The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country
Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Fo...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2015/920124 |
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| author | Julia Lowe R. Gary Sibbald Nashwah Y. Taha Gerald Lebovic Madan Rambaran Carlos Martin Indira Bhoj Brian Ostrow |
| author_facet | Julia Lowe R. Gary Sibbald Nashwah Y. Taha Gerald Lebovic Madan Rambaran Carlos Martin Indira Bhoj Brian Ostrow |
| author_sort | Julia Lowe |
| collection | DOAJ |
| description | Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P<0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years. |
| format | Article |
| id | doaj-art-b3830a4fa7a84618b554a2bc329e14eb |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Endocrinology |
| spelling | doaj-art-b3830a4fa7a84618b554a2bc329e14eb2025-02-03T05:43:56ZengWileyInternational Journal of Endocrinology1687-83371687-83452015-01-01201510.1155/2015/920124920124The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income CountryJulia Lowe0R. Gary Sibbald1Nashwah Y. Taha2Gerald Lebovic3Madan Rambaran4Carlos Martin5Indira Bhoj6Brian Ostrow7Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, CanadaDivision of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, CanadaDivision of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, CanadaDivision of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, CanadaInstitute of Health Science Education, University of Guyana, Georgetown, GuyanaDiabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, GuyanaDiabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, GuyanaDepartment of Surgery, University of Toronto, Toronto, ON, M5T 1P5, CanadaBackground. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P<0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.http://dx.doi.org/10.1155/2015/920124 |
| spellingShingle | Julia Lowe R. Gary Sibbald Nashwah Y. Taha Gerald Lebovic Madan Rambaran Carlos Martin Indira Bhoj Brian Ostrow The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country International Journal of Endocrinology |
| title | The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country |
| title_full | The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country |
| title_fullStr | The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country |
| title_full_unstemmed | The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country |
| title_short | The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country |
| title_sort | guyana diabetes and foot care project improved diabetic foot evaluation reduces amputation rates by two thirds in a lower middle income country |
| url | http://dx.doi.org/10.1155/2015/920124 |
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