Skip to main content
  • Search
  • AIA Singapore
  • Our Products
    • Life Insurance
    • Medical Insurance
    • Critical Illness Insurance
    • Disability Income Protection
    • Accident Protection
    • Savings
    • Investments
    • Platinum
    • Travel & Lifestyle
    • AIA Vitality
    • Employee Benefits
  • Life Matters
    • Planning For The Future
    • Living Healthily
    • Experiencing Life
    • Your Financial Needs Matter
  • About AIA
    • Our Leadership Team
    • Our Commitments
    • Careers
    • Media Centre
    • Awards
    • AIA Showreel
    • Our Top Awardees
    • MDRT Members
    • AIA Financial Advisers
    • AIA Brunei
  • AIA Vitality
    • About AIA Vitality
    • How It Works
    • Rewards & Partner Benefits
    • Join AIA Vitality
  • Help & Support
    • Contact Us
    • ONLINE PAYMENT WITH AIA PAY EZ
    • AIA HealthShield Support
    • AIA COVID-19 Support Programme
    • FAQs
    • Form Library
    • Submit a Claim
    • Notices To AIA Policyholders
    • AIA Funds Information
    • AIA Annual Fund Reports
    • AIA's Participating Fund Commentaries
    • Consumer Guides
  • My AIA
    • My AIA SG
    • My Rewards
    • AIA Altitude
    • Make Payment Online
    • Submit a Claim
    • Request HealthShield Pre-Authorisation
    • FSC Access
    • Bank Partner Access
    • FA Broker Partner Access
    • eBenefits
  • AIA Vitality
    Visit the AIA Vitality website
  • YOUR FINANCIAL NEEDS MATTER
    Explore our financial calculators and resources for your long term and short term goals at different life stages.
  • Recent Promotions
    Find out more about our latest campaigns and promotions
AIA
AIA Logo AIA Logo
  • Our Products

    Our Products

    Find our products and services according to your protection needs.

    See more
    YOUR FINANCIAL NEEDS MATTER

    Explore our financial calculators and resources for your long term and short term goals at different life stages.

    EXPLORE NOW

    Recent Promotions

    Find out more about our latest campaigns and promotions

    See more

    For Individuals

    For Business

    • Life Insurance

      Protect your loved ones’ future from life’s uncertainties

    • Medical Insurance

      Adequate coverage for medical bills so you can focus on getting better

    • Critical Illness Insurance

      Protect against the financial burdens of critical illness

    • Disability Income Protection

      Protect your ability to earn an income.

    • Accident Protection

      Be financially prepared for the unexpected

    • Savings

      Start planning early and fulfil your saving goals.

    • Investments

      Make your money work harder for you – your dreams matter

    • Platinum

      Plan your enduring legacy, and share it with the generations to come.

    • Travel & Lifestyle

      Cover your personal belongings from loss or damage

    • AIA Vitality

      AIA Vitality is one of the most comprehensive wellness programmes with a wide spectrum of tools and benefits that target different aspects of your health.

    • Employee Benefits

      Secure your company’s most important asset through our market-leading solutions

  • Life Matters

    Life Matters

    We take care of the matters of your life because your life matters

    VIEW ALL IN LIFE MATTERS
    • Planning For The Future

      Prepare for your lives ahead

    • Living Healthily

      Kick-start your journey to better health

    • Experiencing Life

      Live life to the fullest

    • Your Financial Needs Matter

      Explore our financial calculators and resources for your long term and short term goals at different life stages.

  • About AIA

    About AIA

    For almost a century, AIA has served the ever-changing needs of millions of people all across the Asia-Pacific region.

    Healthier, Longer, Better Lives

    • Our Leadership Team

      The Executive Committee and Board & Board Committees of AIA Singapore

    • Our Commitments

      Our healthy living initiatives, partnership with Tottenham Hotspur Football Club and more

    • Careers

      Explore opportunities to work at AIA

    • Media Centre

      News and information about AIA

    • Awards

      Check out our awards and achievements over the years.

    • AIA Showreel

      View videos that showcase AIA Singapore as a company

    • Our Top Awardees

      Presenting our top performers of FY2020

    • MDRT Members

      Presenting our top performers of FY2020

    • AIA Financial Advisers

      Who we are, what we do. Let's forge a partnership that lasts beyond a lifetime.

