Diabetic foot Services at King’s College Hospital London in Dubai
Dr Emran Ghaffar Khan our Consultant Endocrinologist/Diabetologist has extensive experience with actively dealing with Diabetic foot problems and heads our Diabetes Clinic at Dubai Hills.
He has previously set up diabetic foot service. He was in charges of services for diabetes in his previous role in United Kingdom. His special interest in managing diabetic foot problems both preventing initial and dealing with complex issues which can potentially lead to serious complications. He has a belief that everything that is possible should be and could be done to prevent the patient become more complex and progress toward surgery if possible and reduced the amount of surgical intervention to the least possible needed. Diabetes for problems is a complex issue which has been highlighted by the national clinical Institute off excellence ( NICE ) in UK.
Summery from NICE
Diabetes is 1 of the most common chronic diseases its prevalence is increasing. The life expectancy of people with diabetes is shortened by up to 15 years, and 75% die of macrovascular complications.
The risk of foot problems in people with diabetes is increased, largely because of either diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply due to diseased large‑ and medium‑sized blood vessels in the legs), or both. Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50,and can also increase the risk of heart attack and stroke.
Foot complications are common in people with diabetes. It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. A foot ulcer can be defined as a localised injury to the skin and/or underlying tissue, below the ankle, in a person with diabetes.
Diabetes is the most common cause of non‑traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes. After a first amputation, people with diabetes are twice as likely to have a subsequent amputation as people without diabetes. Mortality rates after diabetic foot ulceration and amputation are high, with up to 70% of people dying within 5 years of having an amputation and around 50% dying within 5 years of developing a diabetic foot ulcer. This high mortality rate is believed to be associated with cardiovascular disease,and emphasises the importance of good diabetic and cardiovascular risk management.
People of South Asian, African and African‑Caribbean family origin are more at risk of diabetes,
Foot problems in people with diabetes have a significant financial impact on the NHS through primary care, community care, outpatient costs, increased bed occupancy and prolonged stays in hospital. A report published in 2012 by NHS Diabetes estimated that around £650 million (or £1 in every £150 the NHS spends) is spent on foot ulcers or amputations each year.
Diabetic foot complications are very common in diabetes and overall, 30 -40% of people with diabetes suffer from neuropathy and 30-40% suffer from poor circulation having peripheral vascular disease. Foot problems cause reduced mobility, some morbidity and have significantly social and financial implications. The complications of Neuropathy and poor circulation are secondary to poor blood glucose control and adverse arterial risk factors e.g. smoking, high cholesterol, obesity etc.
The goal of the diabetic foot services is only to provide early optimal diagnosis and timely treatment for complex cases with difficult revascularization problems or even complex cases with neuro-osteoarthropathy (Charcot). We have access to, neurologist, vascular surgeons, CT angiogram and Angioplasty , Doppler studies and Orthopaedic Surgeon, radiology ,physiotherapy, microbiology, podiatry, casting, etc. The care is led by Dr Emran Ghaffar Khan and he refers to the members of the multidisciplinary team as required.
The overall goal is identify and prevent issues at early stage to minimize amputation rates even in advanced and complex foot problems.
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