Tuesday, November 13, 2012

Diabetes: Prevention is better than cure

Diabetes mellitus is one of the most common non-communicable diseases globally. It is also a leading causes of death in most high-income countries with substantial evidence there is an epidemic in many economically developing and newly industrialised nations. Population-based diabetes studies consistently show many people remain undiagnosed largely because there are so few symptoms during the early years of type 2 diabetes or symptoms may not be recognised as being related to diabetes. In addition to diabetes, the condition of impaired glucose tolerance (IGT) describes where blood glucose level is higher than normal but not as high as in diabetes, is also a major public health problem. People with IGT have a higher risk of developing diabetes as well as an increased risk of cardiovascular disease. Blood sugar imbalance can damage nerves and blood vessels. In the legs this often gives symptoms such as a lack of feeling and when combined with poor circulation to the feet may lead to tissue breakdown (ulcers), infections and eventually amputations. Complications due to diabetes are a major cause of disability, with reduced quality of life, and death. Currently there is no internationally agreed standard for diagnosing and assessing diabetes complications. The absence of which makes it difficult to make comparisons between different populations. A recent study, published in the Journal of Foot & Ankle Research, confirms Australia has the second highest rate of diabetes amputations in the developed world. Diabetes amputation rates (amputations per 100,000 people) have in Australia increased 30% over the past decade. By comparison to other countries more Australians end up with an amputations. Many of these are preventable as studies have consistently demonstrated better preventative services such as podiatry help reduce diabetes foot-related amputations, hospitalisation and costs by 50% to 85%. The reason it is tought the United Kingdom and the Netherlands have amputation rates about half of Australia is because their health care strategies focus on making sure doctors, nurses and, importantly, podiatrists work together as a team and use the best treatment tools. Multidisciplinary foot care teams, and better use of podiatrists, have been consistently shown to prevent and heal many more foot ulcers than professionals working on these problems alone. The health care statistics from the Netherlands support an inverse relationship and the more teams and podiatrists available, the less amputations and hospitalisations follow. In Australia the National Health and Medical Research Council (NHMRC) endorsed the research base of these strategies with National diabetes foot guideline recommendations yet this has made no appreciable difference. At present only one half of these NHMRC diabetes foot guideline recommendations are funded by Medicare whereas all other NHMRC guideline recommendations for diabetic complications are Medicare funded.

Peter A Lazzarini, Joel M Gurr, Joseph R Rogers, Andrew Schox and Shan M Bergin 2012 Diabetes foot disease: the Cinderella of Australian diabetes management? Journal of foot and ankle 2012, 5:24

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