Diabetes is the most common cause of lower limb amputations in the UK, with a someone living with the disease 20 times more likely to have an amputation than someone without the condition.

From 2015 to 2018 there were 27,465 lower limb amputations related to diabetes in England, an increase of 18.3% on the 2011-2014 period

The most significant rise was in minor lower limb amputations, defined as below the ankle, while major lower limb amputations – below the knee – showed a slower, but gradual increase.

Diabetes UK said part of the increase in amputations was due to a lack of an integrated approach by many hospitals involving podiatrists, physicians and nurses, with just 1 in 6 hospitals having such multidisciplinary specialist foot care teams.

And it highlighted the cost for the health service with at least £1 in every £140 of NHS spending going towards foot care for people with diabetes.

Dan Howarth, Head of Care at Diabetes UK, said: “Ensuring that multidisciplinary specialist foot care teams are in every single hospital across the country will not only significantly improve outcomes for people with diabetes, it will also cut down on long-term costs to the NHS.

“The differences in the standard of treatment between areas is unacceptable. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing.

A ‘minor’ amputation can still involve losing a whole foot. Especially as many diabetes amputations are avoidable through better quality care – we have to do better.

“To stop this upward trend in amputations, we are urging NHS England to stay true to their commitments and ensure people with diabetes have access to the specialist care and support they need.”

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However, Public Health England (PHE) said challenges around the virus remain, with figures showing that almost half the people newly diagnosed last year were at a late stage of infection, increasing their risk of death.

Diagnoses fell by just over a quarter (28%) from 6,271 in 2015 to 4,484 in 2018, PHE said, adding that the continued decline in the virus was down to the success of preventive measures.

These include HIV testing, condom provision, more use of the pre-exposure prophylaxis (PrEP) drug – taken before sex by HIV-negative people at high risk of contracting the virus – and drugs that keep the level of HIV in the body low and prevent the virus being passed on, known as anti-retroviral therapy (ART).

The biggest falls in new diagnoses have been among gay and bisexual men, particularly those who are white, born in the UK, aged between 15 and 24 and living in London, the figures show.

During the same period, between 2015 and 2018, diagnoses fell by 24% among people who got HIV through heterosexual contact.

Last year, 43% of people were diagnosed at a late stage of infection. Late diagnoses increase the risk of death within a year up to tenfold, compared with people diagnosed promptly, PHE said.

The public health minister, Jo Churchill, welcomed the overall drop in diagnoses, but vowed not to be complacent as the government works towards a target of having no new HIV transmissions by 2030.

She said: “I am delighted to see new figures released today which show we are well on our way to achieving our ambition of zero HIV transmissions in England by 2030, with HIV diagnoses at their lowest level since 2000.

“This decline in diagnoses is a result of our unwavering commitment to prevention which has led to more people getting tested, and has allowed people with HIV to benefit from effective treatment, stopping the virus from spreading further.

“However, I am not complacent and remain dedicated to ensuring we reach our target of zero new HIV transmissions by 2030.”

The Terrence Higgins Trust has called for wider access to the three-year PrEP trial, which recruited more than 13,000 participants by June this year and is scheduled to end next year.

Ian Green, the chief executive at the trust, said: “In light of today’s data from Public Health England, we’re urging NHS England, the Department of Health and local councils to immediately begin planning for PrEP to be given a home as part of routine sexual health services.

“Raising awareness of PrEP outside of the gay community will also go a long way in helping us to reach zero transmissions by 2030.”

The drug is almost 100% effective at preventing HIV when taken as prescribed. It involves a pill containing a combination of two anti-HIV drugs, emtricitabine and tenofovir, taken daily or around the time of sexual activity.

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