There are an estimated 4.5 million people living with diabetes mellitus in the UK. As a consequence of long-term diabetes, people are at risk of developing foot ulcers — in the UK alone, around 86,000 people with diabetes have a foot ulcer.
Foot ulceration is the most common cause of lower-limb amputations, with 90% of amputations preceded by a least a single foot ulcer. The current rate of amputations in England is 140 a week or 20 a day among people with diabetes. This figure continues to rise — it was 130 in 2014 and 135 in 2015. Further complications are associated with foot ulceration and amputation, which result in almost a 50% 5-year mortality rate for people undergoing an amputation. However, with effective treatment and preventative strategies, 80% of amputations are avoidable.
The impact on the NHS of foot ulceration continues to put further financial pressures on an already stretched service. The cost of foot ulceration in 2015 was £1.13 billion and represents £1 in every £140 spent by the NHS.
To increase awareness of the 140 amputation per week in England, a group of clinicians, plus Mark Allatt from Derma Sciences, Rob Yates from OmniaMed Ltd and Paul Saunders from Vancive Medical, rode 140 (sic!) miles over two days from the Wounds UK summer conference in Birmingham to the Annual Sugar Fall Charity Ball in Southampton.
The ride is in its third year and aims to increase the awareness of diabetes foot disease across the NHS and people with diabetes to ensure they get access to the best possible treatment and care to reduce foot ulceration and minimise the risk of amputation.
Ready, Set, Go
Thursday 6 July
The ride departed from the annual Wounds UK summer conference held at the National Motorcycle Museum in Birmingham at 9:30 am sharp on the Thursday (Figure 1). The finish line was to be Southampton in time for the Annual Sugar Fall Charity Ball (a fundraising event at the University Hospital Southampton NHS Foundation Trust University Hospital, which raises money to purchase specialist equipment and educational resources to help with the care of adult patients with diabetes) at 7pm on the Friday evening.
For once, the good old English weather was set fair. Sun, warm and no wind. It wasn’t quite the Grand Depart of the Tour de France, but the team of six did get a very kind and appreciative send off from the delegates at the conference.
The target for Day 1 was Newbury, over 90 miles away, leaving a steady 50 miles for aching legs the following day.
The team was led by me, map-reader extraordinaire, whose priority was to keep everyone safely off the M42 and find a route that was quiet with as few hills as possible. This was achieved by finding a small gap off the NEC/M42/A45 roundabout, which had a certain ‘Narnia’ feel about it, and we were off! My diligent preparation had even involved driving the route the previous week. I recalled this confidently to all, as I did not need a map: “Don’t worry lads, I know the route like the back of my hand”. After navigating the beautiful lanes and villages of Warwickshire, we reached our first target of a smashing pub in Shipston-on-Stour for a well-earned lunch and a chance to rehydrate and update the newly created Facebook account ‘Diabetic Foot Amputation Awareness Cycle Ride’ with progress on route. At this point, the temperature was 32oC. The Facebook account attracted quite a bit of attention, which is exactly what the whole event was about.
After lunch we entered the Cotswolds, which had hills that rolled on and on. The villages and hills came and went and the temperature rose. We reached our next target of Witney for a well-deserved late-afternoon coffee stop. The pace was good, but starting to take its toll a little on a few of the group. This was not helped by the need to cross the Ridgeway hill, which separated us from our stop over location in Newbury. As time rolled along, the group splintered and the rescue van was called to save some tired legs.
At this point, somebody mentioned that, mechanically, we had experienced no issues and nobody had fallen off. One mile from overnight stop location — “boom” — Mr Saunders suffered a blow-out. With no spare, he begged and pleaded for help; Mr Yates, who was more concerned about his saddle soreness, duly provided a spare tube and the team were back on route again.
So Day 1 finished. A truly cracking and memorable day, but as part of the group had missed 20 miles, the map-reader had to add 20 extra miles for Day 2 to make it a true 140-miles ride.
Friday July 7
Day 2 greeted us with another perfect glorious morning. With mainly flat routes to our finish line, the eagle-eyed map-reader had found those essential 20 extra miles to get to our target. The target for lunch was the picturesque Hampshire village of Wherwell, with its perfect country pub and fantastic food. A number of the cycle team did appear keen to remain at this watering hole for the remainder of the day, but common sense prevailed and onto the final leg as we had the Annual Sugar Fall Charity Ballstarting at 7 pm and we had to get out of our Lycra® and into our dinner suits.
On reflection, key to the success of the ride was due to the fact that the longer ride had been done on Day 1, leaving a relaxing short ride on Day 2. During the ride, spirits were sky high and banter-a-plenty, and the miles clicked by on the way down to Southampton.
We looked forward to getting to the Annual Sugar Fall Charity Ball, an ideal place to share our stories of the past two days and to connect with clinicians and patients to continue our awareness message.
Conclusion
The shocking statistics around diabetes, the long-term complication and outcomes of diabetic foot ulcers are very worrying. The amputation rate is growing year on year, and with 80% of amputations being avoidable, raising awareness of these issues is key, so that patients know how to access care for prevention and treatment.
There is growing interest in the annual Diabetic Foot Amputation Awareness Bike Ride and I welcome others to join us next year. To register your interest, you can email me at: Graham.Bowen@solent.nhs.uk. Over the past three years, we have covered many counties and miles, and have spoken to many people about diabetic foot disease and amputations. The goal of the team is to make this a yearly event and link it where possible to diabetes educational events; so that the team can continue to raise awareness. Hopefully this will, in some small way, help to contribute to improving outcomes for patients with diabetes.
