Ramya Kannan

Blood sugar control, lifestyle adaptations and care of feet mooted

CHENNAI: Blood sugar control, making lifestyle adaptations and taking recommended care of the feet will enable diabetics to remain free from foot ulcers that may lead to amputations, a recent study has revealed.

About 80 per cent of a total of 1,143 patients who had been treated for foot ulcer remained free of the problem during the follow-up period of three years by wearing therapeutic footwear, maintaining a good HbA1c count (an average of blood sugar over three months) and not smoking.

Vijay Vishwanathan, of M.V.Hospital for Diabetes and Diabetes Research, said the study provided further proof that aggressive management could help to prevent recurrence of foot ulcers, common among diabetic patients.

“Ulcer-free survival is a new entity to measure the effectiveness of management of patients with diabetic foot. Avoidance of major amputation is obviously crucial to the patient, but living longer without an ulcer is also important,” he said.

Diabetic foot is a common reason for hospital admission in India, Dr. Vishwanathan said. Up to 27 per cent of the ulcers were associated with some form of amputation. In this context, the importance of foot care for diabetics could not be overemphasised, he said.

The study was done among patients at the foot clinic of MV Hospital for Diabetes, Royapuram.

It showed that recurrence of ulcers was associated with smoking, poorer glycaemic control, alcohol abuse and poor self-care. Recurrence of infection was common twice a year for those with poor control.

“Over the last two years, we have been getting more people with diabetic foot complications,” said V.B.N. Murthy, plastic surgeon, Sundaram Medical Foundation. However, tremendous advances had been made in the area of treatment.

“Twelve years ago, it was just chopping off feet, now a more conservative approach is being followed. The point is to save the limb,” he said.

However, the expenditure, including indirect costs incurred by patients for loss of man hours, kept rising.

Therefore one of the key components of any effective diabetic foot care programme was to sensitise patients to prevention of complications. Patients must take care of their foot, seek the help of a doctor at the hint of trouble and know when to approach a specialist.

However, the focus was now on training general practitioners, who treated a large number of patients with some complaints.

“It is important to get this group to know what should be done, so we have begun to focus on developing their knowledge,” Dr.Viswanathan said.

This would top the agenda at the annual conference of the Diabetic Foot Society of India, scheduled here for September 8 and 9. A primer on handling the diabetic foot for general practitioners would be released.