Blood pressure drugs could DOUBLE the risk of leg amputation in patients with type 2 diabetes

Diabetics who take medication to lower their blood pressure could be more than twice as likely to have their leg amputated.

Patients taking diuretics, also known as ‘water pills’, have an increased risk of various problems with their feet and legs, a study has revealed.

People with diabetes already suffer more serious foot and lower leg conditions because the condition causes nerve damage and reduces circulation.

But diuretic medications could push this risk ‘significantly’ higher because they reduce the amount of blood flowing round the body, experts warn.

People with type 2 diabetes who take diuretic medication, which can be used to lower blood pressure, could be up to 2.3 times more likely to need a lower limb amputation because of their condition, according to French researchers

Research by the Assistance Publique – Hôpitaux de Paris discovered the link between the drugs and lower limb problems.

Amputations of the feet and lower legs are a serious concern for people with type 2 diabetes.

And they are more likely to need blood vessels in their legs bypassed or widened with surgery because of poor circulation.

People with the condition suffer more problems because a combination of nerve damage and bad blood flow mean small wounds can either go unnoticed or take a long time to heal, increasing the risk of infection and gangrene.

HOW CAN DIABETES LEAD TO FOOT AMPUTATIONS?

People with diabetes are far more likely to need their toes or feet amputated because their injuries do not heal normally.

High blood sugar can cause nerve damage which means patients cannot feel their skin as well and may not know when they have a wound, or feel how serious it is.

And diabetes restricts circulation in the legs, which slows down healing because oxygen and nutrients are in short supply.

The combination of these two factors means it can take longer for people to get over injuries and the healing time means there is more opportunity for it to become infected or for flesh to die because of gangrene.

If an injury becomes too infected or untreatable the affected part of the body may have to be cut off.

Source: American Podiatric Medicine Association

In a study which followed 1,459 diabetics for seven years until December 2015, 13 per cent of diuretic users (85 out of 670) had a serious problem with their legs.

Meanwhile, only seven per cent of those not taking the drugs (57 out of 789) had a similar problem.

An even more specific breakdown compared 537 medicine users with 537 non-users who were otherwise similar and found those on the drugs were 2.3 times more likely to need an amputation.

Lead author Dr Louis Potier said: ‘Among patients with type 2 diabetes treated with diuretics, there was a significant and independent increase in the risk of lower limb events, coming predominantly from a rise in lower extremity amputations.

‘Diuretics should be used cautiously in patients with type 2 diabetes at risk of amputations.’

The researchers explained they found the link after a recent study revealed a different type of drug used to lower blood sugar increased the risk of amputation.

This drug, canagliflozin, reduced the amount of blood in the body in the same way as diuretics, leading to hypovolemia – a low blood volume – which scientists believe is the link to amputation risk.

That finding led them to suggest both drugs would have the same effect.

Their research confirmed this and was presented at the annual meeting of the European Association for the Study of Diabetes in Berlin.

Dr Potier added: ‘Further studies are needed to explore the role of drug-induced hypovolaemia in the association between the use of diuretics and lower limb events.’

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