Dorset County Hospital has pledged to further improve services for people with diabetes who have problems with their feet.
Diabetes UK has recently highlighted concerns about the rates of amputations among patients with diabetes, saying that many could be prevented.
Dorset has seen a significant reduction in amputation rates over the last few years, but the team at DCH are committed to lowering that further.
Service improvements have already made a difference and diabetes consultant Dr Adeel Ghaffar says more developments are planned.
He said: “We have two new vascular consultants and I joined the diabetes team this year. We are really starting to see the benefits of the changes we have made since the summer.
“We now have a multi-disciplinary team (MDT) of professionals dedicated to the foot service.
“That team includes a diabetes consultant, vascular consultants, podiatrists, orthotists, an orthopaedic consultant, orthopaedic practitioners, microbiologists and radiologists.
“We discuss cases together and hold a fortnightly clinic for patients which acts as a one-stop shop, so there are fewer separate waits and referrals. This reduces clinic attendances by as much as two thirds as the patient can see all the relevant specialists on one occasion. The whole process is now much quicker and effective for patients – the patient is very much at the centre of everything we are doing. Patients now wait two weeks to see a vascular consultant in a dedicated clinic rather than previously waiting several weeks. Prompt decisions can be made and potentially limb-saving treatment expedited.
“Although we are pleased with the progress we have made, we know there is still a lot of work to do. We currently run a foot clinic four days a week. We want to increase that to five and reduce waiting times further. We also don’t currently have a podiatrist who sees patients in hospital so we are hoping to put that service in place too.
Dr Ghaffar explained why diabetic patients often have problems with their feet and why sometimes this can lead to amputation.
He said: “Dorset has been highlighted as having high amputation rates in the past, but our rate is coming down significantly thanks to the improvements in services. We were seeing around 30 to 40 leg amputations a year in West Dorset several years back – in the last 12 months we have had 10.
“Unfortunately there will always be amputations because sometimes people don’t seek treatment early enough because of the nature of the symptoms. Also, the underlying problems caused by the diabetes and poor circulation means that even with the best care, in some patients there is little that can be done to prevent an amputation.
“Diabetes is associated with nerve damage and the longest nerves are affected first. The feet become numb so you don’t have pain to tell you something is wrong with your feet if you get injured. Pain is important in protecting your feet from harm. A patient may get a blister or ulcer which becomes infected. If that infection gets to the bone before any treatment then it can lead to amputation.
“With diabetes you will also often have a poor blood supply so when you get an injury the blood flow doesn’t increase as it should and you don’t heal well.
“It’s really important that people with diabetes check their feet every day, looking for breaks in the skin, and seek medical attention promptly regardless of whether they think the foot problem is serious or not.”
Diabetes Telephone Helpline Extended
As part of the improvements for patients with diabetes, the Diabetes Nurse Specialists are extending their telephone advice service to include weekends and bank holidays. If people are unwell or have concerns about their diabetes over the weekend when they cannot access advice from their GP or practice nurse, they can call the diabetes team on 01305 255342 between 8am and 5pm.
Diabetes Nurse Specialist Lisa Clark said: “Often when people with diabetes are unwell their blood glucose is very different from their usual patterns. This can lead to very high sugars or hypoglycaemia, neither of which are good for people with diabetes and can lead to problems that may require admission to hospital.
“A Diabetes Nurse Specialist will also be available to the Emergency Department at DCH and the admissions ward over the weekend so that we can support people in managing their diabetes and avoid them being admitted to hospital and get them home promptly and safely.”
