Diabetes is a global disease which is a public health problem in developed as well as developing countries as evident from the statistics of International Diabetes Federation (IDF) diabetes alone affected 382 million people worldwide in 2013, a number that is expected to grow to 592 million by 2035. Global prevalence rate amounts 8.
3% among average age group of 20-79 years according to 2013 statistics and taken together two third of these individuals are living in low- and middle-income countries fuelled by factors such as rapid urbanization, nutrition transition and increasingly sedentary lifestyles. i By the Global Report on Diabetes by World Health Organization (WHO) it is one of four priority non-communicable diseases (NCDs) targeted for action by world leaders. Its prevalence constantly increasing over the decades as estimated 422 million adults are living with diabetes in 2014 compared to 108 million in 1980 which shows that global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.
7% to 8.5% in the adult population. Moreover, the prevalence has risen faster in low- and middle-income countries than in high-income countries. Diabetes alone caused 1.5 million deaths in 2012 and higher-than-optimal blood glucose caused an additional 2.2 million deaths by increasing the risks of cardiovascular and other diseases particularly in developing countries.
As sophisticated laboratory tests are required to distinguish between type 1 diabetes (which requires insulin injections for survival) and type 2 diabetes (where the body cannot properly use the insulin it produces) separate global estimates for type 1 and type 2 do not exist. ii Leading cause of morbidity and mortality across the globe its complications damage multiple organs of the body which increase the overall risk of dying prematurely. Possible complications include heart attack, stroke, kidney failure, leg amputation, vision loss, nerve damage, risk of fetal death in pregnancy and many other complications. Moreover, the economic impact of this disease is also high as it is a major contributor to the escalating healthcare cost worldwide.
iii Narrowing down to developing countries there is an increasing prevalence of this disease as being reported by several developing countries.iv The main target of interest is South Asia which hosts countries like China, India, Pakistan, Singapore and Bangladesh which host major populations affected by this disease. According to the data of WHO the proportional mortality (% of total deaths, all ages) due to Diabetes Mellitus is 3% in Pakistan along with prevalence and related risk factors accounting 9.8% of total population being affected by this disease. According to an old survey Pakistan has currently more than 6.
34 million people with diabetes and it is estimated that 11.4 million Pakistanis will have diabetes by the year 2030. v However according to a recent survey the prevalence was found to be 16.98% and 35.3 million people were found to be diabetic from the total population according to the reported cases.vi When we consider the complications diabetic foot is very common throughout the world resulting in major economic consequences generally and disabilities particularly for the patients, their families, and society in general in spite of foot ulcers being preventable this complication of neuropathic origin leads to severe consequence of amputation in poorly compliant cases.
vii According to global data co-morbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%).viii In Pakistan, 6-7 % of the diabetics suffer from foot problems, many of which lead to leg amputation.
45-89% of all leg amputations are preventable but unfortunately no integrated diabetic foot care strategy exists in Pakistan.ix Moreover, when assessing the economic effects of diabetic foot, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years.x In Pakistan about 20-40% of diabetics are reported to have neuropathy of which almost 50% are likely to develop symptomatic peripheral vascular disease within twenty years of diagnosis. The lifetime prevalence of foot ulceration is about 15% while diabetes is an important non-traumatic cause of major amputations of the lower limbs. Basit et al. studied 2199 Type-II diabetics which showed that the prevalence of diabetic foot ulcers was 10.
4% and it was higher among the males. Burden of diabetic foot: The true incidence regarding prevalence of diabetes in Pakistan is reported to be between 5-7%.xi In another study of the 230 subjects, 94(40.86%) were males and 136(59.
13%) females. The overall mean age was 53.82±9.96 years and mean glycated haemoglobin was 8.81±2.04%.
The prevalence of diabetic foot syndrome was 32(13.9%).xii However, this is still a huge gap in this area of study and proper evaluation of the spectrum of this particular adverse complication of diabetes needs to be conducted to find the exact spectrum of the number of patients and how many lead to an amputation which is again a preventable cause but occurs due to lack of awareness concerning proper care of this disease as it has a long standing history before it reaches the stage where amputation becomes compulsory therefore the shortcomings in primary prevention needs to be addressed as well. Furthermore after exploring the spectrum, next step is to evaluate the effects of disabilities caused by diabetic foot amputations and the economic burden of surgeries on public health required to be addressed through proper research.