It is estimated that approximately 250 million people have diabetes - 5.9% of the world's
population. Around 80% of these people live in developing countries. By 2025, the global
estimate is expected to rise to some 380 million - 7.1% of the adult population. Worryingly,
type 2 diabetes is increasing among young people around the world.
Every year, more than 1 million people with diabetes lose a leg as a consequence of their
condition. This means that every 30 seconds a lower limb is lost to diabetes somewhere in
the world. The majority of these amputations are preceded by a foot ulcer. The most
important factors relating to the development of these ulcers are peripheral neuropathy,
foot deformities, minor foot trauma and peripheral vascular disease.
The spectrum of foot lesions varies in from region to region due to differences in socioeconomic
conditions, standards of foot care, and quality of footwear. In developed
countries, one in six people with diabetes will have an ulcer during their lifetime; In
developing countries, diabetes-related foot problems are thought to be even more common.
These complications do not only represent a major personal tragedy for each sufferer; they
also place a considerable financial burden on healthcare and society in general.
It is now recognized that type 2 diabetes in children is becoming a global public health
issue. It is inevitable that these young people will go on to develop diabetes-related microand
macrovascular complications - including disabling and life-threatening foot problems -
at a relatively early age.
In 1999, the International Working Group on the Diabetic Foot (IWGDF), a Consultative
Section of the International Diabetes Federation since 2000, published the International
Consensus on the Diabetic Foot and Practical Guidelines on the Management and the
Prevention of the Diabetic Foot. To date, these publications have been translated into 26
languages, and more than 80.000 copies distributed globally. In order to implement the
International Consensus, IWGDF recruited local champions - 88 people representing
countries around the world.
In 2005, IWGDF decided that the International Consensus texts should be updated and
expanded. Experts in the field were asked to revise the 15 chapters, and improve the
definitions and criteria according to current knowledge and standards. The consensus
process was followed: new texts were reviewed by the IWGDF Editorial Board, IWGDF
representatives provided critical evaluation, and agreement was reached.
IWGDF is very much in step with developments in the guidelines field. Nowadays,
recommendations must be written based on sound scientific evidence. So for the first time,
three IWGDF working groups used this technique to produce their consensus reports -
Footwear and off-loading, Wound management and Osteomyelitis.
Consensus day 2007
It was decided that the fully updated International Consensus and Practical Guidelines 2007
should be published as an interactive DVD-ROM, creating the opportunity to add educational
programmes and teaching materials in an Addendum section. A wide range of photographs,
illustrations and graphics are accessible in the picture gallery.
The DVD was launched in May 2007 at the 5th International Symposium on the Diabetic
Foot in Noordwijkerhout, the Netherlands. IWGDF would like to express its deep gratitude to
the many authors and members of the working groups who have collaborated tirelessly,
lending their expertise and dedication to the realization of this huge project. Sincere thanks
also go to the sponsors, who, by providing generous and unrestricted educational grants,
made it possible for IWGDF to develop the International Consensus and Practical Guidelines
2007.
More than ever before, it is imperative that appropriate action be taken to ensure access to
quality care for all people with diabetes, regardless of their age, geographic location or
social status. IWGDF hopes that global awareness of diabetes and foot complications will
continue to increase. The need for improved foot care for people with diabetes throughout
the world must be recognized. If the recommendations contained in this DVD are followed,
they will result in improved management of the diabetic foot and a subsequent worldwide
reduction in limb loss.
Karel Bakker
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