    • AIA Brunei

      Find out more about our branch office

  • AIA Vitality

    AIA Vitality

    AIA Vitality supports and motivates you every step of the way towards achieving your health goals. What’s more, get rewarded for healthy choices and earn points when you Get Active, Eat Well and complete Health Checks!

    Find Out More
    • About AIA Vitality

      AIA Vitality is a comprehensive programme that motivates you to keep fit and helps you to manage your health.

    • How It Works

      ​Discover how you can live a healthy lifestyle by staying active, eating well and maintaining good health with AIA Vitality.

    • Rewards & Partner Benefits

      Discover the rewards and benefits you have unlocked with your AIA Vitality points.

    • Join AIA Vitality

      Join us today, and get motivated to live a healthier, longer and better life!​

  • Help & Support

    Help & Support

    We strive to assist you for all your inquiries with high touch customer service.

    Contact AIA

    For Customer Support

    For Resource/Useful Links

    • Contact Us

      Cannot find the answer in our FAQ section? Contact us now

    • ONLINE PAYMENT WITH AIA PAY EZ

      Manage all your AIA payments from one convenient location

    • AIA HealthShield Support

      Quality Healthcare Specialist Partners exclusively for AIA HealthShield Gold Max customers

    • AIA COVID-19 Support Programme

      Support Programme to extend the grace period for payment of premiums due up to 180 calendar days for customers who are financially affected by COVID-19

    • FAQs

      Have a question? You may find the answer here

    • Form Library

      A selection of forms you can download, fill in and send back to us

    • Submit a Claim

      Need to make a claim? Learn more about the claim process.

    • Notices To AIA Policyholders

      Useful information for policyholders

    • AIA Funds Information

    • AIA Annual Fund Reports

    • AIA's Participating Fund Commentaries

    • Consumer Guides

  • My AIA

    My AIA SG

    Exclusive for AIA policyholders and Vitality members to conveniently access policy information, Vitality membership and rewards

    Register For My AIA SG

    If you are an AIA customer, and do not have a login, you can register for My AIA SG account here.

      Customer
    • My AIA SG

      My Rewards

      AIA Altitude

      Submit a New Request
    • Make Payment Online

      Submit a Claim

      Request HealthShield
      Pre-Authorisation

      Distribution
    • FSC Access

      Bank Partner Access

      FA/Broker Partner Access

      Employee Benefits
    • eBenefits

    My AIA SG

    Exclusive for AIA policyholders and Vitality members to conveniently access policy information, Vitality membership and rewards

    Register For My AIA SG

    If you are an AIA customer, and do not have a login, you can register for My AIA SG account here.

      Customer
    • My AIA SG

      My Rewards

      AIA Altitude

      Submit a New Request
    • Make Payment Online

      Submit a Claim

      Request HealthShield
      Pre-Authorisation

      Distribution
    • FSC Access

      Bank Partner Access

      FA/Broker Partner Access

      Employee Benefits
    • eBenefits

    Home

    My AIA Perks

    Logout

  • Search
  • Contact Us
    • Book an Appointment

    • Email Us

    • Call Us

      Open: 8:45am to 5:30pm, Mon - Fri

Living Healthily
Prev | Next
  • {{title}}

    {{label}}
  • Diabetic Foot Complications- A Diabetic’s Worst Nightmare


    diabetic-foot-complications

    Diabetes is a growing epidemic in our nation and globally. The prevalence of diabetes among Singapore residents (Singapore citizens and Permanent Residents) has increased over the decade. In Singapore, it is estimated that 1 in 9 adults has diabetes1. Today, there are over 450,000 Singaporeans living with diabetes. This number is projected to go up to 1 million by 2050, if nothing is done2. The Ministry of Health (MOH) launched the War on Diabetes in 2016, in response to the significant health and societal burden posed by diabetes. The cost burden of diabetes, including loss to productivity, is anticipated to double from S$940 million in 2014 to S$1.8 billion in 20503.

    People with diabetes are at high risk of developing a range of serious complications, including heart disease, kidney failure, blindness, and lower-extremity complications. The most disabling of these is the lower limb complications. It is the leading cause of diabetes-related reason for hospitalization and lower limb amputation. In addition to high healthcare costs, it is also associated with significant reduction in quality of life4-5.

    diabetes-infographic

    Diabetes Complications

    Approximately 25% of diabetics will develop a foot wound or ulcer in their lifetime. Amputation in people with diabetes is 10 to 20 times more common than in people without diabetes6. Every year, more than one million of leg amputations are performed globally because of diabetes, which is equivalent to one leg amputation every 30 seconds7.

