Inequity in New Zealand podiatry services behind hundreds of preventable amputations

November is Diabetes Action Month, and this year Diabetes New Zealand is calling on Kiwis to Step Up for Diabetes – our largest and fastest growing health crisis. Earlier this year, along with other partners, Diabetes New Zealand commissioned The Economic and Social Cost of Type 2 Diabetes Report*, which found that a preventative approach to footcare could prevent over 600 diabetes-related amputations in New Zealand every year.

The report was commissioned by Diabetes New Zealand, the University of Otago’s Edgar Diabetes and Obesity Research Centre (EDOR), Healthier Lives - He Oranga Hauora National Science Challenge, and sponsors Tony and Heather Falkenstein, and undertaken by PwC New Zealand.     

Diabetes New Zealand CEO Heather Verry says regular foot checks with a podiatrist are crucial to preventing lower limb amputations in people with diabetes. However, whether you are eligible for funded podiatrist support is dictated by where in New Zealand you live.

“People living with diabetes are at an increased risk of lower limb amputations. This is because diabetes can cause nerve damage and reduce blood flow to the legs and feet, causing simple injuries such as a cut or blister to go unnoticed. This can lead to irreparable damage requiring amputation,” she says.

“600 diabetes-related amputations in New Zealand every year are preventable. This is a shocking statistic that can and should be eliminated. With at home foot care and access to a podiatrist for regular foot checks, 600 Kiwis would not need to lose a leg or a toe. With funding for podiatry only available in some areas and for the most high risk, people with diabetes are subject to a ‘postcode lottery’ where it’s luck of the draw whether they can access funded podiatry appointments.

“Diabetes New Zealand has identified the gap in access to podiatry services and we are providing subsidised podiatry clinics in areas where we can resource a podiatrist. One of these areas is Otago, where we have seen huge uptake in our podiatry service. However, as a non-profit, it just isn’t sustainable for us to continue subsidising the cost of these clinics. We’re at a crisis point in the delivery of this service.”

Renal podiatrist at Counties Manukau District Health Board Lawrence Kingi is passionate about prevention as opposed to end-stage intervention, which is often where his patients end up at the hospital.

“Too often we see people with diabetes lose a limb, which could have been prevented if we saw the patient earlier,” he says.

“If we poured our resource into educating people with diabetes and providing them with preventative podiatry services, we would see much fewer people presenting at the hospital and requiring amputation. Education and prevention are where the focus should be.”

Verry says that Diabetes New Zealand is working with the Ministry of Health to develop an action plan for diabetes and a national strategy for long-term conditions, and it is crucial that podiatry is included.

“Diabetes is on a trajectory to increase by 70 – 90% in the next 20 years. Right now over 277,000** people have diabetes, and a million New Zealanders have pre-diabetes. Prevention of diabetes and of diabetes-related complications, such as lower limb amputations, is something that must be addressed urgently, with a clear action plan and increased government funding.

“The Ministry of Health has recognised the size of New Zealand’s diabetes problem and committed to creating an action plan for the prevention and management of diabetes. Diabetes New Zealand is supporting the Ministry with the development of this plan, but we want to be clear that any action plan must include funded access to podiatry services, no matter where in the country someone lives.

“Alongside access to podiatry services, it is crucial that people with diabetes look after their feet at home, wearing properly fitted shoes and regularly checking their feet for cracks, cuts and blisters. Blood glucose control, blood pressure and cholesterol control will also help to prevent foot complications.”

This November, Diabetes New Zealand is calling on Kiwis to Step Up for Diabetes by having regular foot checks to prevent possible amputations and making the right lifestyle choices to prevent or manage diabetes, which affects over a million New Zealanders.

To learn more about Diabetes Action Month or how to care for your feet, visit www.diabetesactionmonth.org.nz.

To find out if you are at risk of diabetes, visit www.diabetes.org.nz/are-you-at-risk-1.