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A new commentary paper published in Diabetic Medicine has reported diabetic foot disease to be one of the leading causes of disability across the world. The paper – authored by DFA’s Dr Pete Lazzarini and A/Prof Jaap van Netten and DFA’s friends A/Prof Rosana Pacella and Prof David Armstrong – has already received media attention with its claims that diabetic foot disease causes more global disability than heart disease, kidney disease and stroke. But, as we always say here at DFA, is this really the full story?
What do we know about the global diabetic foot burden?
For a while now many authors have suggested that diabetic foot disease causes a large global burden of disease. This is probably because we have also known for a while that diabetic foot disease is the leading cause of global amputations and has mortality rates worse than many cancers. More recently we have discovered that diabetic foot disease is also a leading cause of all doctors’ visits and hospital admissions.
So, with all that perhaps we shouldn’t be surprised with this recent news that diabetic foot disease is a leading cause of global disability. But, up until now, no one had formally compared the global burdens caused by diabetic foot disease with that of other conditions.
What did this new paper do then?
In short, the authors used disability data published in the Global Burden of Disease (GBD) Study to estimate the global burden of disability caused by diabetic foot disease and compared it to ~3,000 other conditions (various diseases, injuries and complications).
The GBD Study is regarded as the most prestigious study that quantifies the global burden of disease caused by all conditions. Each year GBD publishes an update of the global disability, death and disease burdens for these conditions in the globe’s leading medical journal, The Lancet.
To estimate these burdens, GBD uses the latest most robust epidemiology data available, in combination with some fancy algorithms, to transform this data into specific measures: years lived with disability (YLDs) (disability), years of life lost (YLL)) (death) and disability-adjusted life years (DALYs) (total disease burden). One DALY represents one year of healthy life lost and is the sum of YLDs and YLLs.
In 2016, the GBD Study on disability also broke up the disability caused by diseases into different complications for the first time; unfortunately they didn’t also do this for death. Diabetes was broken up into many complications, including diabetic peripheral neuropathy, foot ulcers and amputations. So, for the first time ever, the authors could use this GBD data to estimate the global disability burden caused by what they collectively called “diabetes-related lower-extremity complications”.
What did they find?
First, they looked at the numbers of people affected and found ~159 million people had diabetic foot disease (2.2% of the global population); i.e. either diabetic peripheral neuropathy, foot ulcers or amputations. When they compared this to all other conditions, they found diabetic foot disease ranked in the top-40 of all conditions for numbers of people affected. It affected less than those affected by all diabetes (5.9%) and kidney disease (4.4%), but more than heart disease (1.5%) and stroke (0.6%).
Second, they looked at disability and found ~20.5 million YLDs (~2.6% of all global YLDs) were caused by diabetic foot disease. When they compared this, they found diabetic foot disease ranked in the top-10 conditions for numbers of YLDs caused. It caused less YLDs than all diabetes (33.4 million YLDs), but more than kidney disease (8.2 million), heart disease (7.3 million) and stoke (6.5 million).
They displayed this comparison in a nice figure which we have jazzed up with permission here.
Last, they looked at increases in disability over the last decade and found that YLDs caused by diabetic foot disease increased by 35.6%. They found this was the 2nd largest YLD increase of all conditions. It was higher than all diabetes (32.5%), kidney disease (23.8%), heart disease (30.2%) and stroke (20.7%)
What was good and not so good about this paper?
This paper had many strengths, including: i) used independent robust GBD Study data; ii) compared all conditions using the same processes and measures; and iii) the authors have expertise with authoring GBD Studies and global diabetic foot burden studies.
But, this study was not without limitations, including: i) the paper was commentary letter which means we are reliant on the authors expert interpretations; ii) they used GBD data for diabetic peripheral neuropathy to help estimate diabetic foot disease and we know that some neuropathy disability affects the arm, so this may have caused them to over-estimate the burden; ii) but, on the flip side they did not use GBD data for other diabetic foot complications such as diabetes-related peripheral arterial disease, cellulitis and pressure ulcers, so this means they were probably more likely to under-estimate the burden; iii) GBD data relies on pooling epidemiology data from other studies and thus their estimates can fluctuate over time; and iv) GBD includes diabetes-related kidney disease as its own condition separate to diabetes, so this means that the combined diabetes burden is under-estimated.
What does that all mean?
