Technology for measuring oxygen levels in the brain’s blood supply offers hope for diabetics risking amputation.
Fast facts:
• 12 people undergo diabetes related amputations in Australia every day
• 4 out of 5 diabetes related amputations are preventable
Of the number of challenging side effects of diabetes, losing a lower limb ranks with loss of sight as one of the worst.
Unfortunately, the risk of amputation of the foot or leg is increasing fast according to vascular surgeon, Professor Shirley Jansen, Director of the Heart and Vascular Research Institute at the Harry Perkins Institute of Medical Research.
“Increasing rates of obesity, poor diets and unhealthy lifestyles are causing rising rates of diabetes and therefore of Diabetic Foot Disease which can result in amputation.
“At the Harry Perkins Institute we’ve been adapting established technology that measures oxygen saturation levels in the brain and applying it to the foot to give us detailed information, for the first time, about blood flow.”
“It can tell us when blood flow is low so we can intervene earlier with balloons to stretch narrowed arteries or stents to keep the arteries open before a patient gets a wound or when the wound is new, which ultimately is going to save limbs.”
50-year-old diabetes patient Greg Nicholls, who is a Clinical Engineer at Royal Perth Hospital, has already had a toe amputated and is at risk of losing a limb.
“I banged my toe at home and because of compromised circulation in my legs, I lost my toe.”
Having his toe amputated was the beginning of an avalanche of problems for Greg. It led to a fall and bruising on the other leg which resulted in an infection which is now delaying his chances of a kidney transplant.
“I am waiting on a double transplant, kidney and pancreas, and I was ready to go when COVID struck and all the airlines got shut down and now with this infection everything is put on the back burner.”
Professor Jansen said the new technology and a new Diabetic Foot Unit at Sir Charles Gairdner Hospital which brings together all disciplines to optimise patient care will reduce rates of amputation.
“There are three reasons patients with Diabetic Foot Disease run the risk of amputation.
“The first is narrowing and blockages of the arteries in the lower leg, the second is damage to nerves in the foot, which means they can’t feel when they step on something harmful and the third is deformity of their feet when the muscles don’t work properly and the joints get destroyed.
“The skin of the feet becomes dry which results in cracks developing and bacteria getting in.
“Due to the effects of diabetes on the immune system, these patients don’t fight infection well. They can rapidly develop a life-threatening infection from organ failure and need amputation of the foot or leg to limit infection spread,” she said.
“Working with colleague Professor Danny Green, who is an expert physiologist at The University of Western Australia, and a clinical team at Sir Charles Gairdner Hospital we’ve adapted existing technology typically used to gain information about blood flow in the brain and applied it to the foot, and for the first time are measuring blood flow to the foot in the clinic and at the bedside with a simple device that anyone can use, from diabetes nurses to surgeons to podiatrists.
“We’re currently trying to get funding so we can integrate the technology into patient care for all people treating Diabetic Foot Disease,” she said.
Greg says, “It’s all about timely management and intervention with these things because they do go backwards very, very quickly.”
image: diabetes patient, Greg Nicholls
