The disease that is quietly costing the nation its limbs, livelihoods and billions of rupees
There are some public health crises that announce themselves with dramatic headlines. Dengue outbreaks fill hospital wards. Infectious diseases trigger emergency meetings. Pandemics bring entire countries to a standstill.
Diabetes does none of those things.
It arrives quietly. A little extra thirst. A wound that takes longer to heal. Tingling in the feet dismissed as age. A pair of shoes that suddenly feels uncomfortable. Then, months or years later, comes the diagnosis that changes everything. By then, for many Sri Lankans, diabetes has already begun doing what it does best: causing damage silently.
The World Health Organization estimates that diabetes has become one of Sri Lanka’s most significant public health challenges. Among adults aged 30 years and above, approximately 31% are estimated to be living with diabetes, and millions remain untreated or are unaware they have the disease. Premature deaths linked to diabetes have doubled over the past two decades.
Yet diabetes itself is rarely what destroys lives. Its complications do.
Kidney failure. Blindness. Heart disease. Stroke. Nerve damage
And perhaps most devastating of all – amputations.
Every diabetic foot specialist knows the familiar story. A tiny blister develops after wearing new shoes. A nail is cut too deeply. A person steps on a sharp object but feels nothing because the nerves have already been damaged. The wound becomes infected. Blood circulation is poor. Healing slows dramatically. Weeks later, what began as something barely visible has become a limb-threatening emergency.
It is one of medicine’s greatest ironies that the smallest wound can become the largest tragedy.
Studies conducted in Sri Lanka reveal that diabetic foot complications are alarmingly common. Among patients already suffering diabetic nerve damage, nearly two-thirds have developed foot complications, while the overwhelming majority have lost normal protective sensation in their feet. Even more concerning, the use of specialised diabetic footwear remains exceptionally low despite its proven ability to prevent ulcers and amputations.
Behind every amputation lies a story that seldom appears in official statistics.
It is the father who can no longer climb onto a fishing boat.
The three-wheeler driver forced to abandon his livelihood. The garment worker unable to stand for an entire shift.
The grandmother who suddenly depends upon her children for the simplest daily activities.
A limb lost to diabetes is not merely a medical event. It is often the beginning of financial hardship for an entire household.
Treatment itself is expensive even when consultations are available through Sri Lanka’s public health system. Families frequently bear the cost of repeated travel to specialist clinics, dressings, antibiotics, specialised footwear, glucose monitoring, lost income and months away from work. Where prolonged hospitalisation becomes necessary, the economic consequences can be devastating.
Ironically, much of that suffering is preventable.
In countries that have invested heavily in multidisciplinary diabetic foot care, amputation rates have fallen dramatically. The formula is not complicated. Early diagnosis. Regular foot examinations. Better patient education. Prompt treatment of minor wounds. Access to podiatrists. Proper footwear. Close cooperation between physicians, surgeons, vascular specialists and nurses.
Sri Lanka possesses highly skilled doctors capable of performing extraordinarily complex limb salvage procedures. What remains scarce is the healthcare infrastructure that prevents patients from reaching that stage in the first place.
The word “podiatry” remains unfamiliar to many Sri Lankans.
In much of the developed world, podiatrists form an essential part of diabetes care. They monitor circulation, identify pressure points, treat minor foot problems before they become major infections and educate patients about daily foot care. In Sri Lanka, dedicated podiatry services remain limited, leaving much of this preventive work to already overstretched medical teams.
That is rather like waiting for the fire brigade while declining to employ smoke detectors.
The numbers alone should concern policymakers.
Diabetes is now among Sri Lanka’s leading causes of death and contributes substantially to cardiovascular disease, kidney disease, blindness and disability.
Beyond the human suffering lies a substantial economic burden through repeated hospital admissions, surgery, rehabilitation, dialysis, disability payments and lost productivity. Every preventable amputation represents not only a personal tragedy but also a long-term cost to the national economy.
The encouraging news is that much of the battle can still be won long before anyone enters an operating theatre. For those living with diabetes, prevention begins with remarkably simple habits: maintaining good blood sugar control, inspecting both feet every day, never walking barefoot, wearing properly fitting shoes, seeking immediate medical attention for even the smallest wound, avoiding smoking and attending regular medical reviews.
Equally important is identifying diabetes before complications develop. Many Sri Lankans discover they have the disease only after presenting with heart disease, kidney problems or serious foot infections. Earlier screening, particularly for those over 35 or with a family history of diabetes, could prevent thousands of complications each year.
Sri Lanka has rightly earned international recognition for many aspects of its public health system. Diabetes now presents an opportunity for another success story but only if prevention receives the same attention as treatment.
Because by the time an operating theatre is preparing to remove a leg, the opportunity to prevent the tragedy has usually passed months, if not years, earlier.
Be that as it may, the real measure of a country’s diabetes programme should not be how skilfully it performs amputations. It should be how rarely they become necessary in the first place.
