More than three million Canadians suffer from diabetes. That’s eight per cent of our general population, or 20 per cent of the population over 70 years old and a staggering 30 per cent among aboriginal populations. With the baby boomers entering their senior years, the prevalence of Type 2 (age-related) diabetes is only getting worse. It is becoming a health-care crisis — but not for the reasons you might expect.
It may surprise you to learn that the number one cause of limb amputations in Canada is diabetes. Fifteen per cent of diabetics will develop a leg or foot ulcer during their lifetime. That’s 300,000 people. One in five of those — or 60,000 Canadians — will be forced to have a limb amputated. According to a 2015 Canadian Diabetes Association report, most of the time, the amputation will be of a leg, leaving a person permanently disabled.
The medical statistics are sobering. Sixty percent of amputees will die within five years — a rate higher than that of breast, bladder or colorectal cancer combined. More than one third of patients who undergo a single leg amputation will lose their other leg within five years. After a second leg amputation, many patients die within five months. Amputation is particularly difficult for the elderly to cope with, as they cannot adapt well to artificial legs and so become wheelchair bound, losing their independence and, too often, their dignity to the disease.
You can’t quantify the impact an amputation will have on an individual and his or her family. It is absolutely devastating. But in addition to the immense personal costs, there are some costs we can quantify: those to our health-care system. In Ontario alone, there are approximately 2,000 lower limb amputations per year, most due to diabetic ulcers. To amputate a limb costs approximately $70,000 and the overall annual cost to Ontario’s health system, for amputations, is $140 million dollars, not to mention other indirect costs including: long-term care, rehabilitation, prosthetics (artificial limbs), wheelchairs and social services. This is a heavy burden not just for individuals and their families, but for our health-care system.
While in decades past amputation was often the only solution, modern medical advances have given us other options. Advanced Wound Care includes new diagnostic tools and imaging, new therapies, antibiotics and wound care dressings. New diagnostics and imaging technology can determine the cause of the diabetic leg/foot ulcers and identify problem areas such as blocked arteries and low oxygen levels in tissues. This can allow doctors to precisely target affected areas, and potentially save a limb.
New treatments focus on ‘unblocking’ arteries through vascular surgery, such as angioplasty, atherectomy and bypass. Blocked capillaries too small to be treated with angioplasty can be treated with hyperbaric oxygen therapy. This treatment is recognized by Health Canada and all Provincial Ministries of Health as an essential medical service. Hyperbaric oxygen increases tissue oxygen levels up to 30 to 40 times baseline, flooding an ulcer with much-needed oxygen to help heal a wound. The therapy also causes a release of substances in the bloodstream that stimulate growth of new capillaries and a release of stem cells that can develop into new skin and blood vessels.
Hyperbaric oxygen therapy has been proven effective by numerous research studies and reviews. A highly regarded Swedish study found that individuals given hyperbaric oxygen treatment healed at double the rate of a control group. Most Canadian centres offering hyperbaric oxygen therapy for diabetic wounds report a 75 per cent healing rate. Many prominent medical publications — such as the Mayo Clinic Proceedings, the Canadian Association of Wound Care (Best Practices – 2010), and the Registered Nurses’ Association of Ontario Guidelines — have recognized its effectiveness. Hyperbaric medicine is now recognized by the Royal College of Physicians and Surgeons of Canada as a specialty.
Recognizing the potential benefits and savings of hyperbaric medicine, the Quebec Ministry of Health opened a state-of-the-art multi-million dollar hyperbaric centre, which can treat up to 18 patients at a time. Unfortunately, there are only nine other hospital-based hyperbaric facilities that can treat diabetic leg/foot ulcers in all of the rest of Canada. Ontario has six. But in places where facilities are lacking, amputation is often the only choice offered to patients. It simply isn’t right that someone can lose or keep a limb based on where they live.