    In a person with diabetes, higher than normal sugar levels in the body will over time damage nerves (neuropathy)8 and cause blood vessels of the leg and foot to narrow and harden (atherosclerosis) leading to reduced blood flow down to the feet (Peripheral Arterial Disease (PAD))9.
     

    a) Diabetic neuropathy8- This can result in:

    1. Poor sensation in the feet- Minor injuries to the foot can be left undetected because of poor sensation and may consequently lead to foot ulceration and infection.
    2. Foot deformities- Structural changes in the foot such as hammer toes, claw toes, collapse of the midfoot (Charcot foot) and limited joint mobility can result in focal areas of high pressure on the sole. Skin can break down over pressure points leading to ulceration.
    3. Decreased sweating- Nerves supplying the sweat glands stop functioning, leading to dry, flaky and cracked skin. Cracked skin in the foot may allow bacteria to enter and cause infection.

     

    b) Peripheral Arterial Disease (PAD)9 – People with diabetes are at increased risk of atherosclerosis which narrows and harden the blood vessels of the leg and within the foot. Poor blood supply to the foot will lead to poor healing and gangrene as well as reduced ability to fight infection.

    diabetes-peripheral-aterial-disease

    CAUTION: GRAPHIC CONTENT

    Atherosclerosis with narrowing of artery

    Here are some statistics of diabetic peripheral arterial disease 10:

    • 70% of diabetic wounds have associated PAD
    • Nearly 85% of diabetes-related amputations are preceded by an ulceration. This imply that majority of the amputations can be prevented.
    • Two-thirds of elderly patients undergoing amputation do not return to independent life
    • About 70% of amputees will die within 5 years

     

    c) Immunocompromised 11- Poor immune system reduces the ability to combat infection. Small injuries to the foot such as cuts, blisters and ingrown toenails can become infected easily if left untreated. The combination of neuropathy, PAD and poor immunity is responsible for the increased risk of developing foot complications such ulcers, gangrene and infection which may eventually lead to leg amputation if treatment is not sought early. 

    diabetes-foot-skin-cracks

    Skin Cracks

    diabetes-foot-callus

    Callus

    Diabetic Foot Deformity Photos

    diabetes-hammer-toes

    Hammer Toes

    diabetes-claw-toes

    Claw Toes

    diabetes-flat-foot

    Flat Foot

    diabetes-pathologies-foot

    Amputation

    diabetes-amputation

    Diabetic Foot Wounds/Ulcers

    diabetes-foot-wounds-ulcers

    Gangrene

    diabetes-foot-wounds-ulcers

    Infected Wounds

    diabetes-foot-wounds-ulcers

    Neuropathic/Pressure Ulcers

    Management of Diabetic Foot Complications

    It is important to recognize that most diabetic foot complications are manageable and amputation can be prevented if treatment is sought early. Delayed in treatment of diabetic foot complications is common. The main reasons are underestimation of the severity of foot problems and lack of recognition of poor circulation12. Management of diabetic foot problems is often complex and experts from other specialties may need to be involved, including vascular/ endovascular surgery, diabetology and podiatry.

    Successful management of diabetic foot ulcers/wounds hinges on addressing the following treatment modalities:

    1) Ensure adequate blood supply to the foot- Every foot ulcer/wound should be examined for the presence of ischaemia. If poor circulation of the foot is suspected, investigations such as ultrasound scan or CT angiogram are required to assess the nature of the blockage in the leg arteries. The procedures to improve blood supply to the leg include surgical bypass or endovascular techniques (balloon angioplasty with or without stent)13. The treatment of choice depends on the specific type of blockage and which artery is involved and the general health condition of each patient.

    diabetes-balloon-angioplasty

    Balloon Angioplasty 

    diabetes-stenting-of-artery

    Stenting of Artery

    2) Control of infection- Signs of wound infection may include:

     a) Peri-wound redness/ swelling
     b) Foul smelling wound
     c) Pus
     d) Pain

    Systemic signs of infection may include fatigue, fever, tachycardia (increased in heart rate), and general malaise. When infection is present clinically, cultures should be obtained. Antibiotics that are shown to be effective against the offending bacteria through sensitivity testing should be given either orally or intravenously, depending on the severity of the infection.

