Is enough being done to prevent and reduce diabetic amputations in Grenada? At a graduate seminar held at St. George’s University, Dr. Gerry Rayman, a consultant physician and Head of Service at the Diabetes and Endocrine Centre at Ipswich Hospital NHS Trust, UK, spoke on the topic “a national programme to reduce the variation in amputations in the UK.” In his lecture, Dr. Rayman outlined measures shown to significantly reduce the number of diabetic amputation cases. Although geared towards developed countries, many of the measures outlined by Dr. Rayman can be adapted to help alleviate the incidence of amputations due to complications of diabetes in Grenada.
Dr. Rayman refers to diabetic complications of the foot as foot attack to demonstrate the severity of the condition, presenting research showing the high mortality rate of foot ulcers, 50 percent over five years. “This is not just an amputation. This condition kills… Lung cancer, breast cancer and prostate cancer have a lower rate of mortality, yet most of the investment is focused on these.”
According to Dr. Rayman, Finland, Sweden, and the Netherlands have significantly reduced their rates of amputations which he attributes to their structured delivery of services for the diabetic foot. “The key elements to reducing amputations are screening, education, proper care pathways and immediate access to medical care for those with foot attack,” he said. “Most amputations are preceded by foot ulcers, most of which are preventable. If we can prevent the foot ulcer, we can prevent the amputation.” He advocates a structured nationwide program involving multiple disciplines within the medical profession to arrest this problem.
As national clinical lead for inpatient care, Dr. Rayman responded to lapses in the treatment and prevention of foot attack in patients in UK hospitals by developing the Ipswich Touch Test along with his colleagues at Ipswich in 2009. The test switched responsibility for screening from junior doctors to the nurses and removed the need for high tech equipment to detect neuropathy or loss of sensation in the feet. The simple and highly effective test increased screening for neuropathy and foot lesions to nearly 100 percent in hospitals resulting in dramatic decreases in amputations. The test can also be conducted at home by the family members of diabetic patients; Dr. Rayman recommends doing this at least once per year.
The Ipswich Touch Test is also virtually free to implement. Dr. Rayman commented: “I marvel that health care systems should persist in wasting large sums on the disasters arising from poorly managed diabetic foot problems but little or none on integrating care to prevent these in the first place.”The economic toll of diabetic foot complications in the UK is nearly three quarters of a billion.
Recently, sparked by a talk by Dr. Rayman in 2012, St. George’s University student group Public Health Student Association (PHSA) introduced and promoted the Touch the Toes Test. If this test is adopted in Grenada’s hospitals and homes along with proper education and vigilant care, the nation can also reduce amputations and their personal and economic burden.