Diabetes is a global epidemic with devastating human, social and economic consequences. The disease claims as many lives per year as HIV/AIDS and places a severe burden on healthcare systems and economies everywhere, with the heaviest burden falling on low- and middle-income countries. Despite this, awareness of the global scale of the diabetes threat remains pitifully low.
In 2011 it is estimated that 366 million people worldwide have diabetes, representing roughly 8.3 % of the adult population (20-79 age group). The number is expected to reach some 552 million by 2030, representing 9.9 % of the adult population.
Diabetes is associated with various short and long-term complications, many of which, if left untreated, can be fatal. All have the potential to reduce the quality of life of people with diabetes and their families. The most common long-term complications affect the heart, eyes, kidneys and feet.
Each year, some 3.8 million adults die from diabetes-related causes. Diabetes is the fourth leading cause of death by disease globally. The burden is particularly harsh in low- and middle-income countries, where many children with type 1 diabetes die because they lack access to life-saving insulin and where many do not receive the education and care required to delay and prevent complications.
Diabetes and the foot
Diabetic foot problems are among the most serious and costly complications of diabetes. The rising prevalence of diabetes all over the world has brought with it an increase in the number of lower limb amputations performed as a result of the disease. Epidemiological reports indicate that over one million amputations are performed on people with diabetes each year. This amounts to a leg being lost to diabetes somewhere in the world every 30 seconds. But having the recent prevalence data of 2011 available means that nowadays every 20 seconds a lower leg is lost due to diabetes globally.
A majority of these amputations are preceded by ulcers. Only two-thirds of ulcers will eventually heal and the remainder may result in some form of amputation. The median time of healing for an ulcer is approximately six months. Both ulcers and amputations have an enormous impact on people’s lives, often leading to reduced independence, social isolation and psychological stress. The diabetic foot is also a significant economic problem, particularly if amputation results in prolonged hospitalization, rehabilitation, and an increased need for home care and social services.
Despite being one of the most serious and costly complications of diabetes, foot complications can be effectively prevented. By implementing a care strategy that combines prevention, the multidisciplinary treatment of foot ulcers, appropriate organization, close monitoring, and education of people with diabetes and healthcare professionals, it is possible to reduce amputation rates by up to 85%.
International Working Group on the Diabetic foot
The International Working Group on the Diabetic Foot (IWGDF) was set up in 1996 to improve outcomes of diabetic foot problems, and enhance communication and collaboration between the many professionals involved in diabetic foot care and those in a position to decide healthcare policy and provide funding. The IWGDF is a truly global network, comprising of representatives from many countries. In 2000, the International Working Group became a Consultative Section (IDF CS) of the International Diabetes Federation in order to facilitate the development of a worldwide network of foot representatives and to work together towards raising awareness of the costs and consequences of the diabetic foot. In 2003 the IDF CS/IWGDF has extended its aim. The IWGDF is now also a strong advocate of stimulating foot care programmes in the developing world. The successful Step-by-Step project, carried out in India and Tanzania, is a good example of the kind of activity that the Working Group is involved in. In 2010 the IDF Consultative Section of the Diabetic Foot was invited to become an integrated programme of the IDF. It’s new name is now IDF Diabetic Foot Programme (IDF DFP). For more details on activities of the IWGDF add IDF DFP read further the Triennium 2010-2012 programme page.
One of the objectives of the IWGDF is to develop guidelines to reduce the impact of diabetic foot disease through quality and cost-effective healthcare, based on the principles of evidence-based medicine, augmented with expert opinion. The first International Consensus/Guidelines were launched in 1999. Since then, thanks to the organisation's global network, over 80,000 copies of the guidelines have been distributed throughout the world, and the publication has been translated into 26 languages.
The IWGDF consensus project is an ongoing process. In 2007 the consensus document was completely updated, several new chapters were added, based on expert opinion. In the document the basic concepts in diabetic foot care are addressed, with clear description of the various diagnostic, preventive or therapeutic strategies. Furthermore, the organization of care and the implementation of the guidelines are described. Since 1996 also techniques of producing guidelines have evolved and the new 2007 texts on Wound healing, Footwear and Off-loading and Osteomyelitis in the Diabetic Foot have been produced according to systemic literature review following the (SIGN) procedure. Specific Guidelines have been formulated. The revised Consensus document and Guidelines 2007 were launched on an interactive DVD-ROM at the 5th International Symposium on the Diabetic Foot in May 2007 in Noordwijkerhout, the Netherlands.
The proceedings of the 5th ISDF are published as Supplement in Diabetes/Metabolism, Research and Reviews (DMRR), in May 2008 The IWGDF guidelines 2007 could be read in: Apelqvist J, Bakker K, van Houtum WH, Schaper NC. The development of global consensus guidelines on the management of the diabetic foot. Prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2008; 2 Suppl 1:S116-93
In 2009 the IWGDF invited again 3 working groups to produce three new specific guidelines on Wound management, Infection and PAD based on: A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes; a systematic review of the effectiveness of interventions in the management of infection in the diabetic foot and a systematic review of the effectiveness of revascularisation of the ulcerated foot patients with diabetes and peripheral arterial disease (PAD) After careful consideration by the IWGDF Editorial Board the 2011 review reports and specific guidelines were sent to the IWGDF representatives from over 100 countries for comments. On a special Consensus Day prior to the 6th International Symposium on the Diabetic Foot (ISDF) May 10th 2011, all representatives were invited to reach consensus on the three specific guidelines (fig 1). During that day some additional comments were incorporated in the texts and the final texts were eventually endorsed by the IWDGF representatives. These review reports, expert opinion documents and specific guidelines on wound management, infection and PAD were launched at the 14th of May 2011 at the ISDF 2011 in Noordwijkerhout, the Netherlands and will be published as a special supplement of DMRR early 2012. The principles set out in the Consensus are implemented throughout the world. They are adapted for local use, taking into account differences in socio-economic circumstances and access to healthcare
While working on the consensus documents the scope of the Working Group evolved and a broader goal was set. In order to implement the consensus local champions were recruited, resulting nowadays, in a total of over 100 persons as representatives of their country or region. Also this website was created to inform all healthcare workers in the field of the diabetic foot on current status of diabetic foot management and treatment, but in addition more specific information is provided on future meetings and also personal experiences of people in the field are displayed in the “Footnotes”. Hopefully the information provided here improves diabetic foot care throughout the world. This website will function best if there is a mutual interaction between the IDF DFP/IWGDF and those who read it. Therefore feel free to contact us and provide us with additional information and remarks concerning this website.
Karel Bakker, Chair IDF Diabetic Foot Programme and International Working Group on the Diabetic Foot
International Working Group on the Diabetic foot
The proceedings of the 5th ISDF are published as Supplement in Diabetes/Metabolism, Research and Reviews (DMRR), in May 2008 The IWGDF guidelines 2007 could be read in: