Can We Reduce Diabetes-Related Lower Limb Amputations?

Lower extremity amputation is the most feared complication in people living with diabetes and produces a significant physical, psychosocial and economic burden. The annual cost of diabetes-related ulceration and amputation is £837-£962 million, i.e., 0.8-0.9% of the National Health Service budget for England. Major amputation rates have reduced globally, largely in association with the introduction of diabetes foot multidisciplinary team services. However, more recently, amputation rates have stagnated in the UK and started to increase again in the USA, driven by increased amputation rates in younger patients and those from areas of greater social deprivation. We discuss interventions shown to reduce lower limb amputation in diabetes including multidisciplinary team services, root cause analysis, prompt referral for expert assessment and whole systems approaches designed to improve diabetic foot care throughout the patient experience. Some recent novel clinical interventions also demonstrate potential for greater limb preservation. We also discuss recent novel plastic and vascular surgery interventions and advanced dressing solutions, which show promise in improving limb salvage rates in the context of diabetic foot ulceration.