From Singapore: Stepping up Efforts to Save A Limb

MORE than 200 legs were amputated due to diabetes in Singapore last year, most of which could have been prevented, according to doctors Today spoke to.

For diabetics, a small cut on the foot can potentially lead to disastrous consequences. In Singapore, the chronic condition affects one in 10 people between the ages of 18 and 69 years old.

Dr Kevin Tan, vice-president of the Diabetic Society of Singapore (DSS), explained that diabetics are usually not aware of their foot condition because of sensory nerve damage caused by their condition.

Factors such as poor blood sugar control, poor blood supply to the wound and reduced resistance to infection can further impair the healing process of the wound.

Often, “sacrificing a limb” is required if the diabetic’s life is in danger from complications arising from a severely infected wound, said Dr Tan.

However, research has also shown that losing a leg to diabetes could also mean you run a higher risk of early death.

Besides a 10 per cent risk of mortality at the time of amputation, diabetics are also at an increased risk (as high as 70 per cent) of death within five years following an amputation, according to a 2007 report in the Malaysian Orthopedic Journal.

“A lower limb amputation definitely affects quality of life and may bring on depression, and hence affect the motivation to live life to the fullest,” explained Dr Tan.

Another important reason is that patients who need an amputation are more likely to be arteriopaths, meaning they are more likely to have severe artery damage and blockages, added Dr Cosmas Chen, a general surgeon at Mount Alvernia Hospital.

He explained: “Severe arterial disease occurring in their legs makes wound healing more difficult, and this may lead to amputation. This also has similar effects on the blood vessels of the heart and brain, hence putting them at a higher risk of stroke and heart attacks. All these can then lead to death.”

According to Dr Chen, legs can be saved with good sugar control, early intervention and proper foot care, which includes nutritional intake to enhance the process of wound healing.

That is why Abbott and the DSS are on a mission to reduce lower limb amputations due to diabetes.

The Abound Save a Leg campaign has been launched this month to stress the importance of early detection and management of diabetic foot wounds to general practitioners (GPs) and patients. Up to 800 GPs will receive educational materials and case studies to enhance their understanding of diabetic foot care and wound healing.

“The burden of disease associated with amputations is enormous – patients and caregivers go through a lot of emotional, financial and physical turmoil,” said Dr Tan.

“It is thus important to involve GPs in our efforts to reduce lower limb amputations because they are at the front-line and in a position to detect diabetic foot ulcers early during routine checkups.”

Dr Cosmas Chen (left) and Dr Kevin Tan with foot models given to GPs for the Save A Leg campaign.

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