Diabetes foot care - Step by Step

Over 190 million people in the world suffer from diabetes. Many people with diabetes lose the feeling in their feet and may not be aware of skin injuries developing into infected ulcers. Left untreated, the infection spreads, leading to gangrene which requires amputation. 40-70% of all lower limb amputations in the world are related to diabetes. 85% of all diabetes related foot/leg amputations begin with a foot ulcer. Walking barefoot or wearing unsuitable shoes are common causes of foot ulcers in developing countries. In India, 32 million people have diabetes. Rough estimates indicate 40,000 lower limb amputations per year, most of them 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 patients who present late.  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. Objectives The project aims to improve diabetic foot care in developing countries. The project has the following specific objectives: Create awareness of diabetic foot problems in India and Tanzania Provide sustainable training for health care professionals in management of the diabetic foot Facilitate cascading of information and knowledge from the trained health care professionals to their colleagues Reduce the risk of lower limb amputation in people with diabetes Train people with diabetes in proper foot care to prevent ulcers Approach The project builds on the premise that by 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 3-day training courses will be conducted in India and Tanzania for medical teams of doctors and nurses. 100 teams from India and 15 teams from Tanzania consisting of 1 doctor and 1 nurse will be trained. Each team represents a district or state. The teams will be taught the principles of basic foot care education 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 in view of the level of literacy, special focus will be on audio visual materials and pictures. The course will be followed by a second, advanced training programme after 1 year. At this point, performance and effectiveness of the strategy will be assessed for possible replication. Upon completion of the training, the teams are expected to disseminate the acquired knowledge to colleagues in their regions in order to create a spin-off effect. Expected impact Reduction by 50% in amputations resulting from the diabetic foot in target areas In India, this implies 3,600 legs saved In Tanzania, this implies 600 legs saved 200 Indian doctors and nurses trained in diabetic foot care 30 Tanzanian doctors and nurses trained in diabetic foot care Results at completion 115 teams of doctors and nurses have been trained in two day courses in 2004 and given a two day repeat training in 2005. 94 teams came from India, 3 from Bangladesh, 2 from Sri Lanka, 1 from Nepal and 15 from Tanzania. 100 teams were trained in four major cities in India and 14 teams were trained in Dar es Salaam, Tanzania India  In 2007, additional foot care training was given to 115 health care professionals in India 100 foot care clinics have been established all over India A total of 127,761 people with high risk feet have been screened A total of 124,399 patients have received foot care education 14,216 trivial foot lesions have been treated 2,843 limbs have been salvaged A donation from Novo Nordisk Germany made it possible to establish an exchange programme involving 14 delegates visiting and receiving training at German diabetes foot care clinics and vice versa Tanzania 14 foot care clinics established, covering 14 regions of Tanzania A further 125 medical officers and 176 nurses have been trained on the job by the foot care teams 5,540 people with high risk feet have been screened A reduction in the rate of lower limb amputations from 9% to 6.5% has been found 563 patient education sessions have been conducted See the educational videos produced by the project. Two versions are available; one aimed at patients and another aimed at health professionals.

Project data

Area Partner Project responsible Duration Project budget/WDF contribution Project number

India/Tanzania Dr. K. Bakker et al. Dr. S. Pendsey/Dr. Abbas  November 2003 - January 2008 USD 400,000 WDF03-056

This page was last updated 4-15-2008 by sfh.wdf