Diabetes causes more amputations than landmines

December 8, 2008
The condition now accounts for 70 per cent of all lower limb amputations

Dr Thomas Stuttaford
Mohandas Gandhi was known as Mahatma, or “great soul”, because he combined patriotism with moral teaching, reform and a horror of violence, consumerism and class, caste or racial discrimination.

Gandhi would have welcomed the support given to the World Diabetes Foundation (WDF) and the World Health Organisation (WHO) by Handicap International. That is the French charitable organisation that has been awarded a Nobel prize for its work with people left crippled and handicapped in Vietnam, Cambodia and other countries by landmines.

Exploding hidden landmines remain a considerable danger, but one that has been overtaken by diabetes as a reason for the amputation of younger people's legs around the world. Diabetes now accounts for 70 per cent of all lower limb amputations. Hence the decision of Handicap International, while continuing to work in Vietnam, Cambodia and other former war zones, to add to its agenda the WDF campaign to reduce the incidence and improve the treatment of diabetes in developing countries.

The loss of a lower limb in a working man usually heralds the loss of the family's livelihood so that poverty becomes inevitable. Locally made artificial lower limbs are satisfactory for walking but rarely adequate for hard manual work.

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The WDF's expertise helps in the formation of partnerships to deal with diabetes in the developing world. It unites the various people and organisations interested in raising the awareness of the lifestyle changes needed to prevent diabetes and the need for prompt diagnosis and treatment. Earlier treatment of diabetic foot complications would prevent 85 per cent of amputations.

Currently 40,000 legs are amputated in India each year. Last week doctors, health workers and journalists gathered in Bangalore and Madras. In Bangalore they visited the vascular surgical unit at the Bhagwan Jain hospital. The unit, led by Dr Kalkunte Suresh, is financed by the WDF, the WHO, Handicap International and several local philanthropists. It runs a footcare division that organises local clinics that screen people in surrounding villages for diabetes and the first signs of nerve damage that could desensitise their feet so that they become vulnerable to minor injury.

The clinics also raise public awareness of the lifestyle changes needed to reduce the incidence of diabetes and its complications. Dr Suresh, the director of the scheme and of the hospital's vascular surgical unit, said that diabetic foot complications were increasing and that someone with diabetes in India was 25 times more likely to have a leg amputated than someone without it.

Dr Suresh added that doctors trained in the developed world associate foot complications including gangrene and amputation with elderly or obese, under-exercised patients. This is not so in India. There, the most common cause for a crisis leading to gangrene and amputation was more likely to be precipitated by diabetic nerve damage than deteriorating arterial blood flow.

The Indian patients who need amputation are often aged only around 35 to 45, a time in the manual worker's life when he has maximal domestic responsibilities and is probably providing for several generations. Most of Dr Suresh's patients who had leg amputations were not overweight but lean, tough and muscular agricultural workers.

Gandhi, delegates were reminded, taught that India lives in its villages, and in order to bring about change it was necessary to change the way that village people think.

Dr Suresh and his team, when spreading the message about diabetic prevention and treatment, rely on well -respected local people - popular village postmen or bus drivers are ideal - to educate their fellow villagers about the signs and symptoms of early diabetes, the need for foot care, and the importance of wearing shoes in and out of the house (more feet are injured indoors than in the fields).

All these aspects of diabetes can be taught in the villages by troupes of enthusiastic street performers acting out short plays and singing traditional folk songs, modified to spell out the methods of prevention and treatment of diabetes.

While India watched and mourned the atrocities in Mumbai, the delegates moved to Madras. There they visited the projects the WDF has established with the Pabolu Ogirala and Sriram Charitable Trust. It aims to combat eye problems in diabetic patients, who are twice as likely to develop them as non-diabetic people. Fifty per cent of all diabetic people develop some degree of diabetic eye disease.

www.worlddiabetesfoundation.org