Physician warns Far too many foot amputations because of diabetes type II

Diabetic foot syndrome often leads to amputation
Diabetes is a widespread complaint, one of the most unpleasant consequences of which is the so-called diabetic foot syndrome (DFS). Often a foot amputation is performed on this. However, the stressful procedure could be prevented in many cases, emphasizes the German Society for Internal Medicine e.V. (DGIM) in a press release on the occasion of the 123rd Internist Congress in late April in Mannheim.

According to the DGIM experts, a large part of the amputations in diabetic foot syndrome would be avoidable if the patients were already cared for early on by a multidisciplinary network of competent experts. Also, every diabetic patient should be instructed early on to inspect his feet closely, adds Professor Dr. med. Petra-Maria Schumm-Draeger, chairwoman of the DGIM and president of the 123rd Internist Congress.

If the blood glucose levels are poorly adjusted, the risk of diabetic foot syndrome increases. This often leads to amputations, which, however, would be avoidable if the affected were adequately cared for, reports the DGIM. (Image: Andrey Popov / fotolia.com)

Amputation the last option
In diabetes, the nerves and blood vessels in the feet are sometimes so severely damaged by the high blood sugar level that "even small wounds heal poorly, become infected and sometimes even extend to the bone," explain the DGIM experts. The symptoms are described as diabetic foot syndrome. In the end, often only the amputation remains to get the wounds under control, according to the DGIM.

Four-fifths of the intervention avoidable
"After all, 70 percent of the amputations that are performed in Germany every year - that is about 40,000 - affect patients with diabetes mellitus," reports the DGIM. Four-fifths of these interventions, according to Professor med. Ralf Lobmann, Medical Director of the Clinic for Endocrinology, Diabetology and Geriatrics at the Klinikum Stuttgart, however avoidable with a suitable treatment. For this, however, medical specialists such as diabetologists and vascular surgeons would have to work closely with representatives of other health professionals such as podiatrists, wound assistants and orthopedic footwear technicians.

Interdisciplinary cooperation required
First of all, an optimal metabolic control and the consequent relief of the affected foot are provided for in the treatment, reports the DGIM. For infections, targeted treatment with antibiotics remains essential. "If the blood flow to the foot is severely limited, individual vessels have to be dilated by balloon catheterization or bypassed by a vascular surgical bypass," explains Professor. Lobmann continues. In order to avoid relapses it is also important to adapt the shoes optimally to the (residual) foot and to avoid pressure points.

Number of amputation clearly lowerable
The stressful amputations would be avoidable in many cases if patients are cared for by such a cross-disciplinary network of competent experts, reports Prof. Lohmann. An initial data analysis has shown that the concept is quite successful and only about 3.1 percent of around 18,500 DFS patients treated at certified centers between 2005 and 2012 received a so-called high amputation (foot above the ankle amputated). This value is well below the usual rate of 10 to 20 percent. In 17.5 percent of the cases, according to the DGIM, an amputation below the ankle was required.

Regularly inspect your own feet
"The figures make it clear that care in specialized centers can avoid many amputations," stresses Professor Lobmann. However, those affected are also required to do so. On the one hand, they should recognize the warning signs and, on the other hand, inform their doctor optimally about their own illness. Every diabetic patient should regularly inspect their own feet, the experts explain. Because the wounds usually remain painless and are therefore often noticed late, so, "said the chairman of the DGIM, Prof. Schumm-Draeger, on. By the time a doctor or podiatrist sees her, it may already be too late.

Establish interdisciplinary care structures
Once the first signs of DFS are present, interdisciplinary treatment of patients is essential to reduce the risk of amputation, the DGIM experts emphasize. Professor Lobmann is therefore working in a corresponding working group of the German Diabetes Society to establish and certify interdisciplinary care structures for the treatment of the diabetic foot in Germany. "We hope to be able to reduce the alarmingly high number of amputations," stresses the diabetologist. (Fp)