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WDF-funded project to set up 100 diabetic foot clinics in India
Shardul Nautiyal - Mumbai
To reduce diabetes-induced leg amputations and create awareness about diabetic
foot, 100 diabetic foot clinics across the country will be set up by a project
funded by the World Diabetes Foundation (WDF). The project, Step by Step, costing
4,00,000 USD will have academic support from International Diabetes Foundation
(IDF), International Working Group on the Diabetic Foot (IWDGF), Diabetic Foot
Society Of India (DFSI) and Muhimbili University College of Health Sciences
(MUCHS), Dar es Salaam, Tanzania.
Says Dr Sharad Pendsey, chairman and project in charge, Step-by-Step, “The
clinics would provide education, diagnosis and therapy to the patients. The
clinics would identify high-risk feet and minor lesions. The diagnosis of lesions
through diabetic foot clinics would therefore help in prevention of 75 per cent
of diabetic foot complications. With around 40,000 leg amputations taking place
in India annually, the clinics will help reducing limb amputations due to diabetes
by 50 per cent within a period of five years,” adds Dr Pendsey.
The project was conceived three years back by five international experts on
diabetic foot. The project committee comprises Dr Sharad Pendsey, Dr Karel Bakker
from the Netherlands, V M Foster, chief consulting podiatrist, King’s Medical
College, London and Sanjeev Shishoo, managing director, Novo Nordisk India Pvt
Ltd, United Kingdom, Dr Zulfiqarali G Abbas, Tanzania and Dr Vijay Viswanathan,
India.
The project will educate healthcare professionals involved in the running of
diabetic foot clinics. These healthcare professionals in turn will educate patients
on aspects of diabetic foot treatment. The clinics will have a dedicated team
of pedicurists, podiatrists, nurses, diabetologists, surgeons (general, orthopaedic
and vascular), neurologists, dermatologists, rehabilitation specialists and
educators.
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Goals
and objectives of Step by Step
- To create awareness of diabetic foot problems
in India and Tanzania ( and possibly other developing countries).
- To provide training of healthcare professionals
in the management of diabetic foot.
- To facilitate the dissemination of information
from healthcare professionals who have undergone training to other healthcare
professionals.
- To reduce the risk of lower limb complications
in people with diabetes.
- To empower people with diabetes to care
for their feet better, detect problems earlier and seek timely help.
Strategies
to be implemented to reduce amputations
- Regular inspection of the foot at every
patient visit.
- Early detection of neuropathy and ischaemia.
- Continuous follow up of high risk patients.
- Education in preventive foot care and
early warning signs.
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Trivial foot lesions precede 85 per cent of leg amputations. Training of doctors
and nurses will thus help prevent majority of leg amputations. In all, a total
of 115 teams of doctors and nurses from India(94), Tanzania(15), Bangladesh(3),
Sri Lanka(2) and Nepal (1), were selected for training in diabetic foot care
and offered basic course in 2004 and advanced course in 2005 in India and in
Tanzania.
Around 100 Indian physicians have already been trained to set up the clinics.
The training programme comprising Basic and Advanced Course in Diabetic Foot
treatment was conducted in the month of September, 2004 to October, 2004 in
the country. According to Ali Foster, consultant podiatrist, King’s College
Hospital, London, “With only one training centre on podiatry at Amrita
Institute of Medical Sciences (AIMS), Cochin, India need more training centres,
which will now be set up by ‘Step by Step’ programme.”
Centres would be networked with each other depending on the
zones. While Delhi would be linked with states of Punjab, Haryana, Himanchal
Pradesh, Uttar Pradesh, Rajasthan and Jammu Kashmir, Kolkata will have linkages
with centres in Bengal, Orissa, Bihar, Imphal, Darjeeling, Chennai will network
with centres in Tamil Nadu, Kerala, Karnataka and Andhra Pradesh and Mumbai
with centres in Gujarat, Karnataka and Maharashtra. “This will also help
in advanced or complicated cases of diabetic foot like bypass surgery, leg amputation
and Gangrene for referral to higher centres,” says Pendsey.
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The clinics would provide education, diagnosis and therapy
to the patients. The clinics would identify high-risk feet and minor lesions
Dr Sharad Pendsey, chairman and project in charge, Step-by-Step
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The treatment of diabetic foot is expensive with the
direct cost accounting from Rs 4,000 to Rs 7,000 annually in the form
of cost associated with the routine care
Dr Anil Kapur,
vice chairman, WDF
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Early diagnosis assumes significance as the cost, both in
terms of human health as well as economic burden associated with diabetic foot
treatment is alarming. Says Dr Anil Kapur, vice chairman, WDF, “The treatment
of diabetic
foot is expensive with the direct cost accounting from Rs 4,000 to Rs 7,000
annually in the form of cost associated with the routine care and around Rs
12,000 annually as the indirect cost in the form of loss of manpower and man
power hours.”
Diabetes is the most common cause of non-traumatic lower extremity amputation
and concerted efforts in raising awareness, education, capacity building of
healthcare professionals through this programme will go a long way in identifying
and reducing diabetic foot complications. An estimated 34 to 35 million people
suffer from diabetes in India, which is the highest in the world. Among the
chronic complications of diabetes, diabetic foot is the most devastating and
is the leading cause of leg amputation among diabetics. Experts pinpoint that
the lack of awareness, practice of barefoot walking, home surgery, faulty footwear
(Hawaii slippers) and delay in reporting further compound this problem.
WDF is an NGO dedicated to prevention of complications of diabetes in the developing
world through funding of sustainable projects in education, capacity building,
distribution and procurement of essential drugs and monitoring. It has already
funded over 30 projects in the developing world.
shardulnautiyal@rediffmail.com
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