06/09/2013
World Diabetes Day: too many people are losing lower limbs unnecessarily to diabetes
11 NOVEMBER 2005 | Geneva - Amputations due to diabetes cause unnecessary loss of life and disability. On the occasion of World Diabetes Day, the World Health Organization (WHO) and the International Diabetes Federation (IDF) call attention to this problem and state that more than half of these lower limb amputations could be prevented with adequate detection and care.
It is estimated that more than 170 million people are suffering from diabetes globally and this number is expected to double by 2030. Diabetes and its numerous complications are extremely burdensome on the health and economies of countries worldwide. In high income countries, for instance, treatment of diabetic foot complications accounts for 15-25% of total healthcare resources for diabetes. This is an enormous waste not only of scarce public health resources but also of healthy lives. It is estimated that with basic diabetes management and care, up to 80% of all diabetic foot amputations can be prevented.
Diabetes mellitus is a chronic disease caused by the body’s inability to produce insulin, or by the ineffective use of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems. Diabetic foot problems are caused by changes in blood vessels and nerves that can lead to ulceration and subsequent limb amputation.
"It is unacceptable that so much disability and death are caused by leg amputations, when the solutions are clear and affordable," said Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health, "Small investments in prevention and education can mean fewer leg amputations, increased quality of life for individuals and dramatic reductions in health-care costs."
Leg and foot amputations of people with diabetes can be prevented using low cost, low technology solutions. Simple behaviours should be encouraged such as regular foot examination and examining the inside of shoes before putting them on, not walking barefoot, wearing comfortable footwear, keeping feet clean, and maintaining good care of the skin and nails.
“People with diabetes need to take an active role in their own care,” said Professor Pierre Lefèbvre, President of IDF, “but they need to be supported by their health-care system to learn how to self-manage effectively. Timely access to proper treatment and medical advice is also vital.”
The story of Zahida Bibi, a 65 year old woman living with diabetes in Pakistan is typical of the experience of many people with diabetes, especially in low income countries. Zahida did not seek care for an ulcer on her foot and she ultimately lost her leg below the knee. If Zahida had received self-care education and routine follow-up for her diabetes, her complications could have been prevented.
Beyond prevention of diabetes complications, type 2 diabetes, which accounts for the vast majority of the disease, is also largely preventable. Type 2 diabetes can be prevented by addressing risk factors such as physical inactivity and overweight/obesity. These risk factors are shared by other chronic diseases such as heart disease, stroke and cancer. As such, WHO advocates an integrated framework for the prevention, control and treatment of all chronic diseases, particularly in low resource settings. The integrated approach incorporates cost-effective measures to prevent common risk factors and to address common health-care needs.
World Diabetes Day slogan "Put feet first: prevent amputations", WHO and IDF are working together to raise awareness of this preventable complication and to promote prevention and integrated treatment and care.
