Diabetes, lower extermity amputations and podiatry

ABSTRACT

We are all worried and simultaneously frustrated by the increasing prevalence of diabetes mellitus (DM) throughout the world and the anticipated increase in diabetes-associated complications, including lower-extremity amputations (LEAs). At the same time, we realize that primary prevention programmes for both Types 1 and 2 diabetes, and/or a "cure" are both still a few years into the future; and secondary (controlling blood glucose, blood pressure, and blood lipids) and tertiary (detecting complications early and treated appropriately) prevention programmes have been scientifically and economically validated. However, even with this knowledge, we are frustrated by two things the "gap" between what we all should be doing and what is actually happening in daily clinical and public health practice; and between information we need about important and practical health services research questions about LEAs, e.g. how often should we really be examining the feet of someone with diabetes and with what methodology. With this background, where do podiatric health care professional fit into efforts to address diabetes-related LEAs? While certainly the rigour and completeness of podiatric training programmes in many countries legitimize their more active role in preventive care practices for people with DM, my own experience is that the podiatry community has skills, interests, abilities relevant to LEAs, beyond care. Both within academic centres and from practice, podiatrists have added and can add to the understanding and knowledge base about diabetes-related lower extermity disorders. Further, based on experiences with the CDC-NIH supported National Diabetes Education Programme (NDEP), podiatrist have embraced and enhanced general secondary prevention and public awareness activities about diabetes. Podiatrists have demonstrated their thoughtfulness and "power" by addressing a very large United States of America governmental agency - the Health Care Financing Administration (HCFA) - to begin to seriously address prevention programmes for diabetes-related LEAs, i.e. changing policies. While there are and will always be tensions within and among various diabetes disciplines, "today's podiatry is not your father's podiatry".(Au)