World Diabetes Day 2005 – Focus on Foot Complications

IDF/ADA Symposium
Saturday, June 11, 2005
10:15 AM-12:15 PM

Chair:
Pierre Lefebvre, MD, PhD

Faculty:
Andrew JM Boulton, MD
Zulfiqarali G. Abbas, MBBS, MMed, DTM&H
Karel Bakker, MD, PhD
Peter Sheehan, MD

Reviewed by Kimberly McFarland, PhD

Dr Boulton highlighted the success of the “Save the Diabetic Foot – Brazil” campaign which has resulted in the establishment of 52 foot clinics staffed by nurses and physicians specifically trained in foot care. Establishment of clinics and education regarding regular foot inspection are important goals, particularly given the discrepancy in clinic availability in developing countries. While Brazil now has 52 clinics, China has only 5.

Dr Abbas reminded the audience that, in developing countries, there is increased risk of infection following injury to insensate diabetic feet, and such injuries contribute significantly to morbidity and mortality. Late presentation is of particular concern among African patients, as reliance on traditional cures and lack of education can delay presentation. Foot inspection, identification of at-risk patients, education, proper footwear, and early treatment of nonulcerative injuries can all improve outcomes; the first three of these actions require only physician attention.

Dr Bakker reviewed efforts of the International Working Group on the Diabetic Foot (IWGDF) to put diabetic foot care on the national agenda of many countries. Toward this end, the IWGDF generated a consensus document to provide guidelines for prevention and treatment that consider cost and are evidence-based. These guidelines and other consensus documents are available at the IGWDF website. An international IWGDF network is also at work promoting podiatry as a medical specialty and stimulating national initiatives such as pilot studies and educational team formation.

Dr Sheehan concentrated on generation of guidelines for treating PVD. PVD is commonly asymptomatic, but identification of PVD is beneficial because it also identifies patients at high risk for myocardial infarction, stroke, and limb loss. Diabetes patients with PVD also have 4x the risk of amputations and a 5 year death rate that is twice as high as diabetes patients without PVD. The ankle brachial index (ABI) is the best assessment for presence of PVD. Appropriate treatment includes aggressive atherosclerosis risk factor intervention and symptomatic treatment, where appropriate. The 2003 ADA consensus document is currently the best set of guidelines available, but a revision of Transatlantic Intersociety Consensus (TASC) guidelines is underway.