    For severe wound infection with significant tissue destruction involving muscle, tendon and bone; urgent surgical intervention will be needed to control the spread of infection.

    3) Wound care

    a) Debride all non-viable tissue (e.g. callus, foreign bodies and necrotic tissue) that may impede wound healing
    b) Appropriate dressing choice to ensure moist wound environment for healing.
    c) Antimicrobial dressings need to be considered to treat and prevent wound from infection

    4) Offloading- redirecting weight (or pressure) off and away from the wound with proper footwear. Some patients may require wheelchair or crutches to achieve effective offloading.

    Prevention

    1) Management of risk factors

    a. Blood sugar level- High blood sugar, the hallmark of diabetes, injures nerves and blood vessels throughout the body.
    b. High blood pressure- high blood pressure damages blood vessels, leading to atherosclerosis
    c. High cholesterol level- accumulation of cholesterol-rich fatty deposits in arteries can result in atherosclerosis.

    2) Lifestyle modification

    a. Smoking cessation- Smoking interferes with blood circulation, and so compounds the effects of nerve and blood vessel damage.
    b. Exercise- naturally improves circulation while working to lower cholesterol and improve heart function.
    c. Healthy diet- Steering clear of excessive amounts of salt and saturated fats can help you manage your body weight, blood pressure and cholesterol.
    d. Weight loss- losing weight improves the body’s ability to control blood sugar and it also takes some pressure off the feet.

    3) Foot Care

    a. Check your feet and toes every day for cuts, sores, corns or blisters
    b. Never go barefoot. Choose shoes that are comfortable and fit well. Ill-fitting shoes can cause corns and calluses, ulcers and nail problems.
    c. Wash feet daily. Apply moisturising skin lotion to feet to prevent dryness and cracks.
    d. Cut or file your toenails regularly.
    e. Yearly foot screening by podiatrist, doctor or trained nurse- Early identification of those at risk of diabetic foot ulcers will prevent development of foot complications and thus reduce the number of amputations. Education on proper foot care and good glycaemic (blood sugar level) control

    diabetes-healthy-feet

    Finally, if there are symptoms of unusual pain, redness in the foot, swelling, injury to the foot, infection or ulcer; make sure this is checked by your doctor or diabetic nurse as soon as possible. There is a clear need to recognise decreased perfusion or vascular impairment as an indicator for the need for revascularisation in the diabetic foot in order to achieve and maintain healing and to avoid or delay a future amputation. Early identification of the problem and treatment before the problem becomes severe is CRITICAL in preventing limb loss.

    This article was contributed by Dr Tan Yih Kai, AIA Quality Healthcare Partner, and Consultant Vascular and Endovascular Surgeon of Farrer Vascular Vein and Wound Centre. Clinic. To request an appointment with Dr Tan, please click here.

    References

    1. Information Paper on Diabetes in Singapore. Vol6 2016/ Accessed 28 Oct. 2020
    2. Ministerial Conference on Diabetes to Tackle Global Diabetes Epidemic. 25th Nov 2018.Accessed 28 Oct 2020
    3. Singapore’s War on Diabetes. 30 Aug 2018. Accessed 28 Oct 2020.
    4. Singh N, Armestrong DG, Lipsky BA. (2005) Foot ulcer in patients with diabetes. JAMA. 293(2):217–228.
    5. Frykberg RG, Zqonis T, Armstrong DG, et al. (2006) American College of Foot and Ankle Surgeons. Diabetic foot disorders: a clinical practice guideline (2006 revision). J Foot Ankle Surg. 45(5 Suppl): S1–S66.
    6. International Diabetes Federation. IDF Diabetes Atlas, 8th ed. Brussels, Belgium: International Diabetes Federation, 2017.
    7. Bakker K, Foster AVM, van Houtoum WH, Riley P (Eds). International Diabetes Federation and International Working Group of the Diabetic Foot. Time to act. The Netherlands. 2005
    8. Pop-Busui R, Boulton AJM, etal. (2017) Diabetic Neuropathy: A Position Statement by the American Diabetes Association Diabetes Care. 40:136–154  
    9. American Diabetes Association. (2003) Peripheral Arterial Disease in People with Diabetes. Diabetes Care. 26(12): 3333-3341
    10. Mavrogenis A F, Megaloikonomos P D, Antoniadou T, etal. (2018) Current concepts for the evaluation and management of diabetic foot ulcers. EFORT Open Rev. 3(9): 513–525.
    11. Berbudi A, Rahmadika N, Tjahjadi A I, and Ruslami R. (2020) Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 16(5): 442–449.
    12. Manu C, Lacopi E, Bouillet B, etal. (2008) Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units. Journal of Wound care. 27(3): 186-192
    13. Heikkinen M, Salmenperä M, Lepäntalo A, Lepäntalo M. (2007) Diabetes Care for Patients with Peripheral Arterial Disease. European Journal of Vascular and Endovascular Surgery. 33(5): 583-591.

