The Economic and Social Cost of Type 2 Diabetes report, commissioned by the Edgar Diabetes and Obesity Research Centre, along with Healthier Lives–He Oranga Hauora National Science Challenge, Diabetes New Zealand, and philanthropists Tony and Heather Falkenstein, found that 600 amputations could be avoided in New Zealand each year if better foot screening and podiatry services were made available for everyone with type 2 diabetes.
The report, produced by PwC New Zealand, found that millions of dollars are spent in the public hospital system each year on diabetes-related amputations, which are often preventable.
The five-year survival rates following a diabetes-related amputation are low, and around half of amputees are rendered 'functionally dependent', placing a huge strain on them, their family, whānau and carers. Avoiding an amputation can therefore increase an individual's life expectancy and quality of life.
Amputation rates in New Zealand also reflect underlying health inequities, with the rate of diabetes-related amputations for Māori being a third higher than for non-Māori.
Podiatrists play a central role in the foot care of people with type 2 diabetes, but workforce shortages contributes to the current crisis, meaning that falls, ulcerations and infections can rapidly become life or limb threatening. PodiatryNZ is calling for immediate investment to increase the size of the workforce.
“New Zealand needs to more than double the current number of podiatrists if it is going to meet current and future demand” says Jennifer Pelvin, PodiatryNZ CEO. “Without regular podiatric care, people with diabetes can find themselves candidates for amputations when their physical condition deteriorates."
Confounding the situation, only a small percentage of New Zealand's podiatrists are actually employed in the public health sector. Associate Professor of Podiatry at Auckland University of Technology (AUT) Matthew Carroll notes that there is minimal investment in podiatry positions within New Zealand DHBs.
“In 2019, only 32 podiatrists (8% of the workforce) were employed in the public health sector at the frontline of diabetes management. This level of investment lags well behind Australia and the UK”, says Associate Professor Carroll.
Better foot screening and protection is one of four interventions analysed in The Economic and Social Cost of Type 2 Diabetes report recently launched in Parliament by Associate Minister of Health Hon Peeni Henare. The report estimated that for each diabetes-related lower limb amputation avoided, a net present value cost saving of $40,654 (major amputation) and $36,505 (minor amputation) could be achieved.
With the number of New Zealanders with type 2 diabetes projected to increase by 70-90% over the next 20 years, urgent action is required. The organisations who commissioned the report are calling for the development of a national diabetes strategy.
“The number of preventable amputations in New Zealand is shocking and we can't leave it up to individual DHBs to fix this problem. New Zealand needs a nationwide strategy and approach to tackle workforce shortages, improve risk identification and access to footcare for all those with type 2 diabetes. This would reduce health inequities and save millions of health dollars by avoiding long hospital stays and loss of limbs,” says Professor Jim Mann, EDOR Co-Director.
Better podiatry services can avoid diabetes-related amputations and save lives, NZ Doctor, 25 March, 2021
Ms Jennifer Pelvin
Professor Jim Mann