New drug treatments and special care units aim to reduce foot amputations in diabetics

by Barbara Hewitt on May 23, 2014

More is being done to help diabetics with foot problems in a bid to reduce the number of hospitalisations and lower limb amputations.

Some of the latest research suggests that patients were twice as likely to have a diabetic foot ulcer heal within eight weeks when they were treated with a tissue repair drug.


Patients were twice as likely to have a diabetic foot ulcer heal within eight weeks when treated with PDRN

Researchers at the University of Messina in Gazzi Messina, Italy, believe that they have shown for the first time that a pharmacological approach can improve wound healing.

In the clinical trial, 216 people with diabetic foot ulcers (free of visible infection) were given either the tissue repair drug polydeoxyribonucleotide (PDRN) or a placebo. They received injections of the PDRN or the placebo for eight weeks and were monitored for an additional four weeks for any change in the ulcer.

After two months, 37% of the patients who were treated with PDRN had their ulcers completely closed, compared with nearly 19% of the patients who received the placebo. Study subjects reported few side effects from PDRN.

‘This approach could revolutionize the treatment of diabetic foot ulcers, a main cause of hospital admissions in the developed world. An estimated 382 million people worldwide have diabetes, and it is crucial to find effective treatment options for hard-to-heal ulcers and other complications facing millions of patients,’ said lead author Dr. Francesco Squadrito.

Meanwhile, a report from charity Diabetes UK shows that amputation rates have not improved within the last year and that the difference between amputation rates across the country has widened.

While amputation rates have improved in high performing areas such as Brent in London, in other parts of the country, amputation rates for people with diabetes have become significantly higher.

For example, in the Fareham and Gosport, an area in and around Portsmouth, the rate of amputations is seven times higher than in Brent. By comparison, in the previous year, the difference between the best and poorest performing areas had been a fivefold difference.

Diabetes UK estimates that around four in every five amputations can be prevented through better care. The fact that some areas of the country are performing substantially better than other parts outlines the fact that the amputation rates can be reduced—if poorer performing areas improve their level of diabetes care.

Some hospitals are actively doing something about it. In London, St Mary’s Hospital has just opened a new specially constructed foot unit to provide rapid access for diabetics with foot problems. Patients can see specialists, including diabetes consultants, podiatrists, vascular and orthopaedic surgeons, microbiologists, orthotists, dieticians, and nurses, all in one place.

‘Amputations among our diabetes patients have fallen by 40% as a result of rapid access and multi-disciplinary working. We hope this will benefit even more people as there will be greater opportunity for our patients to see all the experts in the same place at the same time, enabling our clinicians to put together a comprehensive care plan for each patient,’ said Professor Jonathan Valabhji, diabetes consultant at Imperial College Healthcare NHS Trust and National Clinical Director for Obesity and Diabetes at NHS England.

Richard Lane, president of Diabetes UK, who opened the new unit, said there is a vital need for specialist care. ‘It’s all about having the right care at the right time—quick access and partnership working between primary and secondary care and specialists,’ he added.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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