By Jessica Jaganathan

THE loss of feeling in the limbs of diabetics, which can see small cuts become major infections, is one of the main reasons patients lose their toes and feet, a new study has found.

While long-considered a factor, doctors behind the National University Hospital (NUH) study say it is one of the first to show a conclusive link between amputations and loss of sensation, which is caused by nerve damage from high blood sugar levels.

The study was released this weekend during a conference at NUH focusing on diabetes and its effect on limbs.

It found the other major causes of amputations are infections in other parts of the body - including the kidneys and bladder - and reduced blood flow caused by the build up of fat in arteries.

Over 8 per cent of Singaporeans are diabetic, according to 2004 figures.

Every year, doctors are forced to amputate 700 feet and legs because of diabetic complications.

In the nearly one-third of patients in the study who had a major amputation, common links included age - most were over 60 - and existing medical conditions, such as heart disease, stroke or kidney disease.

Contrary to popular belief, smoking, drinking and obesity were not themselves factors in amputations.

The study involved over 200 NUH patients from January 2005 to May 2006.

It found that seven in 10 patients had poor control of their diabetes, neglecting to do things like keep their blood sugar levels in check.

The head of the study, senior consultant Aziz Nather, said the results prompted NUH to put together a team of doctors and nurses to look at treating diabetics in a holistic way.

'With the team in place, I have got better investigations and my decisions can be more accurate,' said Assistant Professor Nather, who works in NUH's Orthopaedics section.

He said foot screenings are neglected by many diabetics, who often have no feeling in their toes and on the soles of their feet.

Besides the yearly screenings in polyclinics or hospitals, patients should also check their feet regularly for wounds and cuts.

He said hospitals and family physicians should help educate patients with diabetes.

One such patient was 70-year-old Pun Haji Abdullah who has had diabetes for more than 10 years.

Although careful with medication, she relied only on a yearly foot screening at her polyclinic and did not check her own feet, said her daughter-in-law Nobiaha Samsuddin, 44.

A few months ago, a small pimple formed on her toe and pain started to shoot up her leg.

'She visited the doctor only when the pain started getting unbearable,' said Ms Samsuddin.

By then, it was too late. Her toe had to be amputated.

Diabetic foot problems account for one-fifth of all emergency admissions at NUH, the study noted. Last year, the hospital saw 108,748 patients at its A&E department.

NUH will be holding a diabetes exhibition and a public forum on diabetes care on Friday.

To register, please call 6772-2184 or visit www.nuh.com.sg/events/eventsforPublic/events_calendarOfEvents.htm#diabetes

jessicaj@sph.com.sg

This story was first published in The Straits Times on Oct 13, 2008.

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