Enhanced population longevity, decrease in physical activity and the obesity pandemic have resulted in an increase in incidence of type 2 diabetes in all WHO health care areas. The prevalence of the condition has been further increased by an increase in life expectancy of those living with both type 1 and type 2 diabetes as a result of lifestyle and therapeutic interventions. Microvascular complications of type 1 and type 2 diabetes mellitus are related to duration of the condition and include neuropathy in 20% of cases in all cultures. Diabetic peripheral neuropathy in combination with propensity to distal peripheral vascular disease, poor healing, infection and foot deformities often result in foot ulceration and a uniquely high minor and major amputation risk. The risk for foot ulceration is modified by ethnicity (foot flexibility) and life style (footwear and culture of walking bare-foot). Once a deep diabetic foot ulcer has developed the epidermis, dermis, tendon insertions and bone architecture will never return to normal . The lack of resilience in the scar tissue formed and foot deformity after a deep ulcer will confer a high risk of re-ulceration-in fact previous foot ulceration is by far the highest risk factor for occurrence of a foot wound in persons living with diabetes.
The highest priority for prevention of diabetic foot disease is prevention of diabetes-primary prevention. Unfortunately, public health measures to reverse the obesity pandemic have not so far been successful. Diabetes prevention programmes have succeeded in reducing the 10-year diabetes incidence across several continents. Delay in the development of neuropathy through tight metabolic control would be the most effective form of secondary prevention of diabetic foot disease. Footcare and footwear advice and self management in those with at risk feet is deemed crucial to prevent ulceration but not of proven efficacy in studies of long duration. Much of the considerable economic burden of diabetic foot disease is incurred through professional time and resource cost including dressings to treat foot ulceration. Tertiary prevention encompasses prompt diagnosis of foot wounds immediate offloading debridement, treatment of infection and revascularisation when ischaemia is present. Many assessments, audits and re-organisations of multidisciplinary secondary care services worldwide have sought to optimise timely vascular, orthopaedic and antimicrobial interventions to minimise amputation. Success is strongly associated with early referral and treatment. There is therefore compelling scientific and epidemiological evidence to configure diabetic foot care services to initiate prompt treatment of any foot wound. A corollary of this is the need for close working relationships between podiatrists in hospital and the community, family practitioners and community nurses. In fact, the multidisciplinary foot care team should include all of these health care professionals. Above all the person living with diabetes must be regularly invited to engage with annual review and be confident about how to self-refer for appraisal and treatment.
This edition of Frontiers in Endocrinology has sought current practice and outcomes for the treatment of diabetic foot disease from all WHO healthcare areas, from a range of socio-economic populations and cultures. We have asked each author to include engagement strategies for patients and community carers as well as intervention strategies and outcomes.
Enhanced population longevity, decrease in physical activity and the obesity pandemic have resulted in an increase in incidence of type 2 diabetes in all WHO health care areas. The prevalence of the condition has been further increased by an increase in life expectancy of those living with both type 1 and type 2 diabetes as a result of lifestyle and therapeutic interventions. Microvascular complications of type 1 and type 2 diabetes mellitus are related to duration of the condition and include neuropathy in 20% of cases in all cultures. Diabetic peripheral neuropathy in combination with propensity to distal peripheral vascular disease, poor healing, infection and foot deformities often result in foot ulceration and a uniquely high minor and major amputation risk. The risk for foot ulceration is modified by ethnicity (foot flexibility) and life style (footwear and culture of walking bare-foot). Once a deep diabetic foot ulcer has developed the epidermis, dermis, tendon insertions and bone architecture will never return to normal . The lack of resilience in the scar tissue formed and foot deformity after a deep ulcer will confer a high risk of re-ulceration-in fact previous foot ulceration is by far the highest risk factor for occurrence of a foot wound in persons living with diabetes.
The highest priority for prevention of diabetic foot disease is prevention of diabetes-primary prevention. Unfortunately, public health measures to reverse the obesity pandemic have not so far been successful. Diabetes prevention programmes have succeeded in reducing the 10-year diabetes incidence across several continents. Delay in the development of neuropathy through tight metabolic control would be the most effective form of secondary prevention of diabetic foot disease. Footcare and footwear advice and self management in those with at risk feet is deemed crucial to prevent ulceration but not of proven efficacy in studies of long duration. Much of the considerable economic burden of diabetic foot disease is incurred through professional time and resource cost including dressings to treat foot ulceration. Tertiary prevention encompasses prompt diagnosis of foot wounds immediate offloading debridement, treatment of infection and revascularisation when ischaemia is present. Many assessments, audits and re-organisations of multidisciplinary secondary care services worldwide have sought to optimise timely vascular, orthopaedic and antimicrobial interventions to minimise amputation. Success is strongly associated with early referral and treatment. There is therefore compelling scientific and epidemiological evidence to configure diabetic foot care services to initiate prompt treatment of any foot wound. A corollary of this is the need for close working relationships between podiatrists in hospital and the community, family practitioners and community nurses. In fact, the multidisciplinary foot care team should include all of these health care professionals. Above all the person living with diabetes must be regularly invited to engage with annual review and be confident about how to self-refer for appraisal and treatment.
This edition of Frontiers in Endocrinology has sought current practice and outcomes for the treatment of diabetic foot disease from all WHO healthcare areas, from a range of socio-economic populations and cultures. We have asked each author to include engagement strategies for patients and community carers as well as intervention strategies and outcomes.
