The Australasian Podiatry Council (APC) estimates as many as 85 Australians a week-20 per 100,000 people-are undergoing diabetes-related lower-limb amputations, a rate it says is nearly the worst in the industrialized world.
“In Australia we don’t follow best practice as would be suggested by the scientific studies, and in countries where they do follow best practice they get dramatically better outcomes than we do,” said APC president Andrew Schox. “Best practice would be better or increased access to podiatry services for people who either have diabetes ulcers [or] who are at risk of it, and integration with teams of multi-disciplinary practitioners in the hospital setting for people who either have or are at very high risk. Both of those things have been shown to improve outcomes and prevent ulcers.”
In keeping with these best practices, Australian podiatrists are calling for urgent action from the Federal Government to help reduce the number of diabetes-related amputations.
Schox said the rate of lower-limb amputations in Australia in the 1990s was about 14 per 100,000 people, and in 2008 it was 18 per 100,000 people.
“If we were to spend an extra $85 million a year on consultations and other things, our cost savings would be between $200 million and perhaps closer to $400 million a year,” Schox said. “We would save up to 3,500 amputations a year because about 80 percent of ulcers are preventable. We could save up to 160,000 bed days and about 600 deaths.”
But the Australian Medical Association (AMA) is not convinced that a boost in funding for diabetes-related podiatry services is warranted.
AMA federal president Steve Hambleton, MD, said large amounts of funding need to be spent in the best possible place, starting with the family physician. He also said the hospitalization rate for lower-limb amputations is falling, which would indicate that they are treating diabetes better.
“I think the evidence that we’re using for this type of proposal was actually quite strong evidence, it’s high-quality evidence,” he said. “We’re not just trying to promote something that’s good for us or our profession, but we’re using strong scientific evidence to say this is where we should go…. It’s not just an idea, it’s something that’s been shown to work elsewhere and there’s no reason why it couldn’t work here.”