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Early diagnosis and better management of the illness cited
FEWER people are losing their limbs to the ravages of diabetes as doctors and patients get a better grip on managing the disease.
Last year, 203 diabetics had to have a leg amputated when gangrene ate away at wounds that did not heal. This is less than half the all-time high of 413 legs amputated in 2004.
Likewise, fewer people are losing their toes. The number of toes removed last year was 269, slightly down from the 304 removed in 2004.
Amputation is one outcome of poor control of diabetes. The high blood sugar levels damage diabetics’ nerves. As a result, they are unable to feel the pain when they injure their feet.
These wounds go unnoticed until they start to fester.
Diabetes also thickens blood vessels, reducing the flow of blood through the body; it destroys kidney function, raises the risk of heart attacks and is a major cause of blindness as well. About one in 11 adults in Singapore is believed to have diabetes, against the global average of one in 13 adults.
The number who reach end-stage renal failure and require regular dialysis or a kidney transplant to survive has been climbing steadily, from 330 new cases in 1999 to 750 in 2007.
If there is a silver lining to this statistic, it is that the time between diagnosis and kidney failure has widened considerably, from six years in 1999 to 16 years in 2007.
Doctors say this is because people are getting diagnosed sooner, and are also learning how to manage the illness through lifestyle changes and medication.
TAKING DOC’S ADVICE
“She said I was lucky to be still alive with such a high blood sugar level. I took what she said to heart.”
Mr Mohd Jufri Mohd Sharif, who started taking his diabetes seriously after a doctor at a polyclinic scolded him for having a blood sugar level of more than 14 per cent. It is now 6.7 per cent.
The Ministry of Health (MOH) said the number of patients who are able to control their sugar levels has gone up, especially since the launch of the chronic disease management programme in 2004.
 Mr Mohd Jufri Mohd Sharif, 54, used to be in this high-risk group. He had known of his condition since he was in his early 40s, but did nothing about it as he felt well.
No symptoms appear in the early stages of diabetes, which is why doctors emphasise the importance of testing for the problem.
It was only in 2006 that Mr Mohd Jufri sought help because he was getting tired too easily; his lethargy was affecting both his work and family life.
On his first visit to a polyclinic, the senior technician said he received a shelling from the doctor when his blood sugar level was found to be more than 14 per cent.
“She said I was lucky to be still alive with such a high blood sugar level. I took what she said to heart.”
He has since brought his sugar level down to a healthy 6.7 per cent with medication and now jogs 4km thrice a week. He said: “I feel really good now.”
Under the chronic disease management programme, patients can withdraw up to $300 a year from their Medisave accounts to pay for outpatient treatments.
Out of 80,684 diabetic patients on the programme now, almost half are able to keep their blood sugar at the optimal level of 7 per cent or less, and a third are at the “acceptable” level with blood sugar at under 8 per cent.
This leaves only one in five diabetics at serious risk of the complications linked to the illness.
For those whose high blood sugar levels have wreaked havoc on their bodies, all is not lost.
Doctors are now able to salvage legs through a procedure which unclogs arteries and improves blood circulation to the patient’s extremities.
In the procedure, a catheter with a balloon attached is inserted into the patient’s groin or arm and threaded to the target artery. The balloon, measuring 1mm to 7mm in diameter and up to 12cm in length, is inflated. This pushes the plaque in the artery out of the way. The balloon is then withdrawn, leaving a widened artery. The improved circulation promotes the healing of wounds and obviates the need for amputations.
Changi General Hospital’s Dr Tan Yih Kai said his team saved about 120 legs between last November and May this year. The hospital now does 40 per cent fewer major amputations.
One patient is Mrs Savita Daswani, 61, who lost all five toes on her right foot which had rotted away. She is still in hospital, but her doctors are confident she would be able to walk.
Dr Tan said: “Saving their legs means they can remain independent. It’s also less costly than an amputation followed by rehabilitation.”
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