Taking steps in the right direction to prevent diabetes-related amputation
That Dr. Charles de Mestral spent the morning before our interview at Queen’s Park advocating for improved wound care for people with diabetes in Ontario should not be surprising. The researcher and vascular surgeon at St. Michael’s Hospital has become a passionate voice for the need to stem the tide of amputations related to diabetes.
de Mestral, who is a Diabetes Action Canada researcher, recently co-led a study, published in the Canadian Medical Association Journal (CMAJ), that showed a rise in the number of diabetes-related lower limb amputations in Ontario. While this does correspond to the increasing number of type 2 diabetes diagnoses in the province, the results were still alarming.
“It’s discouraging,” says de Mestral, “because so many of those amputations could have been prevented. We know that [type 2] diabetes is increasing and that’s likely what’s driving this.” Part of the solution, he believes is to prevent diabetes and better control blood sugar in those living with the disease, but he also sees a need for improvements in foot care.
Unlike in other complications of diabetes, like eye disease or kidney damage, there is not always coordinated care of foot complications. Patients may not be able to access a chiropodist or podiatrist without paying additional fees and their family doctor may be too busy to provide the detailed regular foot care checks that Canadian and international guidelines recommended for patients with diabetes. This means that a patient may not get the care they need until far too late, when a wound that could easily have been treated requires a much more invasive approach.
For de Mestral, a vascular surgeon, a large part of his job is dealing with poor circulation in a patient’s legs. He estimates that he and his colleagues at St. Michael’s Hospital alone see a dozen patients a week with a limb-threatening problem, most often related to diabetes. “We know that in Canada over 80% of amputations are related to diabetes, often in conjunction with poor circulation, known as peripheral artery disease. And what I see too often is that patients are struggling to get the right care at the right time in order to prevent amputation. He is hopeful that by raising awareness among patients and scaling up the success of multi-disciplinary foot care teams involving doctors, podiatrists, chiropodists and nurses, diabetic foot ulcers can be diagnosed and treated earlier in order to ensure they heal properly, rather than result in amputation.
There is also a need to better understand the issues behind rising numbers of amputations and to develop an evidence-basis for prevention efforts across Canada. This is why the Government of Ontario recently awarded de Mestral an Early Researcher Award to support his work. “That award is allowing me to hire graduate students and other research team members to really focus on the problem of amputation in patients with diabetes and peripheral artery disease,” he says. “We’re first looking at better characterizing the burden of disease, with studies like the one that came out in CMAJ looking at rates of amputation over time in addition to identifying regions and patient groups with high rates of limb loss across the province.” de Mestral’s team will also be analyzing the economic impact of amputation and existing prevention efforts across the province in order to better understand where improvements can be made.
While he hopes to have an impact on patient lives through his research, de Mestral also knows that practical advice can be helpful for those living with diabetes who might be concerned about amputation risk. “The single most important message to anyone with diabetes is check your feet every day,” he says. “Or have a family member or caregiver help with this.” He suggests looking for wounds, redness, areas that might be tender or painful and discoloration of the toes – if you detect any of those things, go to your family doctor right away. “We know that people with diabetes have a 30% lifetime chance of getting a wound on their foot. Thankfully, and if a wound is recognized early, the chance of healing it is over 80%.”
Diabetes Canada offers a helpful checklist for those with diabetes to help support better foot care. You can access it on their website.
For more information about the work Diabetes Action Canada is doing in this area, visit the section of our website on Foot Care and Prevention of Amputation.
Story by Krista Lamb