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The Diabetic Foot

By Rt Hon Keith Vaz MP, Chair of the All Party Parliamentary Group for Diabetes

[This article was first published on the Huffington Post, 8th June 2015]

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I often maintain, that the greatest long-term threat to our National Health Service comes not from the usual range of suspects people would immediately think of, but from diabetes and obesity.

Why would two conditions, which so many people appear to live with relatively normally, be so concerning? It is because, whilst these conditions are preventable, millions more are likely to develop them, and not everybody lives ‘normally’ when they do.

For a vivid demonstration, one could have attended the aptly named ‘International Symposium of the Diabetic Foot’, a large and international conference held in the Hague, dedicated to the feet of diabetics.

My feet had never been the centre of attention before. After being invited to speak at this event, that was to change.

A Creeping Affliction

The story of how I discovered I had type-two diabetes will be similar for many who have the condition. A simple blood test by my local GP, with little prior knowledge of the condition, and a few days later I needed to take a regular cocktail of pills, adjust how I ate and prepare myself for a lifetime of diabetes ‘management’.

The trouble is, managing diabetes effectively is an immensely difficult task, a fact not lost upon patients or medical practitioners. Policy-makers face a real challenge in making this task easier.
Diabetes costs the NHS £14 billion every year, or 10% of its budget. The majority of these costs are expended solely on the complications of diabetes, with only a fraction of these funds spent on regular treatment.

People often say to me, that it must be difficult to campaign for diabetes, as it does not have the same shock factor of conditions such as cancer or AIDS. For anybody who has seen people who have required lower-limb amputations for diabetes, or indeed the condition of those limbs before amputation, will say the complications of diabetes are as shocking as they come.

Shocking indeed, an operation needed by over 120 people every single week. These and other serious operations, often a last resort after the condition was poorly managed or undiagnosed, are the greatest fear for patients and doctors.

It is also the main source of the ballooning costs diabetes incurs, as 50% of diabetes spending is on complications, whilst only 7% of costs are attributable to the prescription of medicines.

Saving the Diabetic Foot

This is why so many experts and hugely respected medical practitioners have dedicated their careers to feet.

The experts I spoke to and heard speeches from in The Hague, including experts like Kristien Van Acker who Chairs the International Diabetes Federation’s Diabetic Foot Programme, have gathered numerous examples of best practice for us to follow.

The first is early diagnosis. The NHS Health Check, launched with bold promises, has not been enormously successful in screening people for diabetes. It needs to be given stronger teeth, because for 700,000 people live with undiagnosed diabetes is simply unacceptable. The condition will be a ticking time-bomb for their health, with possibly devastating consequences.

Once an individual is diagnosed, the NHS needs the capacity, across the country, to deliver a comprehensive treatment programme. This means health centres with dedicated diabetes units, specialist diabetes nurses and a full range of educational programmes to ensure patients can manage their conditions.

We currently say diabetics should have their feet checked once a year, but saying this and ensuring it happens are two different things. Diabetic patients need to be monitored carefully, and have regular contact with healthcare teams. Ensuring the NHS has the resources for this level of contact is imperative.

Changing Lifestyles, Saving Lives

Of course, these treatment models must be run in tandem with a serious awareness campaign for exercise and healthy eating. The links between obesity and diabetes are absolutely clear. Taking this challenge on properly can stop millions of people from becoming afflicted diabetes in the first place.

Parliament may be haunted by the Coca-Cola Eye across the river, but we should not flinch in cutting levels of sugar, salt and fat in food and drink, particularly for children.

It is the start of a new Parliament, and we can allow ourselves some optimism that progress can be made. The NHS’s bold National Diabetes Prevention Programme will be implemented over the next few years, let’s hope its ambition is matched by its effectiveness.

As Simon Stevens said upon launching the programme, “It’s time for the NHS to start practising what we preach”. Quite right, and it is time for politicians to do the same.

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