1. DIABETIC FOOT CARE: INVESTING IN PREVENTION IS COST-EFFECTIVE Dr Karel Bakker Chair IDF Consultative Section IWGDF

2. Foot facts worldwide Over 1,000,000 amputations per year Every 30 seconds a leg is lost to diabetes

3. Foot facts People with diabetes are 25 times more likely to lose a leg than people without the condition Throughout the world, up to 70% of all leg amputations happen to people with diabetes

4. Foot facts In developed countries one in every six people with diabetes will have an ulcer during their lifetime In developing countries, foot problems related to diabetes are thought to be even more common 85% of diabetes-related lower extremity amputations are preceded by a foot ulcer

5. Nerve damage Poor blood supply Injury Infection Amputation Ulcer Pathway to diabetic foot problems

9. Nerve damage Poor blood supply Injury Infection Amputation Ulcer Pathway to diabetic foot problems

11. Nerve damage Poor blood supply Injury Infection Amputation Ulcer Pathway to diabetic foot problems

13. Nerve damage Poor blood supply Injury Infection Amputation Ulcer Pathway to diabetic foot problems

14. Costs of diabetic foot problems (US $) Ulcer healing 7,000-10,000 Direct costs of amputation30,000-60,000

15. Costs of diabetic foot problems In developed countries diabetic foot care accounts for 15-25% of total healthcare resources available for diabetes. In some developing countries, it has been estimated that foot problems may account for as much as 40% of the resources available

16. Prevention Up to 85% of all diabetes-related amputations can be prevented It is possible to save up to 30% of healthcare budget Education and podiatry are the most cost effective strategies

17. Prevention In countries where National Diabetes Programmes exist, foot clinics are emerging EVA project: opening of 10 foot clinics in 5 countries of the Andes (Bolivia, Peru, Ecuador, Colombia, Venezuela) However: Podiatric education is still scarce in many countries of the SACA Region Prevention programmes are still the exception

18. What can be done? Cornerstones of Prevention 1.Regular inspection and examination of feet and footwear 2.Identification of the high-risk foot People with diabetes –Make sure you have your feet checked periodically by a healthcare professional

19. What can be done? Healthcare professionals: Risk of neuropathy can be detected by using a 10g monofilament Palpation of foot pulses is the simplest means of identifying peripheral arterial disease

20. What can be done? Cornerstones of Prevention 3.Education of people with diabetes, family members and healthcare workers 4.Appropriate footwear 5.Rapid treatment of all foot problems

21. Sponsors WDD Campaign 2005

22. Conclusions The human and financial consequences of the diabetic foot are devastating Action is possible and affordable Amputations are preventable Even in low-resource settings, foot care can substantially reduce ulceration and amputation Feet should last a lifetime

23. Conclusions Every 30 seconds a limb is lost to diabetes somewhere in the world...... This needs to be changed!