By Emma Wilkinson

BBC News health reporter

Diabetes can lead to damaged feet and toes The number of people in England having a limb amputated because of type-two diabetes has risen dramatically, a study has shown. Between 1996 and 2005, below-ankle amputations doubled to more than 2,000, and major amputations increased by 43%. However the number of amputations in people with type-one diabetes dropped, an Imperial College London team found. A charity said more early diagnosis was needed, as diabetes can go undetected for more than 10 years. The number of people diagnosed with type-two diabetes had increased greatly in the past decade, which could partly explain the findings, the researchers said. In the UK, 2.35 million people have type-two diabetes, which is caused by the body not properly responding to the insulin it produces, and is often a result of lifestyle factors such as obesity. DIABETES AND AMPUTATION Type-one diabetes is caused by the body failing to produce insulin Type-two diabetes accounts for 90% of cases and is caused by the body not responding properly to insulin or not producing enough Both types can impair blood flow to the feet People with diabetes can also suffer nerve damage and might not immediately notice a problem If left unattended a small injury could develop into a hard-to-treat ulcer that could become infected, leading to the need for amputation Along with complications such as heart attacks and strokes, people with diabetes are far more likely to develop foot problems, including ulcers, which can become infected and lead to gangrene. Writing in the journal Diabetes Research and Clinical Practice, the researchers said the number of the most major amputations, above the ankle joint, had risen by 43%. And the average age of those having above-ankle amputations fell from 71 to 69 years, which followed the pattern of people being diagnosed younger, they said. More men underwent amputations than women, a gap that widened during the 10-year period. Study leader Dr Eszter Vamos said they had expected to see long-term complications of diabetes rising to some extent because the number of people diagnosed with the condition had increased. "But at the same time there is very strong evidence that with a multidisciplinary team approach you can prevent up to 80% of the amputations. The findings of this study are especially interesting because they indicate a particular rise in the number of type-two diabetes related amputations

Sara Spiers

Diabetes UK "It highlights the importance of frequent foot checks and that it is very important to get glycaemic control and blood pressure and cholesterol control." Diabetes UK care manager Sara Spiers said there were about 100 diabetes-related amputations each week in the UK. "The findings of this study are especially interesting because they indicate a particular rise in the number of type-two diabetes related amputations," she said. "This rise could be for a number of reasons, including type-two diabetes not being diagnosed early enough, people not getting the education they need to manage their condition effectively, and swifter treatment of foot problems, meaning people are more likely to have an amputation than die because of foot ulcers." She added more early diagnosis was needed, as the condition could go undetected for more than 10 years and most people already had complications when they were diagnosed.



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