Call for comprehensive and well-coordinated care for diabetic foot

Foot care for people with diabetes attains a high priority, given the risk they have for developing complications which, if not cared for, might lead to serious outcomes, such as amputation. In the hospital setting, caring for feet of people with diabetes needs a well-coordinated and multi-speciality response that engages different specialist doctors and other healthcare providers. This was a clear message coming out of the Amrita Endocrine, Diabetes and Diabetic Foot Conference (AEDFC 2012) held in Kochi, India.

“AEDFC 2012 is very unique because it brings together multiple disciplines involved in the management of endocrine, diabetes, and diabetic foot disorders. I think increasingly medicine is becoming dependent on team work and we need professionals to interact together-- then only the patient gets the best care. This is especially true for patients with diabetic foot because most patients of diabetic foot require expert surgical care in addition to the management of various problems like kidney disease, heart disease, blood glucose control, blood pressure control, cholesterol control, among others. I think the value of this conference lies in bringing together people from different fields with a like minded approach to improve patient care and that’ is what makes this conference very unique” said AEDFC 2012 Organizing Secretary Dr AG Unnikrishnan who is also a senior Professor in the Department of Endocrinology, Diabetes and Podiatry Surgery, at Amrita Institute of Medical Sciences (AIMS), Kochi, India.

Added Dr Unnikrishnan, to further highlight key roles played by a range of specialist healthcare providers in caring for feet of people with diabetes: “If you look at diabetes we require a physician to manage the ABC of diabetes: A stands for three months average of patients’ blood glucose level, B stands for blood pressure and C stands for Cholesterol. So we need a trained physician to manage ABC and take decisions related to patients’ cardiac status, renal status, and to manage infections. We also need surgeons to be equally involved because the surgeon is a key member in management of diabetic foot problems, in addition to removing the infected material and also for restoring the blood flow and to graft the skin which heals the foot back to its truly wonderful form. Also, to make sure that the limb is salvaged, we need the surgeon’s help. We need diabetes educators’ help to educate the patients on what is diabetes, what is insulin, what medicines to use and how to monitor blood glucose etc. We need the help of podiatry assistant to actually train the patients and their families to do the dressing at home and take care of the wound so as to prevent diabetic foot wounds. We need all the support staff like we need the nutritionist, other specialists like cardiologists, urologists, and also ophthalmologists, as many of these patients have eye problems. I think it is the coming together of many medical specialists that is going to define the next generation diabetes care.”

Patient empowerment is the next step. “I think we have very good doctors and a reasonably good medical infrastructure in the country, what we require is that the patient needs to be aware of the disease and how to take care of the disease. This is especially true for a disease like diabetes which if left untreated, can increase the risk in people with diabetes of getting kidney disease, foot disease, amputations, and eye-disease among other complications. I think in case of all chronic diseases it is the patient who needs to be empowered. Doctors can act like a coach and tell the patient that the blood glucose is under control, feet are looking good and healthy. But once the patient takes responsibility of her/his illness, then a lot of positive change can usher in,” said Dr Unnikrishnan. “Educate, educate, educate… it is rightly said that to know about diabetes is to say no to diabetes. Diabetes care needs to go to the next level in our country by means of community education” stressed Dr Unnikrishnan.

Let us hope that diabetes care and coordinations between different streams of healthcare improve as some of the positive outcomes of AEDFC 2012.

Bobby Ramakant - CNS