A few months ago, Vijay Viswanathan, head and chief diabetologist at M.V. Hospital for Diabetes, Royapuram, saw a patient who was a tailor.
“He had a diabetic foot infection and had come in so late, and in such bad shape that we had no choice but to amputate his foot. His wife was very worried about how he would make his living, but it had to be done to save his life,” said Dr. Viswanathan. Now, the patient is using prosthetic leg, and hoping to be able to get back to work.
Amputations are one of the worst complications of diabetes, say doctors and thousands of patients who undergo them every year. But despite the scale of the problem — India is estimated to have over 69 million diabetics as per the International Diabetes Federation for 2015, and about 20% of those with diabetes undergo an amputation during their lifetime — there is no registry that keeps track of the number of amputations, said Dr. Viswanathan.
“An amputation registry is the need of the hour. We have registries for other illnesses that can cause disabilities, such as for kidney and heart diseases. A registry of amputations will allow us to know how many are due to diabetes, road traffic accidents or other reasons. The numbers will also help the government plan and formulate policies. If the number increases year on year, we will know that more screening and education is needed,” he said.
Dr. Viswanathan said about 60% of diabetics are at risk of amputation five years after their diagnosis. In Chennai, nearly 17% of the adult population is estimated to have diabetes.
R. Sundararaman, head, internal medicine and diabetology, SIMS Hospital, too says that knowing how many people undergo amputations is very important. “There are policies and guidelines on amputations that need to be implemented. This can happen only when we know the numbers. A mechanism needs to be created to keep track of amputations so that we know how we are doing and whether we are going in the right direction,” he said.
A. Srivatsa, consultant dibateologist at Fortis Malar Hospital, said that at present there is no uniformity on maintaining records of amputations. “A registry will be useful. Such a move should come from the government or from institutions. In India, where barefoot walking is common, a lot more education is needed on prevention of foot infections,” he said.
Counselling essential
For the patients who undergo amputations, counselling is necessary, say doctors.
“Diabetes itself can lead to depression due to insulin resistance causing changes in the brain. In addition, if an amputation becomes necessary, it can lead to a lot of grief, anxiety and body image issues apart from a potential loss of earning ability,” said Dr. Viswanathan.
In a paper published in the International Journal of Psychology and Counselling last month, authors Dr. Viswanathan, along with Mary Jennifer Amalraj and Anitha Rani A., found that patients reported a better overall quality of life when they were given intensive counselling before and every day after the amputation until discharge, compared to those who received counselling only before the amputation.
The study, which had 62 patients and was conducted between June 2015 and February 2016, found better psychological outcomes in terms of what they reported about their physical, psychological and social health using the World Health Quality of Life questionnaire.
“Patients are usually first in denial, and then angry, before finally accepting the need for amputation,” said P. Sivaraj, consultant diabetologist, Gleneagles Global Health City.
“Psychological counselling is essential for these patients. Some patients become depressed after amputation, and rehabilitation — which includes physiotherapy, a proper prosthesis and counselling — is crucial,” he said. Dr. Sivaraj also stressed the need for family support and on educating patients to prevent further complications.
