Professor Keith Harding
Professor of Wound Healing, Cardiff University School of Medicine
For people with diabetes a small, undetected foot wound can quickly lead to infection, amputation and even death. Better wound care and new therapies can save lives.
Diabetic foot ulcers can kill
“Internationally, 50% of people who have amputations as a result of diabetes die within five years, compared with 18% of breast cancer patients over the same period,” says Professor Keith Harding, Professor of Wound Healing, Cardiff University School of Medicine.
“The road to amputation can start with just a small wound.”
Most of these amputations are avoidable. “The road to amputation can start with just a small foot wound,” says Harding.
What happens?
Diabetes damages the nerves, so patients may feel no pain, and have cracked, infection-prone skin. Peripheral arterial disease, seen in a third of patients with diabetes, means that small blood vessels do not supply wounds with enough oxygen, leading to ulcers that do not heal. In diabetes the immune system is also compromised, so the body’s immune response does not kick in at the wound site.
“A diabetic wound can go from uninfected to life-threatening within a week,” says Harding. “Better oxygenation would help wounds heal faster and probably cut infection risk.”
What can be done?
“This might be achieved by putting patients in hyperbaric oxygen units, though the evidence for its effectiveness is disputed. Direct application of oxygen is also being trialled in diabetic foot wounds,” he says.
“There are many potentially valuable therapies but we do not have robust evidence of their effectiveness because wound care is starved of research, funds and facilities.
“Diabetic foot problems are not just about scabby feet – the amputation and death rates show that this area needs urgent attention.”
The graph below shows mortality rates, for different wounds, from the Welsh Wound Innovation:
