Reducing diabetic limb amputations in developing countries

Abstract

Among all the diabetes complications, diabetic foot complications are associated with the highest morbidity and mortality. Across the globe, 40–60% of all lower extremity non-traumatic amputations are performed in patients with diabetes. The most important intervention in reducing diabetic limb amputation in developing countries is the education of patients about proper limb care. Cost-effective education should be targeted for both healthcare workers and patients. One of these programs is the Step by Step Foot Project, which was piloted and carried out in Tanzania and India. In this review, the author explores the feasible ways of reducing diabetic limb amputation which can be achieved through a trained diabetes workforce working in an effective system of care that focuses on the education of both the healthcare provider and the patient.

Keywords:

• amputation
• developing world
• diabetes
• diabetic hand
• education
• foot care
• foot ulcer
• preventive program
• Step by Step Foot Project

Acknowledgements

The author would like to thank the staffs at Muhimbili National Hospital and Abbas Medical Centre, Dar es Salaam, Tanzania and is especially grateful to Shabneez Gangji for her excellent secretarial assistance.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

At the very least, a structured program for foot care should include the following components:

• All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. This examination should include assessment of protective sensation, foot structure and biomechanics, vascular status and skin integrity.

• Persons with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors. Persons with neuropathy should have a visual inspection of their feet at every visit to a healthcare professional.

• Evaluation of neurological status in the low-risk foot should include a quantitative somatosensory threshold test, using the Semmes-Weinstein 5.07 (10-g) monofilament.

• Persons with diabetes and high-risk foot conditions should be educated regarding their risk factors and appropriate management.

• Education should be targeted not only on patients, but also on their relatives and healthcare workers; moreover, educational endeavors are more effective when information is repetitive.

• Initial screening for peripheral arterial disease should include a history for claudication and an assessment of the pedal pulses. Consider obtaining an ankle-brachial index test as many patients with peripheral arterial disease may be asymptomatic.

Notes