85% of amputations due to diabetic foot complications are preventable, says expert

From indianexpress.com/article 

A patient with diabetic foot infection (DFI) spends 50 per cent of his annual income on treatment, and every year 20,0000 patients with diabetes undergo higher-level amputation

Diabetes has assumed epidemic proportions, with India now known as the diabetes capital of the world. The risk of diabetes is increasing rapidly even in young people, with many diagnosed between the ages of 20 and 40. This is unlike Western countries, where diabetes typically manifests after the age of 60. The reasons for this include a genetic predisposition and lifestyle factors like modern-day stress, sedentary routines, reliance on fast food, and lack of regular exercise. One in every four new diabetes patients is below 40 years of age. In Chandigarh, the prevalence of diabetes is 20.4 per cent.

Diabetes is the most common cause of leg amputations

The disease, says Dr Ashu Rastogi, Associate Professor, Department of Endocrinology, PGIMER, can lead to ‘diabetic foot’ complications that include foot ulcers, and gangrene. More than 50 per cent of hospital admissions for diabetes are for diabetic foot ulcers (DFU), which lead to a five-time increase in the cost of diabetes treatment and more importantly cause lower limb amputation, he adds.
A patient with diabetic foot infection (DFI) spends 50 per cent of his annual income on treatment, and every year 20,0000 patients with diabetes undergo higher-level amputation.

“However, the stark reality is that 85 per cent of these amputations are completely preventable. Diabetes is the most common cause of leg amputations in the world and accidental trauma is a distant second. The knowledge about diabetic foot complications is very low even amongst doctors and para-medical, and the need of the hour to focus on this very aspect of diabetes especially the preventive element to empower the patients themselves for foot care,” adds Rastogi.

Power of prevention

The best way to educate patients is one that is in their language, and that’s why Rastogi has conceptualised and written a booklet titled, ‘Pada, Paduka and Aap,’ in Hindi in a simple language and manner for better understanding of this severe condition. The book focuses on the preventive aspect of diabetic foot that details how to take care of feet in diabetes like washing of feet, cutting nails, what should not be done like self-surgeries, and warming feet in front of heater. The type of footwear for the prevention of trauma to foot and foot ulcers is also presented with pictorial representation for a better understanding of the common man.

“The book informs people about various tests that should be performed for early detection of foot abnormalities if a patient has diabetes. And if somebody has blockage in leg arteries, it is an indicator of a high risk of heart attacks and a close evaluation of heart arteries is needed as well. Hence the foot is the mirror of the heart,” explains Rastogi.

According to the experts, one in every five diabetic patients is likely to develop foot ulcers, and in the initial stage, there is a blackening of the feet and swelling in the fingers. If this is not taken care of, there is a risk of ulcers over time. Symptoms like black spots, blisters, abnormal swelling, burning, redness, blue marks and strange smell in the feet are signs of diabetic foot and ulcers, in such a case the doctor must be consulted immediately.

Patients need to take special care of their feet, keep them clean, dry, moisturised, not walk barefoot and protect their feet from injury. The book will be distributed free to all patients of diabetes by Rastogi in the Department of Endocrinology, to educate, empower and enhance the self-care behaviour of people with diabetes to prevent leg amputation.

Rastogi is the recipient of the prestigious Dr Subhash Mukherjee Oration of the Endocrine Society of India, for his work on diabetic foot complications. His novel research in drug development for people with diabetic foot ulcers has resulted in the topical preparation of esmolol, a new and pathbreaking foot gel for patients with foot ulcers.

A study led by Rastogi found that esmolol has a beneficial effect in reducing oxidative stress that may improve wound healing and that esmolol hydrochloride gel was far more effective than standard therapy protocols in use till now.

Sixty per cent of patients had wound closure within 12 weeks with esmolol compared to only 41 per cent with existing care routines, suggesting a 2.1 times increase in chances of wound closure with esmolol. More than three-fourths of patients had complete wound healing with esmolol compared to only half with existing treatments. More importantly, esmolol led to wound healing in a certain group of patients with low haemoglobin, renal problems and low albumin, all of which slow down recovery.

https://indianexpress.com/article/cities/chandigarh/diabetic-foot-complications-preventable-9827623/