World Diabetes Day 2018

Decrease in major amputations for people with diabetes across the north


Amputation rates for people with diabetes in the region have fallen by almost a quarter, according to new figures from Public Health England1.

The North East and North Cumbria region still has a rate slightly higher than the national average but work is continuing to ensure the number of amputations are further reduced. Rates in the region were 11.4 per 10,000 people with diabetes in 2010. These have now fallen to a rate of 8.9 per 10,000 people with diabetes, with the England average being 8.2; a reduction of almost 25%.

An estimated 191,000 people have diabetes in the North East and North Cumbria2. Diabetes is a serious, lifelong condition and new analysis by Diabetes UK shows that 500 people living with diabetes die prematurely every week in England and wales, with many of these deaths being caused by avoidable complications.

The hallmark of diabetes is high blood glucose or ‘sugar’ levels which, can lead to organ and tissue damage if not treated correctly. People with the condition are at a higher risk of a diabetes-related injury to a foot which has reduced feeling or reduced blood circulation.

Amputations are over 20 times more common in people with diabetes and regional groups are working through the Northern England Footcare Network to reduce the number of amputations that have been done.

NHS expenditure on diabetes related to foot ulceration and amputation was estimated in 2014/15 to be between £972m and £1.13bn (£1 in every £140 of NHS budget)3, and it is estimated by Diabetes UK that many of the 6,000 diabetes-related amputations4 a year in the UK are a result of variation in services and a lack of awareness, leading many people to delay seeing their doctor for months and therefore missing the chance to save their foot.

At the launch of the Putting Feet First campaign by Diabetes UK in March 2012, it was estimated that in 2009/10, eighty percent of the 6,000 lower limb amputations carried out could potentially have  been prevented through access to good quality, structured care and improved awareness among people with diabetes about their risk status and the actions they should take. Across the UK, there are now more than 8,500 leg, foot or toe amputations every year.

The Northern England Footcare Network, which includes consultants in diabetes, vascular surgery, microbiology, specialist podiatrists, specialist diabetes nurses and other allied healthcare professionals and patient representatives, have been working together to reduce the high rate of amputations in their area since 2012. They meet regularly to share ideas on improving footcare practices across the region.

Dr Rahul Nayar, Chair of Northern England Diabetes Footcare Network, Diabetes Clinical Lead for Northern England Clinical Networks, NHS England & Consultant Diabetologist at City Hospitals, Sunderland, said, “This sustained reduction in major amputation rates across our region has been achieved through the collective vision of highly dedicated and knowledgeable healthcare professionals. Building upon this success will ultimately eliminate variation and inequality by continually embedding better care pathways, streamlining systems and implementing new research technologies to benefit all.”

The Network is reducing rates by supporting development of multidisciplinary foot clinics and protection teams as well as raising awareness of diabetes amputations and promoting timely referrals.

Clare Howarth, Head of the North at Diabetes UK said: “It’s encouraging to see the hard work being done in the region to reduce diabetes-related amputations, but it is still vital to remind people to get their feet checked regularly. When you have diabetes even something small like a blister can lead to an amputation, so if you notice anything out of the ordinary, no matter how small, get it checked by a healthcare professional immediately. With the right care and swift action most amputations can be avoided.”

Significant variation exists in key aspects of diabetes footcare both in out-patient and in-patient care. The Network’s role will be to identify gaps, share best practice and support teams or units in the implementation of effective clinical guidance with the ultimate aim to eliminate variation and inequality and continue driving down amputation rates.



1. Public Health England. June 2018. Diabetes Footcare Profiles: STP level foot care activity data. Available at:

2. NCVIN, Prevalence Estimates of Diabetes by Clinical Commissioning Group (CCG) and England.

3. Marion Kerr, Insight Health Economics. April 2017. Foot Care in Diabetes: The Human and Financial Cost. Available at:

4. Diabetes UK, 2012, Call for an end to “national disgrace” of diabetes-related amputations. Available at:


An aspirational aim in 2012 when the campaign, Putting Feet First, was launched hoped to reduce major amputation rates by 50% by 5 years.

This was supported by four key objectives:

1.    raise awareness with people with diabetes, healthcare professionals and the public of the seriousness of amputations and the impact of diabetes on feet;

2.    improve standards of care by ensuring people with diabetes have annual foot checks and know how to look after their feet;

3.    improve access to multidisciplinary footcare teams by ensuring these teams are available in all areas; and

4.    increase foot examinations for people with diabetes admitted to hospitals.


Initiatives to reduce major amputation rates.

These include:

• Adopting standardised pathways for diabetes foot care across the region, alongside supporting the development of multi-disciplinary foot clinics and protection teams in each locality.

• Raising awareness of both the personal and financial ‘cost’ of diabetes related foot ulcers, amputations and importantly the significantly high cardio-vascular risk linked to the individual, their families and the overall NHS system.

• Development of a root cause analysis tool identified themes, gaps in care and encouraged timely referrals into multidisciplinary foot clinics.

• Promoting and establishing high levels of timely self-referrals into dedicated clinics supported by the Putting Feet First campaign and the Foot Attack Leaflets developed by Diabetes UK.

• Work continues to implement the NCEPOD recommendations, peer review of units

alongside adapting to vascular unit reconfigurations across the region.