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Diabetes and amputation medical negligence claims

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    A study demonstrates that following guidelines for foot care in diabetic patients can reduce the incidence of amputation.

    By Kerstin Kubiak

In 2012 the Journal of Cardiovascular Diabetology published a Swedish review paper [1] to assess whether the rate of lower limb amputations can be prevented in patients suffering from diabetes. The study concludes that following Guidelines on foot care and practicing good preventative medicine should make a difference.

SWEDISH STUDY

A study undertaken in Sweden reviewed patients with diabetes mellitus to ascertain whether amputation rates were altered following the introduction of Guidelines for the treatment and prevention of diabetic foot complications and to identify groups of people who should be assessed as high risk and targeted for early treatment and management. Amputations are frequently required in diabetic patients due to peripheral neuropathy or vascular diseased, causing ulcers and tissue breakdown due to poor oxygenation of the tissue.

The results of the study seem to be very encouraging and noted a 60% reduction in lower extremity amputations above the ankle between 2001-2006, which demonstrates good diabetic care can make a real difference to the outcome.

The study noted in its conclusion that “only 30% of the patients had been in contact with the multidisciplinary foot team at the Department of Endocrinology, Metabolism and Diabetes before amputation.” and as such “The amputation rate could possibly be further reduced if all patients at risk of LEA [lower extremity amputation] were referred to the multidisciplinary foot team in order to get specialist treatment.”

OUR EXPERIENCE

The Clinical Negligence Team have acted in diabetes and amputation medical negligence claims relating to poor diabetic care, where earlier intervention and treatment would have either avoided or prolonged the need for amputations of limbs or digits.  Losing any part of your body by necessary amputation can have a catastrophic affect on a patient’s life, resulting in significant disability and the need for care and assistance.  Independence and mobility, when lost, not only present a physical but also a very difficult emotional challenge.

We often receive enquiries from diabetic patients in relation to a potential medical negligence claim where there has been a failure on the part of their GP or diabetic nurse or clinic to adequately monitor the vascular condition of their feet, leading to a failure to diagnose and treat deterioration. Quite often the early signs of ischemia or gangrene are missed, leading to the development of foot ulcers, which can then deteriorate very quickly leading to amputation.

The NHS have a care pathway in place for the management of diabetic patient foot care and it specifically notes that: “Foot care is particularly important in people with diabetes because delay in the diagnosis and management of foot problems…..contributes to a higher amputation rate.”  The NICE Guidelines recommend an annual foot review, however this may vary dependent upon patient risk and symptoms.

It is important that patients follow the medical advice given to them as failure to do so can contribute to lower limb complications, but often problems develop through poor medical care where adequate care is not given when a patient is at higher risk of complications and in such circumstances it is important to contact a specialist medical solicitor for further advice.

(1) A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented? Alvarsson et al Cardiovascular Diabetology 2012, 11:18

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