From the Australian Broadcasting Company’s interview with Tim McDonald and Paul Wraight
ELEANOR HALL: A group of doctors is calling for urgent changes to the way diabetes patients are treated in Australia.
Writing in the Medical Journal of Australia, the doctors says that there has been a 30 per cent increase in the number of diabetes-related foot amputations in the last decade.
They estimate that one Australian with diabetes loses a lower limb every three hours and they say that doesn’t need to happen.
Timothy McDonald has our report.
TIMOTHY MCDONALD: Every year about 10,000 people are hospitalised for diabetes-related foot ulcers.
All too often, they leave hospital without the foot.
The number of Australians with diabetes has increased in recent years, and along with it, so has the number of amputations.
Associate Professor Paul Wraight is the head of the Diabetic Foot Unit at the Royal Melbourne Hospital.
PAUL WRAIGHT: If we collect data from discharge summaries and what is logged with the government, it looks like it’s a 30 per cent increase. But the problem is that this data is not equally reported across public and private hospitals and it depends on how well the paper work is being completed and filled out.
So we know it’s probably at least 30 per cent, but it may be much higher.
TIMOTHY MCDONALD: Why do you think it’s increasing?
PAUL WRAIGHT: Well internationally, it’s accepted that we need multi-disciplinary teams. So we need physicians as well as surgeons and podiatrists and wound care people working together in order to help heal diabetic foot ulcers and prevent amputations.
The problem is in the Australian health system, the funding doesn’t really support having these multi-disciplinary teams and it’s very hard to establish it with the funding and the equipment that we currently have.
TIMOTHY MCDONALD: So is the result that people are losing limbs when they really don’t need to.
PAUL WRAIGHT: The problem is because people aren’t being looked after by multi-disciplinary teams, because dressings are not funded and footwear and offloading is not funded and these are accepted standards that should be a part of the treatment plan, then people are not often getting the full treatment package, which means if wounds continue to deteriorate, then amputation is then the outcome.
So it is possible that these amputations can be prevented if you put the right treatment into place with the right personnel on the ground.
TIMOTHY MCDONALD: Professor Wraight says the best way to reduce amputations is to address the problem as early as possible.
PAUL WRAIGHT: Once they start losing sensation in their feet or once the blood supply starts to diminish to the feet, they are already at risk of getting ulcers in the future, and these people need to be identified, they need to be seeing a podiatrist regularly to attend to their nail care.
They need to be having people looking at their feet regularly so that when an ulcer does occur, then it is identified very quickly and treatment can start. Then once somebody has an ulcer, then we need to be putting these people into specialist units who have the skills and the expertise and the multi-disciplinary approach to provide the treatment that is required in order to heal it the quickest and also thus reducing amputation rates.
TIMOTHY MCDONALD: Professor Wraight says at the moment, many forms of treatment aren’t included in the Pharmaceutical Benefits Scheme (PBS).
He says it’s often too expensive for diabetes patients to attack the problem early.
PAUL WRAIGHT: If you came in with a heart attack, you know, the medications you need are subsidised by the Government through the PBS, but you know the treatment for a foot ulcer is wound dressings and orthotics, or shoes that take the pressure away from the ulcer.
And these devices, none of them are rebatable by the government, they’re quite expensive and this is one of the main reasons why people don’t actually get the right treatment. Because one, they can’t afford it, and two, not all hospitals can afford to be able to provide these to the patient.
TIMOTHY MCDONALD: Professor Wraight says the additional cost of adding to the PBS would be outweighed by savings from fewer future hospitalisations and amputations.
ELEANOR HALL: Timothy McDonald reporting.