Over 190 million people in the world have diabetes. Many people with diabetes lose the feeling in their feet. They may not be aware of skin injuries developing into infected ulcers. Left untreated, the infection spreads, leading to gangrene requiring amputation.40-70% of all lower limb amputations worldwide are related to diabetes. 85% of all diabetes-related foot/leg amputations begin with a foot ulcer.Walking barefoot or wearing unsuitable shoes commonly causes foot ulcers in developing countries.In India, 32 million people have diabetes. Rough estimates indicate 40,000 lower limb amputations yearly, most due to diabetes.In Tanzania, around 1 million people have diabetes. 33% of patients admitted for diabetic foot ulcers undergo amputation, with a 54% mortality rate in late patients.Diabetes-related amputations are, to a large extent, preventable when simple measures are applied. Evidence shows that amputation rates can be reduced by 49-85% if strategies for preventing and treating diabetic foot lesions are implemented.ObjectiveThe project aims to improve diabetic foot care in developing countries.
The project builds on the premise that using relatively simple steps systematically, diabetic foot complications may be significantly reduced.The steps include:• Regular inspection of the feet at every patient visit• Early detection of loss of sensation in the patient's feet• Continuous follow-up of high-risk patients• Patient education in preventive foot care and early warning signs training courses will be conducted in India and Tanzania for medical teams of doctors and nurses. One hundred teams from India and 15 from Tanzania consisting of 1 doctor and one nurse will be trained. Each team represents a district or state.The teams will be taught basic foot care education principles and practical management guidelines "Step by Step - improving diabetes foot care in the developing world".Educational materials for patients, doctors and nurses will be provided. As many languages and dialects exist in both countries and given the literacy level, particular focus will be on audio-visual materials and pictures.After one year, the course will be followed by a second, advanced training programme. At this point, the performance and effectiveness of the strategy will be assessed for possible replication.Upon completion of the training, the teams are expected to disseminate the knowledge to colleagues in their regions to create a spin-off effect.
• Amputation rates have significantly reduced in all the regions where foot clinics are active.• Reduction of 2,843 leg amputations in India• The rate of amputations decreased from 9% to 6.5% in Tanzania