The Diabetes Podiatry Initiative Nigeria Project (DPIN) has expressed shock over the sudden rise in Diabetic related foot amputation in the country.
In a communique released to the media, Dr Afokoghene Rita Isiavwe, an endocrinologist and project coordinator of the initiative lamented that it is unfortunate that Diabetes Mellitus cases have quadrupled in just over three decades and has continued its alarming rise globally in many countries like Nigeria along with its numerous debilitating and deadly complications.
Rising from a one-day stakeholders meeting aimed at producing guidelines for the management of diabetes foot ulcer on Friday January 28, 2018 at Lily Gate Hotel, Lekki, Lagos, Isiavwe explained that Nigeria is currently recording unacceptable number of lower extremities amputation and death resulting from diabetes foot ulcer in all part the country.
Prevalence of foot ulcers and amputation in Nigeria
“With lifetime incidence of foot ulcers occurring in up to 25% of persons living with diabetes, prevalence rate in Nigeria is now between 8.3% and 19% in different parts of the country while amputation rate remains as high as 53.2% in some centres; with mortality post amputation as high as 50% in some centre.
“There is a general lack of awareness both among the populace and health care practitioners on foot care for people living with diabetes. The practice of examining the feet of diabetes patients during visits to the clinic is yet to be embraced by a large number of doctors and other caregivers in the country while patients lack basic knowledge to prevent foot ulcer,” she noted.
Interestingly, Diabetes foot is now the most common cause of non-neoplastic and non-traumatic amputation in the lower extremities thus responsible for more hospitalization in patients with diabetes and other complications put together.
Global prevalence of foot ulcer
All over the world, health researchers have posited that a limb is lost every 30 seconds while more than 1 million amputations are performed on people with diabetes yearly. Significantly, 50 per cent of amputees would die within 5 years after amputation. Those who survive are likely to lose the other limb afterwards.
To further compound issue, the cost of managing foot ulcer or performing amputation is enormous and above annual national minimum wage.
In the communique, DPIN observed that although diabetes care is obtained at the primary, secondary and tertiary levels of healthcare in the country, a large number of patients with foot problems are presented too late mostly at a stage where amputation remains the only option to save their lives.
Guideline for diabetes caregivers
“Currently, there is no guideline for the management of Diabetes foot ulcer. Similarly, there is a dearth of podiatrists to co-manage the increasing cases of diabetes foot ulcer hence the need to incorporate podiatry training in the Nigerian University Curriculum as a sub-specialty course.
“There is also an urgent need to pay far more attention to diabetes foot and shift focus to preventing ulcers, rather than treating them. Caregivers must emphasize the importance of foot care to patients when Diabetes is first diagnosed and this should be reinforced at regular intervals,” she canvased.
The meeting which was a partnership project of Rainbow Specialist Medical Centre, World Diabetes Foundation and Podiatry Institute, Georgia, USA had several endocrinologists, Diabetes care physicians from different geopolitical zones, limb revascularization and intervention cardiologists, representatives of the Federal Ministry of Health, Lagos State Ministry of health, Diabetes Association of Nigeria (DAN), Endocrine and Metabolism society of Nigeria (EMSON) in attendance.