Diabetes Ireland calls for expansion of HSE National Diabetes Footcare Programme

Diabetes Ireland calls for expansion of HSE National Diabetes Footcare Programme so it becomes a real “prevention” service

57% of all amputations in 2014 diabetes related. Up to 80% of these could have been avoided with earlier diagnosis and treatment

According to recent HSE figures released to Deputy Ciaran Lynch TD, the number of people with diabetes receiving lower limb amputation surgery increased from 393 people in 2013 to 440 people in 2014. Also in 2014, a further 1,697 people with diabetes required hospital in-patient treatment for foot ulceration spending on average 14 days in hospital.

Despite the introduction of a National Diabetes Footcare programme by the HSE in 2010, a service that today employs 22 podiatrists, numbers of amputations continue to rise. “We are not even stemming the number of diabetes related amputations and in-patient foot ulceration treatment year on year” said Dr Anna Clarke of Diabetes Ireland.

Lower limb amputation is one of the preventable potential complications of long term poorly controlled diabetes. However, due to continued under-resourcing of podiatry services, there is inadequate specialised early screening and thus the lack of early intervention in patients who require it.

Professor Seamus Sreenan, Consultant Endocrinologist, Connolly Hospital said “while we fully support the implementation of the National Diabetes Footcare programme, the programme currently only has the capacity to see patients who have developed a serious foot problem which for many is far too late to save a limb. Despite the appointment of 22 podiatrists under the programme, Ireland still has one of the lowest manpower levels of specialist podiatrists working in diabetes in Europe. There are significant parts of the country which do not have this service despite an urgent need”.

Research has shown that foot complications are almost completely preventable by regular screening of diabetes patients and by early intervention by podiatrists in those requiring urgent in-depth treatment.

An Irish Study showed that the average inpatient hospital treatment of a diabetes related foot ulcer is €30,000 and based on this, the cost to the HSE of treating 440 diabetes related lower limb amputations was over €13.2m in 2014. Add that to the cost of treating a further 1,697 diabetes patients admitted to hospital for foot ulceration treatment and we are looking at a total cost to the HSE of over €63m in 2014.

“A 10% reduction of diabetes patients requiring inpatient foot ulceration treatment would save the HSE around €5m per annum. Other costs savings such as long term social welfare costs, housing alteration costs etc also need to be added to this figure making further cost savings for the Exchequer.

We now have basic grade podiatrists qualifying out of college every year looking for employment and further investment in community based diabetes foot care will go a long way to reducing the hospital treatment cost. The cost of employing the full podiatry class qualifying out of Galway University this summer would be approximately €700,000 per annum and would lead to huge savings within 5 years.” added Dr Clarke.

Deputy Ciaran Lynch TD said “if we can identify at community level those at moderate risk of developing foot ulceration and ensure they are put under active surveillance by a podiatrist we can reduce these costly diabetes complications. It makes economic sense to expand the programme as the foot complications of diabetes and the associated risk of amputation are preventable with regular foot examination, regular podiatry screening and rapid access to footcare specialists for the urgent cases”.


Editors Notes

For further information, including figures on individual counties and interviews with commentators, contact Sinead Deasy on 01 8428118. 

Diabetes Ireland is the national charity dedicated to providing support, education and motivation to all people affected by diabetes. It also raises public awareness of diabetes and its symptoms and funds Irish-based research into diabetes.

Summary of Data

Counties with most significant change year on year

Westmeath 719 11
Kildare 24 35 11
Dublin 92 101 9
Wicklow 12 20 8
Louth 7 13 6
Tipperary 12 18 6

Number of Diabetes Related Inpatient Foot Ulceration treatments without limb amputation

Dublin 340 434 94
Kildare77 13053
Wexford 35 55 20
Westmeath 51 66 15
Cavan 43 55 12
Limerick 54 66 12
Cork 152 163 11
Galway 103 66 (-37)
Kilkenny 56 21 (-35)
Waterford 76 44 (-32)
Clare52 31 (-21)
Louth 81 60 (-21)
Longford 35 19 (-16)
Meath 63 47 (-16)

General Cost of Diabetes

• The cost of diabetes care makes up a substantial proportion of national health expenditure.
• The Irish CODEIRE study suggested the annual cost of treating diabetes in Ireland consumes 6.4% of the annual health expenditure. UK data suggests diabetes consumes 10% of the NHS expenditure.
• Over 60% of the expenditure is spent on the complications of diabetes – many of which could be prevented with appropriate resourced care.
• Diabetes is the commonest cost of blindness in working age adults, renal failure and dialysis, lower limb amputation and significantly increases the risk of cardiovascular disease and stroke
• The annual cost of care for patients with a microvascular or a macrovascular complication are 1.8 and 2.9 times the cost of treating those without clinical evidence of complications.
• The annual cost of care if a patient has both micro- and macrovascular complications, over 20% of patients with diabetes will have both, is 3.8 times the cost of treating patients with no complications
• Many diabetes related complications are preventable, therefore it would appear a cost-effective approach for the government to invest in the prevention of diabetes related complications.

References: CODEIRE Study, Making Diabetes Count