Better Podiatry Services Can Avoid Diabetes-related Amputations And Save Lives

Around 600 amputations could be avoided in New Zealand each year if better foot screening and podiatry services were made available for everyone with type 2 diabetes, a recent report* shows.

The report found that millions of dollars are spent in the public hospital system each year on diabetes-related amputations, which are often preventable.

Five-year survival rates following a diabetes-related amputation are low. And around half of amputees are rendered ‘functionally dependent’, placing a huge strain on them, their family, whānau and carers. Avoiding an amputation can therefore increase an individual’s life expectancy and quality of life. Amputation rates In New Zealand reflect underlying health inequities, with the rate of diabetes-related amputations for Māori being a third higher than for non-Māori.

Lead podiatrist at the Waikato District Health Board (DHB) and Co-Chair of the NZSSD Diabetic Foot Special Interest Group, Claire O’Shea says “There is a huge social impact on the lives of those with diabetic foot disease, given the extended time that it takes for a wound to heal, and to keep it healed. And this affects their family, whānau and carers.”

Podiatrists play a central role in the foot care of people with type 2 diabetes.

“Regular foot screening in combination with comprehensive foot protection services enables the prevention or early detection of foot wounds and ulcers,” says Michele Garrett, Auckland-based podiatry clinical leader. “If these are not detected early enough, it could result in an amputation.”

At present, marked variation exists between DHBs in their rates of diabetes-related amputations. Part of this disparity is due to workforce shortages.

PodiatryNZ is calling for immediate investment to increase the size of the workforce.

“New Zealand needs to more than double the current number of podiatrists if it is going to meet current and future demand” says Jennifer Pelvin, PodiatryNZ CEO. “Without regular podiatric care, people with diabetes can find themselves candidates for amputations when their physical condition deteriorates. Falls, ulcerations and infections can rapidly become life or limb threatening conditions.”

What’s more, only a small percentage of New Zealand’s podiatrists are employed in the public health sector. Associate Professor of Podiatry at Auckland University of Technology (AUT) Matthew Carroll notes that there is minimal investment in podiatry positions within New Zealand DHBs.

“In 2019, only 32 podiatrists (8% of the workforce) were employed in the public health sector at the frontline of diabetes management. This level of investment lags well behind Australia and the UK”, says Associate Professor Carroll.

Better foot screening and protection is one of four interventions analysed in The Economic and Social Cost of Type 2 Diabetes report* recently launched in Parliament by Associate Minister of Health Hon Peeni Henare.

The collaborative report revealed that the number of New Zealanders with type 2 diabetes is projected to increase by 70-90% over the next 20 years. Despite this alarming news, the report also contained positive suggestions for reducing the human and economic costs of this disease.

PwC New Zealand undertook cost-benefit analyses for the report, which showed that providing optimal podiatry services in all DHBs would save lives and livelihoods and improve equity of access to diabetes care across Aotearoa New Zealand. An optimal service is defined as having amputation rates comparable to those in other countries within the Organisation for Economic Co-operation and Development (OECD).

The report estimated that for each diabetes-related lower limb amputation avoided, a net present value cost saving of $40,654 (major amputation) and $36,505 (minor amputation) could be achieved.

The organisations who commissioned the report are calling for the development of a national diabetes strategy.

“The number of preventable amputations in New Zealand is shocking and we can’t leave it up to individual DHBs to fix this problem. New Zealand needs a nationwide strategy and approach to tackle workforce shortages, improve risk identification and access to footcare for all those with type 2 diabetes. This would reduce health inequities and save millions of health dollars by avoiding long hospital stays and loss of limbs,” says Professor Jim Mann, of the Edgar Diabetes and Obesity Research Centre, and the Healthier Lives–He Oranga Hauora National Science Challenge.

*The Economic and Social Cost of Type 2 Diabetes report was commissioned by Diabetes New Zealand, the Edgar Diabetes and Obesity Research Centre, Healthier Lives–He Oranga Hauora National Science Challenge and philanthropists Tony and Heather Falkenstein. PwC New Zealand produced the report with input from health experts. It took almost a year to conduct the detailed analyses in the report, which was launched at Parliament by Associate Minister of Health Hon Peeni Henare on 15 March 2021.

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