Understanding the trends in lower-extremity amputations for diabetes and peripheral artery disease

By Jennifer Stranges

Together, diabetes and peripheral artery disease account for more than 80 per cent of lower-extremity amputations in Canada.

A new study by St. Michael’s Hospital vascular surgeons, Dr. Mohammed Al-Omran and Dr. Charles de Mestral, has found that lower-extremity amputations related to diabetes and peripheral arterial disease have increased over the last decade in Ontario.

We spoke with Dr. de Mestral to learn more about the study’s findings and ways patients with diabetes or peripheral artery disease can be more vigilant about their lower extremity care.

What motivated you to explore trends in the rate of lower-extremity amputations related to diabetes and peripheral artery disease?

As vascular surgeons, we treat people with diabetes and peripheral arterial disease at risk of amputation on a weekly basis. Those who come to St. Michael’s Hospital benefit from multidisciplinary limb salvage efforts. However, we know there are serious gaps in foot care across many parts of Ontario and Canada.

What are some of the clinical, psychological, social and economic burdens related to lower-extremity amputations?

In people with diabetes or peripheral artery disease, leg amputation is one of the most feared complications. Leg amputation often severely limits a person’s mobility and independence. It takes a major toll on the patient, their family and their caregivers, in terms of mental health as well as financially. There is usually a lasting impact on quality of life.

What was most surprising about your findings?

Unlike the decreasing incidence of heart disease and stroke, we found that amputations have recently increased. Part of this rise is likely related to the rise in diabetes. Diabetes currently affects 10 per cent of Ontarians and is expected to increase by 20 per cent over the next decade. A rise in amputations related to diabetes was also recently reported in the United States. These data should serve as a call to action. We need to do more when it comes to foot care for people with diabetes and peripheral artery disease.

What’s next for this research and for lower-extremity amputation prevention?

We are looking at regional differences in amputation rates and prevention efforts across Ontario.

We need to improve screening for foot problems in people with diabetes and peripheral artery disease. We also need to better coordinate the multidisciplinary care they need to prevent amputation when a foot problem arises.

In the context of amputation prevention, what advice would you share with a patient who has diabetes, peripheral artery disease or both?

Check your feet daily for wounds, and if you notice a new foot or toe issue – such as pain, redness, black discolouration, wounds – then see your doctor or foot specialist as soon as possible.

This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.