World Diabetes Day

In a significant number of people, both type 1 diabetes and type 2 diabetes progress to the development of vascular complications and ultimately

Meeting the costs of diabetes represents a major challenge. Proper diabetes care requires complex life-long management, making the condition one of the costlier chronic diseases. In 2006, the awareness-raising efforts of the global diabetes community will highlight the health status of people who are vulnerable or underserved. Not limited to populations in the developing world, this group includes people with diabetes in even the wealthiest countries. In the USA, where financial health cover is widely linked to employment, there are huge and increasing

From the moment they are diagnosed with the condition, people with diabetes receive all kinds of advice – or at least they should – ideally from others with the condition or family members who are ‘experts’ in living with diabetes, and professional health-care providers. Of all of these recommendations, one that is often misinterpreted is that relating to ‘appropriate footwear’. The key to this lies in the word ‘appropriate’.

Foot ulcers are caused by an imbalance between excessive pressure on the sole of the foot and repetitive stress from walking. It does not take much pressure to provoke an ulcer, so the skin has a built-in protection system. Normally, harmful pressure or motion against the skin will set off a protective pain alarm. Unfortunately, in people with diabetes nerve damage (neuropathy), this pressure goes undetected and can cause serious injury. Having lost the ‘gift of pain’, people with diabetes neuropathy often do not notice the problem until an ulcer has formed.

This is the story of ‘Mr L’, a man in Australia with type 2 diabetes and severe diabetes nerve damage (peripheral neuropathy). He developed neuropathy-related ulcers on one of his toes, which remained untreated for a number of months. He faced the prospect of having his left foot amputated. However, this was prevented because Mr L was linked to a multidisciplinary hospital-based diabetic foot clinic.

An ongoing initiative of the Pan American Health Organization/World Health Organization focuses on the development of basic procedures to improve diabetes prevention and control: the Building Blocks project. A set of diabetes care guidelines based on the Building Blocks principles resulted from a number of regional workshops involving experts in a variety of diabetes-related fields

Editor-in-Chief's editorial

President's editorial

The increasing global incidence of diabetes continues to provoke a corresponding increase in numbers of disabling and potentially life-threatening complications. Those affecting people’s feet are among the most feared. The amputation of a limb is one of the most costly of the diabetes complications in terms both of health economics and the devastating impact it has on people’s lives.

Indigenous Australians have poorer health than the rest of the Australian population; for Aboriginal people, life expectancy is about 20 years less than for the general population. Significantly though, the low expectation of life in Indigenous Australians is less associated with high child mortality, as occurs in many groups in developing countries; the big differences are among young to middle-aged adults.