The authors sum this up nicely concluding, “we estimate that the disability burden caused by DRLECs (diabetic foot disease) would rank within the top-10 leading causes of the global disability burden …. With DRLECs also resulting in mortality rates worse than many cancers, we recommend future GBD publications should present YLD, YLL and DALY estimates … to highlight the potentially significant overall global burden of DRLECs to policymakers”.
In short, this means that diabetic foot disease appears to be a leading cause of global disability and is increasing at a very rapid rate compared to other leading causes. The authors go on to recommend to “prioritise policies that improve evidence-based care for people with DRLEC, and thus, potentially reduce a large cause of the global burden of disease”. Obviously, we could not agree more!
This new paper is a very timely reminder during this year’s It’s about time National Diabetes Week Campaign that It’s about time to put your feet first as per DFA’s National Diabetes Week campaign.
In fact, with diabetic foot disease now a leading global condition when it comes to numbers of people affected, doctors’ visits, hospital admissions, amputations, death and now disability we would suggest it is well and truly over-time for everyone to put feet first.
Looking for a central location focused on Australian research on diabetic foot disease?
New research from around the globe is published on almost a daily basis, and here at DFA, we’ve created the Australian Research Repository to showcase published Australian research on diabetic foot disease. This free digital repository includes entries reviewed by the DFA team that meet the following criteria:
• Must focus on diabetic foot disease
• Must be peer reviewed
• Must have one author with an Australian affiliation
So check out our new searchable database highlighting the exceptional efforts of Australian diabetic foot disease research to the rest of the world.
Did you know that in the last two years, we’ve posted over 80 latest research summaries, hosted nine educational events including the 2017 conference, developed the “Australian diabetes-related foot disease strategy 2018-2022” and published the 2018 Australian Guidelines on footwear for people with diabetes? You could say we’ve been busy. And it doesn’t stop there.
Introducing our new interactive website!
Building and supporting the community
We already have a fantastic community and we’re taking that a step further by building a diabetic foot disease focused community noticeboard. So click on ‘What’s On’ to access what’s going on around the country in the world of diabetic foot disease.
Online Australian Research Repository
We’ve established the Australian Research Repository to showcase published Australian research on diabetic foot disease.
Access to Resources
You asked for it and we’ve added it. Our handy infographics are now located on our homepage to download.
Latest Research
New research on diabetic foot disease is published on an almost daily basis. Each month, we release latest news and research to provide practical clinical summaries of the latest evidence on how to assess particular conditions according to the world’s leading authorities.
Interactive Information
Scrolling through our website has never been easier and we’ve updated our information for patients, health professionals, researchers and industry.
So have a good look around at the changes we’ve made and don’t forgot to connect with us on Facebook!
We are delighted to announce that with the conclusion of the Wound Management Innovation Cooperative Research Centre (Wound CRC) this month, the Australian Diabetes Society (ADS) will take Diabetes Feet Australia into its stable of national diabetes clinical and research programs from the 1st July 2018. Read Media Release
Launched by the Wound CRC in 2015, Diabetes Feet Australia has since become the national multi-disciplinary advocacy body for the prevention, care and research of this prevalent disease. We thank the Wound CRC for their vision, support and investment in establishing DFA and continuing in partnership with Wound Innovations as the Wound CRC’s successor.
We now look forward to working with Dr Sof Andrikopoulus and his expert team at ADS in accelerating DFA’s work and Australia’s progression to ending avoidable amputations in a generation. By combining the well-established reputation of ADS as the peak national diabetes body for scientific and medical sectors, with our engaged national diabetic foot community, we can drive further collaborations, research, education and most importantly, advocacy for patients.
So as we always say, watch this space for exciting DFA activities released soon.
We are delighted to announce that with the conclusion of the Wound Management Innovation Cooperative Research Centre (Wound CRC) this month, the Australian Diabetes Society (ADS) will take Diabetes Feet Australia into its stable of national diabetes clinical and research programs from the 1st July 2018. Read Media Release
Launched by the Wound CRC in 2015, Diabetes Feet Australia has since become the national multi-disciplinary advocacy body for the prevention, care and research of this prevalent disease. We thank the Wound CRC for their vision, support and investment in establishing DFA and continuing in partnership with Wound Innovations as the Wound CRC’s successor.
