Objectives & approach

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.

Objective
The project aims to improve diabetic foot care in developing countries.

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 Results 
• 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