    Related Articles

    • LIVING WITH DIABETES: WHAT YOU DON’T KNOW AND HOW TO MANAGE THEM
    • PRE-DIABETES: WHY IT MATTERS AND WHAT YOU CAN DO ABOUT IT
    • 5 DIABETES-FRIENDLY FOODS TO HELP CONTROL YOUR BLOOD SUGAR LEVELS

    Recommended Products

    AIA DIABETES CARE

    AIA DIABETES CARE

    AIA Diabetes Care insurance plan covers pre-diabetics and Type 2 diabetes related conditions, ensuring you with financial support from the unexpected.

    AIA MULTISTAGE CANCER COVER

    AIA MULTISTAGE CANCER COVER

    With affordable premiums that will not go up with time, be protected for 20 years with 100% payout of up to S$250,000 for early, intermediate or major stage cancer.

    AIA HEALTHSHIELD GOLD MAX

    AIA HEALTHSHIELD GOLD MAX

    Get affordable lifetime protection that matches your individual needs with AIA HealthShield Gold Max, a Medisave-approved medical plan that allows lifetime claims. Find out more.

    Get in touch

    What’s your name?*

    What's your mobile number?*

    What's your email address?*

    Are you an existing AIA Singapore customer?*

    Area of concern:

    Thank You

    Partial NRIC / Passport / FIN No.

    (last 4 characters)

    Date of Birth

    CONTACT AIA

    1800 248 8000

    1 Finlayson Green
    Singapore 049246
    View Details
    Marketing Consent

    BOOK AN APPOINTMENT

    GO TO

    AIA.COM

    Visit our corporate site to learn more about AIA.
    Go To
    CONTACT AIA

    1800 248 8000
     

    1 Finlayson Green
    Singapore 049246

    View Details

    BOOK AN APPOINTMENT

    GO TO

    AIA.COM

    Visit our corporate site to learn more about AIA.
    OUR INSURANCE PRODUCTS
    Life Protection
    Medical Protection
    Critical Illness Protection
    Disability Income Protection
    Accident Protection
    Savings
    Investments
    Platinum
    Travel and Lifestyle
    EXPLORE AIA
    Your Learning Buddy
    AIA Altitude
    Not Just Another Job
    AIA Vitality
    Sitemap
    USEFUL LINKS
    Recent Promotions
    AIA Funds Information
    FAQs
    Form Library

    This website uses cookies for the purpose of enhancing your user experience. You can find more information on the types of cookies we collect, what we use these for, and how to manage your cookie settings in our Cookie Policy and AIA Personal Data Policy (Singapore).

    ABOUT AIA
    Explore AIA
    Your Learning Buddy
    AIA Altitude
    Not Just Another Job
    AIA Vitality
    Sitemap
    OUR INSURANCE PRODUCTS
    Life Protection
    Medical Protection
    Critical Illness Protection
    Disability Income Protection
    Accident Protection
    Savings
    Investments
    Platinum
    Travel and Lifestyle

    This website uses cookies for the purpose of enhancing your user experience. You can find more information on the types of cookies we collect, what we use these for, and how to manage your cookie settings in our Cookie Policy and AIA Personal Data Policy (Singapore).

    USEFUL LINKS
    Recent Promotions
    AIA Funds Information
    FAQs
    Form Library

    Copyright © 2021 AIA Group Limited and its subsidiaries. All rights reserved.
    Terms of Use | AIA Personal Data Policy (Singapore) | Cookie Policy