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The complications of diabetes are costly. Not only in terms of physical disabilities, but also in terms of costs for the patient and the health system. Among all the complications of diabetes, "diabetic foot" is one of the most serious.
The Andean region of South America is experiencing an increasing rate of diabetes, some cities having a prevalence as high as 10%. With high rates of diabetes prevalence, the incidence of diabetic foot is equally increasing. According to the International Diabetes Federation, the care of the diabetic foot can reach 40% of the available health care resources in developing countries. Thus, keeping the region's high prevalence rates of diabetes in mind, the diabetic foot needs to be addressed.
The most serious consequence of diabetic foot is a lower extremity amputation, which is often preceded by cases of ulceration, infection and gangrene. These factors, which are responsible for foot lesions, can be avoided through correct training of the patients. Furthermore, early diagnosis and adequate treatment of injuries can maintain proper foot function in most patients, thus avoiding a large number of amputations.
Objective
The project seeks to decrease the prevalence of lower extremity amputations in people with diabetes as well as people, who already have neurological and vascular complications.
Approach
The project builds on a multi-partner approach, involving national diabetes associations, the Ministry of Health in each of the 5 countries, the Pan American Health Organization (PAHO), the International Diabetes Federation (IDF) and scientific societies.
The project follows the 5 basic steps for prevention of diabetic foot recommended by the International Diabetes Federation. The steps are: 1) regular inspection and examination of the foot and footwear; 2) identification of high-risk patients; 3) education of the patient, family and health care providers; 4) appropriate footwear and 5) treatment of conditions that precede the development of chronic ulcers.
An advisory team consisting of project partner representatives will be responsible for the general coordination of the project, whereas a national committee in each country will be responsible for implementation and management of the project in the particular countries.
The project consists of four components, which will be implemented in at least 10 primary care units (both public and private facilities) in each country:
- Training of health care providers in clinical evaluation and management of diabetic foot care. Each training session consists of 12 hours theoretical and practical instructions.
- Improved care delivery with at least one annual leg examination that follows a clinical protocol developed during the project.
- Educating people with diabetes in self-examination of the feet, basic hygiene and selection of adequate footwear. The education will be delivered during collective training activities as well as individual counselling. Furthermore, education material will be distributed.
- Strengthening the referral system
Expected impact
- Implementation of the project in at least 50 primary care units (10 in each country)
- At least 150-200 people trained
- 15,000 people with diabetes (3,000 in each country) reached by the project
Result to date
- A diabetes protocol and educational material have been developed and printed
- An international workshop was held in April 2006; 10 clinics have been identified, 26 “master trainers” were trained and will then train their colleagues in their home countries
- Five national workshops have been held, including the identification of 10 primary care units in each participating country
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