As the number of people living with diabetes continues to rise, so does the risk of developing complications such as those that affect the feet and lower limbs. Diabetes-related foot complications – resulting from damage to the nerves that can lead to chronic ulcers and amputation – are one of the most common and severe complications affecting people living with diabetes across the world. Estimates reveal that people with diabetes are up to 25 times more at risk of amputation than a person without the condition.
However, the good news is that many amputations can be prevented with good management and care. In some countries where data is available, access to quality care has contributed to a reduction in lower-limb amputations caused by diabetes. However, disparities exist between high- and middle- and low-income countries. According to the IDF Diabetes Atlas 2022 report, Diabetes foot-related complications, countries in Africa and the Middle East have the highest number of people with diabetes and foot ulcers or amputations, with more than one in five people affected.
Accordingly, experts look towards a two-pronged education and data collection approach to reduce the risk and impact of diabetes-related foot complications.
Promoting awareness and capacity-building about diabetes-related foot complications is vital in preventing their onset and reducing their impact. Some countries have successfully lowered the rate of lower-limb amputations through standardised and structured diabetes foot care. Additionaly, several programmes have successfully educated healthcare providers and people with diabetes about the risks and how to detect diabetes-related foot complications early.
Investment in awareness and continued education of healthcare providers and people with diabetes is very important. Policymakers must also understand the real social and economic burden of diabetes complications, especially the often-neglected diabetic foot, and guarantee the sustainability of training actions,” Dr Matilde Monteiro-Soares, podiatrist (Portugal).
In Africa and South America, two initiatives focused on appropriate foot care, regular check-ups and empowering people with diabetes to manage their condition. In Tanzania, the training programme Step-by-Step made significant strides in improving the treatment of foot ulcers in people with diabetes, reducing their number by almost 24% over a one-year period. Similarly, the Save the Diabetic Foot project in Brazil, demonstrated how simple and affordable preventative measures can reduce lower limb amputations, resulting in a 78% decline in nine years.
Diabetes care registries are central for assessing the prevalence of foot complications in people with diabetes. They provide data for comprehensive analysis, enabling healthcare providers to identify trends, risk factors, and areas for improvement in prevention and treatment. Moreover, registries foster collaboration among healthcare providers, researchers, and policymakers to allocate resources effectively and implement evidence-based treatment.
You need to have exact numbers to understand healthcare quality. Only with the right data, systematic reviews and similar definitions will you truly understand the differences between populations, between diabetes care provided and clinical results. Investment needs to be made in national data registries and international collaborative studies,” Dr Hermelinda Pedrosa, endocrinologist (Brazil).
Globally, in the last 15 years, healthcare data volume has grown exponentially. However, roughly 75% of the data available represents high-income countries, while most people with diabetes are in middle- and low-income countries. In these settings, national data registries and international collaborative studies on diabetes care can be particularly challenging due to limited resources and infrastructure.
Efforts are ongoing to bridge this gap. The World Diabetes Foundation (WDF) supports collaborative projects in middle-and low-income countries to improve diabetes care and prevention and strengthen healthcare systems, through partnerships with local organisations and international experts.
Establishing and using national data registries are essential steps towards reducing the burden of diabetes-related foot complications on individuals and public health services. Accurate data, systematic reviews and the use of similar definitions in international databases will enable direct comparisons between and within countries and support wider understanding of these complications. The ultimate goal is to turn data into insight and use it to reduce their impact and improve health outcomes for people with diabetes.
Diabetes-related foot complications are a significant concern and need to be urgently addressed. By promoting awareness, capacity-building and the collection of accurate and comparable data, we can make a positive difference for people living with diabetes.
For more insights on the global impact of diabetes-related foot complications, tune into the latest episode of D-Talk, the podcast series of the International Diabetes Federation.
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