Preventing diabetes-related amputations in a developing country – steps in the right direction

In Pakistan, between 4% and 10% of people with diabetes develop a foot ulcer, and more than 10% of those ulcers lead to an amputation. The ‘diabetic foot’ is saddling Pakistan’s already resource-constrained economy with a tremendous and growing cost burden. Significant achievements have been made in preventing diabetes-related foot ulcers and improving foot care throughout the country, including the implementation of a highly effective ‘Step by Step’ programme. Under the auspices of that programme, training is provided for physicians, diabetes educators and foot care assistants. As a result, a large number of foot care teams have been trained. Indeed, a nationwide network of foot clinics has been a key outcome of the Step by Step approach. Among key results to date has been a significant reduction in nationwide rates of amputation. However, as the authors point out in this report, further preventive and curative strategies are needed.