Major leg amputations in diabetics have been reduced by 38 per cent between 2003 and 2013, according to the latest statistics.
The risk of amputations, below or above the knee, is 17 times more common in diabetics and although the number of admissions for foot problems is increasing, major amputations fell to 82 last year compared with 133 in 2003.
A lot of people don’t realise the seriousness of the condition
A major amputation is associated with between a 10 to 15 per cent, 30-day mortality – this means that one in 10 will be dead within a month.
Consultant vascular surgeon Kevin Cassar said these strides were made against expectations and despite increases in population, diabetes prevalence and proportion of elderly people.
However, he warned that Malta was facing an epidemic, triggered by an ageing, obese population, and urged health authorities to make diabetes a priority.
“I’m disappointed that we still don’t have a national foot screening programme as this would ensure early prevention and we can pick out patients before they develop ulcers,” Prof. Cassar said.
“Critical ischaemia [severe blockage in the arteries] is more of a killer than most cancers. So while we have colon and breast cancer screening programmes, we remain without one for the feet.
“I appreciate resources aren’t infinite and it’s important to prioritise, but this is a priority,” he said, adding that Malta had the highest rate of foot problems in comparison with most European countries.
Prof. Cassar was speaking to The Sunday Times of Malta after addressing a series of in-house evening seminars for nurses on vascular disease, organised jointly with Surgery Department chairman Joe Debono.
The treatment of vascular disease – which is any condition that affects the circulatory system – received a huge impetus in 2007 when Prof. Cassar returned to Malta from Aberdeen, where he had been working in the sector since 1998.
This led to the introduction of vascular surgery services, specialised treatments and improved facilities.
The prevalence of diabetes in Malta is 10 per cent, but Prof. Cassar says that this figure could be the tip of the iceberg.
There could be another two to three per cent added on top as diabetics are not registered with a GP and not called in for routine testing.
This meant that sometimes patients were only diagnosed when they presented themselves with symptoms, he said, calling for a national register of diabetics.
Prof. Cassar urged all people over 40 to test their blood glucose levels, exercise, quit smoking, eat healthily and control their weight.
“The Maltese are very undisciplined as a population,” he said, pointing out that very few diabetics checked their blood glucose levels as often as they should.
Asked what could be done to further reduce the number of major amputations, Prof. Cassar said that apart from lifestyle changes, diagnosing diabetes early was crucial, as well as proper control of the disease in those diagnosed.
“A lot of people don’t realise the seriousness of the condition.”