we know how to reduce amputation rates, and when we do in it properly, rates decrease, but we are not doing in properly in enough places.

 

Are those places where it is being done properly identifiable?

In a sense let's hope that the places where it is being 'done properly' are not too numerous at the moment because if they are numerous and the national amputation rate is still going up by 30% something very dangerous is going on?

Bill

 

Yes they are identifiable with About 20 Australia wide at present with probably up to 10 times that needed

 

So why the difference between UK, USA and Australia?

What is it that the UK is doing so well?

 

Health funding processes.
In Australia, primary care is mostly funded by the commonwealth through MBS, which provides extremely limited funding for podiatry and other allied health, but lots for Medicine. No primary care / community funding for casts, dressings etc.
So only the public hospitals have the resources to manage diabetic foot disease, which are state funded, and have capped activity targets, so can't grow to meet demand.

In the US, a divide between the insured and the uninsured, and access to Medicare/ Medicaide.

UK, most health services funded through the NHS, so some better options for coordinated care.

 

Thanks Stephen, where can l find the studies that support these figures please?

 

Not sure exactly what you want, and I know more about Health funding in Victoria than the other states.

There are the Vic DOH Policy and Funding Guidelines
which outline how hospitals will be funded for this financial year
or the National Evidence-Based Guideline: Prevention, Identification and Management of Foot Complications in Diabetes

 

Sorry Stephen, l meant the studies that support the rise or fall of diabetic amputation rates in the USA, UK and Australia, there must be studies that support the statements been made and with in those studies a little more information.

After a quick read of the above report, it would seem there is need for further study regarding footwear.

"There was insufficient evidence to determine the effectiveness of therapeutic footwear (2 average
quality trials) for the prevention of foot complications. The trials demonstrated a trend towards benefit
of therapeutic footwear with cork or prefabricated insoles over usual footwear. One other small trial
also studied the effects of rigid orthotic devices on plantar callus formation. A significant improvement
in the grade of callus was demonstrated. "

 

Australian Institute of Health and Welfare (AIHW). Diabetes Australian Facts. 2008, Australian Institute of Health and Welfare: Canberra.
http://www.aihw.gov.au/diabetes/

National Association of Diabetes Centres (NADC). ANDIAB 2000. Australian National Diabetes Information Audit & Benchmarking. 2000, National Association of Diabetes Centre: Canberra.

Moulik, P.A., R. Mtonga, and G.V. Gill. Amputation and mortality in new-onset diabetic foot ulcers stratifi ed by etiology. Diabetes Care, 2003;26(2):491-494.

http://www.amputee-coalition.org/fact_sheets/amp_stats_cause.html

High rates of amputation among Indigenous people in Western Australia

Rates of diabetes-related amputation vary across U.S.