By Dr. Ashu Rastogi
According to International Diabetes Federation, every 30 seconds, a limb is lost somewhere in the world because of diabetes.1 India, in general, has a lack of awareness for not only diabetes, but also its close relationship with foot complications which occur at a later stage in diabetes.
Epidemiological studies from India and internationally have raised alarm on diabetes prevalence. The current global prevalence of 366 million is expected to rise to 552 million (51% increase) by 2030.2 More than 60% of the world’s diabetes population comes from Asia of which two nations; India and China have the most significant contribution.
The low level of awareness for diabetes and its complications amongst patients results in poor glycaemic (sugar) control, especially in Indians.
Diabetic foot: Ignorance leads to amputation
Having diabetes and having too much uncontrolled glucose (sugar) in your blood for a long time can cause some very serious complications. Foot ulcers may result as a long-term consequence and result in amputation(s). It is evident that the risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus.4.5
Foot ulcers (breaks in the skin) in diabetes are extremely common and costly to treat. Almost 25% of people with diabetes are expected to develop diabetic foot ulcers during their lifetime. In a condition like diabetes, the ability of the body to fight infections decreases drastically.
A small cut, an ill-fitting footwear, a minor wound if anything is ignored may grow into a deeper wound within a fortnight leading to a “foot ulcer”, especially in uncontrolled sugar. Serious infection may set in leading to complications which set the tone for an amputation.
Why does it happen?
Inadequate sugar control, ignorance, non-adherence to medications, improper foot care, nerve damages, irregular physician follow ups, compounded with reduced blood supply may lead to Diabetic foot ulcers (DFU). Diabetic foot ulcers are very stubborn and take a long time to heal due to the rich sugar environment. Doctors term them as “non-healing” wounds and are a common cause of amputations, which are done to prevent the spread of infection throughout the body.
If any such wound or ulcer is taking more than normal time to heal, patients should immediately consult and seek guidance from their doctors at the earliest; “earlier the better”. Your doctor will be the best to decide what is good for you or your loved ones suffering from diabetes or its complications.
In case of diabetic foot ulcers or any chronic wounds, regular debridement (removal of dead skin and tissue) and dressing with rigorous sugar control are the known treatments. Several dressing options exist for the management of diabetic foot ulcers which include iodine and are commonly used due to its long-term clinical experience and effectiveness. Tincture Iodine which was used earlier (red brown staining solution) has been replaced with Povidone Iodine, yet, the unwanted side effects like pain, irritation, and skin staining still have not been overcome. Additionally, they also warrant a daily change in dressings, that too by a Physician.
What is new in wound healing?
One newer option that now is attracting the attention of doctors who treat diabetic foot ulcers is Cadexomer Iodine which overcomes all the drawbacks of traditional iodine preparations with superior healing properties and proven safety, has been recently introduced in the Indian markets.6
In my experience, unlike Povidone Iodine, Cadexomer Iodine is the latest antimicrobial dressing ointment which has a dual benefit in especially non-healing chronic wounds. It helps by absorbing all the unwanted fluids & pus from the leaking wounds and slowly releases iodine that ensures an antiseptic action for a prolonged duration.
In summary, education amongst people for diabetes is the need of the hour for successful management of not only the disease but also its complications, such as ulcers and amputations. Importantly, it is in the hands of the patients and their caregivers/relatives to talk about diabetic foot care with their doctors.
(The author is Associate Professor, Department of Endocrinology and Metabolism, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh and Vice President, Diabetic Foot Society of India (DFSI). The article is for informational purposes only. Please consult health experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)