The diabetic foot is a threat to every person with diabetes. Worldwide, over a million lower-leg amputations are performed per year as a consequence of diabetes (Jeffcoate and van Houtum, 2004). This figure is unacceptably high. The treatment and subsequent care of people with diabetic foot problems involves many people and has a significant impact on healthcare budgets and a potentially devastating impact on the lives of individuals and their family members. This is particularly the case in places where access to healthcare is restricted and awareness of the diabetic foot is low.
The International Diabetes Federation (IDF) has proclaimed 2005 to be the ‘Year of the Diabetic Foot’. Together with the International Working Group on the Diabetic Foot (IWGDF), the IDF has launched a year-long campaign to raise awareness of the diabetic foot worldwide (Figure 1).
International Diabetes Federation
The IDF is a global alliance of more than 190 diabetes organisations, which represent the interests of millions of people with diabetes, their families and their healthcare providers in over 150 countries. The IDF’s mission is to promote diabetes prevention and care worldwide. The group has official relations with the World Health Organization (WHO) and is divided into seven regions. The principal aims of the regions are:
- to bring local needs and activities to the attention of the global diabetes community
- to translate global activities and objectives to a regional context
- to support the work of regional diabetes representative organisations and to strengthen collaboration between them.
International Working Group on the Diabetic Foot
It is known that it is possible to reduce amputation rates by between 49% and 85 % through a care strategy that combines prevention, multidisciplinary treatment of foot ulcers, appropriate organisation, close monitoring and the education of healthcare professionals and people with diabetes. Healthcare decision- makers have a vital role to play in removing the barriers to implementation that still exist in many countries (IDF, 2005a).
On behalf of the IWGDF, which was founded in 1996, both the International Consensus on the Diabetic Foot and the Practical Guidelines on the Management and Prevention of the Diabetic Foot were launched during the 3rd International Symposium on the Diabetic Foot in Noordwijkerhout, the Netherlands, in 1999.
Since then, the IWGDF has initiated consensus projects on wound healing, treating people with diabetic foot ulcers, classifying diabetic foot ulcers for research purposes, and diagnosing and treating the infected diabetic foot. This led to three separate documents being produced, which were launched on CD-ROM in 2003 (IWGDF, 2003).
Implementation
National representatives of the IWGDF were appointed to organise local meetings to implement the consensus documents in their own countries and to facilitate translation into local languages. The International Consensus has thus far been translated into 25 languages, with more to be completed soon.
The IWGDF has grown and can now boast representatives in 84 countries. In many countries, the translation of the consensus documents or the guidelines has led to national implementation programmes. More than 80000 copies of the International Consensus have now been distributed, as have a few thousand CD-ROMs.
IDF Consultative Section on the Diabetic Foot
In 2000, the IWGDF was asked to become an official consultative section of the IDF in order to facilitate the development of a worldwide network of foot representatives, as well as to allow them to work together towards raising awareness of the costs and consequences of the diabetic foot. The IDF designated the diabetic foot as an important future theme for its World Diabetes Day campaign. The decision received enthusiastic support from the WHO.
World Diabetes Day
The World Diabetes Day campaign is aimed at people with diabetes throughout the world and at those in a position to bring about improvements in their healthcare. Chosen to mark the birthday of Sir Frederick Banting (who co- discovered insulin treatment), World
Diabetes Day takes place each year on 14 November. It provides a unique opportunity for people with diabetes, healthcare professionals and healthcare decision-makers to work together. World Diabetes Day campaigning and celebrations unite the international diabetes community to produce a powerful global voice for diabetes awareness.
2005: The Year of the Diabetic Foot
While many events in 2005 will take place on or around World Diabetes Day, for the first time in the history of the campaign the activities have been spread over the whole year. As already stated, this themed year is widely known as the Year of the Diabetic Foot. Although this particular campaign is not yet complete, it has already been sufficiently successful to ensure that the newly established year- long model will be followed in future World Diabetes Day campaigns.
Spreading the campaign over the whole year has generated various opportunities for collaboration with the global network of foot representatives and has attracted interest from every corner of the world. Furthermore, it has allowed the IDF and the IWGDF to take advantage of awareness-raising opportunities in all the IDF regions. The main aims are:
- to produce materials that will support the World Diabetes Day campaigns of diabetes representative organisations worldwide
- to persuade healthcare decision-makers that action is both possible and affordable
- to warn healthcare decision-makers of the consequences of not taking action.
IDF campaign activities
A major campaign activity is to provide many principal stakeholders in the global diabetes community with suitable information to support the global campaign in various formats. IDF material is sent to IDF member associations and is also sent on request to other like-minded organisations, hospitals and clinics, as well as healthcare professionals and individuals with an interest in diabetes.
The campaign has thus far published a 200-page, full-colour publication, Diabetes and Foot Care: Time to Act (Bakker et al, 2005; reviewed on page 120). Translations in Spanish and French will follow. Leaflets and posters have also been produced in three languages (English, French and Spanish). Furthermore, many articles have been published in leading journals to draw attention to the diabetic foot. To coincide with the campaign, the IDF has recently presented its position statement on the diabetic foot (IDF, 2005a).
Significant media exposure has been and, hopefully, will continue to be achieved through a series of eight press conferences (Table 1 and Figure 2). These press conferences are held to tie in with large international meetings on diabetes or with meetings that address the diabetic foot in particular.
Impact
Campaign actions from the IDF Executive Office have included mailings to the IDF membership, the foot representatives from the IWGDF network and health ministers. Information has been distributed to an online audience of over 50 000 visitors per month (this figure is expected to rise to over 100 000 as World Diabetes Day approaches). Forty-three events have been identified where the World Diabetes Day 2005 campaign will be promoted and World Diabetes Day campaign material distributed.
The IDF had received requests to translate this year’s World Diabetes Day campaign material into many languages, including Arabic, Azerbaijani, Bulgarian, Hungarian, Italian, Lithuanian, Macedonian, Russian and Serbian. Feedback from previous World Diabetes Day campaign events suggests that the campaign reaches a global audience of hundreds of millions.
Conclusion
By proclaiming 2005 as its Year of the Diabetic Foot and by making the diabetic foot the theme of World Diabetes Day on 14 November, the IDF has driven awareness to a higher level. For all people involved (healthcare professionals, healthcare decision-makers and patient organisations), it is now time to take appropriate action to ensure that people with diabetes everywhere receive the quality of care that they deserve. It is hoped that increased global awareness of diabetes and its complications will result in improvements and increased investment in foot care for people with diabetes throughout the world.
