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Date: 30 March 2023
Diabetes quality indicators
Percentage of patients under Diabetic Centre follow up (attending follow-up outpatient appointments) who have minor or major lower limb amputation
What is diabetes?
Diabetes is a condition that results from the inability of the body to regulate levels of glucose in the bloodstream. Glucose acts like fuel to the different parts of the body.
Glucose levels are normally tightly controlled to provide adequate amounts of energy to body parts for them to be able to function normally. This is all regulated by a hormone in our body called ‘insulin’.
Some people may not be able to produce any insulin at all and are said to have ‘Type 1 diabetes’. In many other people there is a combination of reduced insulin action and inadequate insulin production known as ‘Type 2 diabetes’.
Certain body parts can become damaged when exposed to high levels of glucose for a considerable amount of time (years). This is either because the person was unaware they had diabetes or because their diabetes control was poor.
One of the body parts that may suffer are the feet. The circulation and the feeling to the feet can be reduced which can increase the risk of developing an infection, injury or ulcers. For example, stepping onto something sharp and not being able to feel it may result in a cut that becomes infected. Poor circulation to the feet might result in the inability to fight infection and an ulcer not healing properly.
Further information about diabetes and foot care is available via the external links below.
How is the Trust doing?
Percentage of patients under Diabetic Centre follow up (attending follow-up outpatient appointments) who have major lower limb amputation
|Rolling year to date (February 2019 – January 2020)||0.1%|
|Rolling 2 years (February 2018 – January 2020)||0%|
Percentage of patients under Diabetic Centre follow up (attending follow-up outpatient appointments) who have minor lower limb amputation
|Rolling year to date (February 2019 – January 2020)||0.3%|
|Rolling 2 years (February 2018 – January 2020)||0.3%|
Lower percentage indicates better performance.
The Trust is performing very well against the above indicators. This improvement would not have been possible without patients with diabetes taking care of their feet and their doctors/podiatrists (chiropodists) in the community promptly acting on foot infections and ulcers.
The Trust’s diabetes and podiatry team are also working very hard to reduce the chance of amputation in diabetic patients who are referred to them from the community.
Why is this indicator important?
Ideally, no-one should have to undergo amputation of their toe(s), foot or leg in relation to diabetes. This, however, may be necessary in a situation where the infection in the foot has not responded to antibiotics.
It is important that the Trust supports patients with diabetes to take care of their feet, to control their diabetes and to seek urgent attention when they have a blister, ulcer or infection, as this can reduce the likelihood of an amputation.
This support is provided through outpatient follow-up appointments at the Queen Elizabeth Hospital Birmingham (QEHB).
How do we measure the indicators?
The indicators are measured by the percentage of patients that had a major or minor lower limb amputation with a diagnosis of diabetes who attended the diabetes follow up clinic six months before their amputation. Amputation of part of the leg is classed as a major amputation; amputation of the foot or toe is classed as minor amputation.
Where does the data come from?
The data for the indicators is compiled from the Trust’s patient administration system called Lorenzo.
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