Delay in referral of patients with foot ulcers is the biggest enemy which leads to amputations


 Podiatrist is the key person for foot care of patients with diabetes

Delay in referral of patients with foot ulcers is
the biggest enemy which leads to amputations

From 2012-2015 IWGDF has trained 3,135 healthcare professionals, 913 GPs and over four thousand nurses in fifteen
Latin American countries - Dr. Kristien Van Acker

Every thirty second a limb is being lost due
to diabetes mellitus - Dr.Zulfiqar Abbas

KARACHI: Dr. Kristien Van Acker from Belgium was one of the invited guest speakers in one of the plenary sessions on Day-2 of the International Conference on Diabetes and Endocrinology 2016 organized by Baqai Institute of Diabetes and Endocrinology here from August 19-21st 2016.  Topic of his presentation was Global strategies to reduce amputation rates worldwide. Our aim in International Working Group on Diabetic Foot (IWGDF) he said was to create awareness besides filling gaps in diabetic foot care. We have one hundred thirty representatives in IWGDF. We prepare Guidelines for prevention and management of foot problems in diabetics. These guidelines are a map which shows where to go and infection is the journey.

Continuing Dr. Kristien Van Acker said that listening to patient, patient care, care in the hospital and diabetic foot clinics will all lead to healing of infections. Delay in referral of patients with foot ulcers is the biggest enemy which leads to amputations. Initiation of such a programme of early referrals is the vision of IWGDF. Significant regional variations call for more guidelines. Podiatrist is the key person for foot care of patients with diabetes. He then referred to the guidelines for Diabetic Foot Stratification Triage developed from 2003 which will be revised in 2017. Prof. Abdul Basit from BIDE Pakistan joined this IWGDF in 2007. He has started a programme for training the Foot Care Assistants.  IWGDF has so far trained 3,135 healthcare professionals in fifteen Latin American countries from 2012-2015. We have also trained 913 General Practitioners and over four thousand nurses. At present nineteen out of 212 countries have podiatry education. Data collection is important for diabetic foot initiative, he remarked.

Dr. Zulfiqar G. Abbas 

Dr. Zulfiqar G. Abbas from Tanzania was the next speaker in this session. In his presentation he discussed at length the diabetic foot experience in Africa. He opined that there will be almost 75% more patients with diabetes in Asia and Africa in the coming years. At present there are 41.4 Million patients with diabetes in Africa. There are sixty three countries in Africa. Neuropathology is the major cause for increased prevalence of peripheral vascular disease. Gangrene infection is most common. The patients present late in hospitals that is why there is an amputation being performed after every twenty second. After every thirty minutes, one patient is lost due to landmine but every thirty second a limb is being lost due to diabetes mellitus. PAD, he said, was increasing in Africa and development is taking place at the cost of Health.  In PAD, neuro ischemic state is not recognized in time hence there is failure to heal ulcer with the result that more than 50% of patients end up in amputation. Foot care, Dr. Zulfiqar Abbas said, should be managed aggressively. Preventive measures should be undertaken.

He then showed slides of cellulites, soft tissue involvement and bone involvement. He also talked about economic burden due to  prolonged hospitalization. In some countries a patient’s twenty five months salary is needed for the treatment of diabetic foot. Home treatment, inappropriate footwear, poor living conditions all add up to the problems for these patients. At present there are forty five centers in Africa with diabetic foot care facilities. We are running courses for doctors, surgeons and podiatrists through a step by step programme. He concluded his presentation by stating that regular inspection of foot is important, patients at high risk need to be identified. There is need to educate the patient as well as the family and healthcare workers. Patients with diabetes and particularly with foot ulcers should be advised to wear appropriate footwear and effective treatment of non-ulcerative pathology should be initiated immediately.