We now look forward to working with Dr Sof Andrikopoulus and his expert team at ADS in accelerating DFA’s work and Australia’s progression to ending avoidable amputations in a generation. By combining the well-established reputation of ADS as the peak national diabetes body for scientific and medical sectors, with our engaged national diabetic foot community, we can drive further collaborations, research, education and most importantly, advocacy for patients.
So as we always say, watch this space for exciting DFA activities released soon.
Are you a podiatrist working in Australia?
As part of a Monash University research project, a short 15 minute survey on the content and method of diabetes related education podiatrist provided by a broad cross-section of podiatrists practicing in this area has been developed. This research aims to determine what diabetes related education is being provided by Australian podiatrists.
Tell us what you do or say, when treating people with diabetes.
To access the survey Click here
PoDFEd: Podiatrists and Diabetes Foot care Education Principal Investigators:
Julia Yuncken, email: Julia.Yuncken@monash.edu Terry Haines, Terrence.haines@monash.edu
Rene Stowlyk: Rene.stowlyk@monash.edu Cylie Williams, email: cylie.wiliams@monash.edu
Approved by Monash University HREC project number 12777
The 46 global experts invited to write the 2019 international diabetic foot guidelines have just been announced, and this time four Australians are amongst them. With only one Australian previously invited onto the last 2015 international guidelines, this announcement recognises that Australia is fast becoming a leading global nation when it comes to expertise in managing diabetic foot disease.
The International Working Group on the Diabetic Foot (IWGDF) is the peak global body for all things diabetic foot. As part of this role the IWGDF publishes the international guidelines that outlines the most up-to-date robust global recommendations for assessing and managing diabetic foot disease. These guidelines are recognised as the global gold standard and are launched every four years at the ‘Olympics of the diabetic foot’ conference, the International Symposium of the Diabetic Foot (ISDF).
To develop these international guidelines, the IWGDF selects and invites leading global experts to write the international diabetic foot guidelines. To be eligible to be invited, experts must have authored leading research in a key field of diabetic foot disease in the last 4 years. For the 2019 guidelines the IWGDF has recognised four such experts from Australia, inviting:
- Professor Rob Fitridge for the field of peripheral artery disease (PAD) (re-invited from 2015)
- Dr Anita Raspovic for the field of prevention
- Dr Matthew Malone for the field of infection &
- Dr Pete Lazzarini for the field of offloading.
The overall IWGDF guidelines are led and coordinated by an Editorial Board comprising the world’s leading ‘expert experts’ in diabetic foot disease. The editorial board for 2019 is made up of:
- Prof Nicolaas Schaper from The Netherlands (Chair)
- Dr Jaap van Netten from The Netherlands (Secretary)
- Prof Ben Lipsky from the United States
- Prof Jan Apelqvist from Sweden
- Prof Robert Hinchliffe from the United Kingdom &
- Dr Sicco Bus from The Netherlands.
Many of these names will be very familiar to Australians and in particular those that have lectured at events in Australia over the last 12 months. For example:
- Prof Schaper headlined the Diabetes Feet Australia (DFA) 2017 Conference
- Dr Bus has headlined several DFA ‘What’s New in DFU’ 2017 events &
- Dr ‘Aussie’ Jaap van Netten is very well-known as the DFA Scientific Director.
The guidelines are divided up by the editorial board into multiple chapters covering key diabetic foot fields. In 2015, there were five chapters covering the fields of prevention, offloading, PAD, infection and wound healing. And in 2019, there will be six chapters, updating the same five chapters from 2015 and adding an additional chapter on diabetic foot ulcer assessment and classification.
Each chapter is developed by a working group of 6-12 experts. To be eligible to be invited onto a working group, an expert has to have authored leading research in the field of the chapter concerned in the last 4 years. Each working group then develops their particular chapter, which includes:
- formulating the key clinical questions for the chapter
- undertaking systematic reviews of the evidence to answer those clinical questions
- drafting the key clinical recommendations to manage diabetic foot disease for that chapter &
- finally drafting the full chapter and systematic reviews that goes into the final guidelines.
Each step of each chapter is carefully checked and approved by the editorial board before all chapters are brought together into the final guidelines to be published in the Diabetes Metabolism Research and Reviews journal and launched at ISDF; this time at The Hague in The Netherlands in May 2019.
Overall, there are thousands and thousands of hours of work from dozens of global experts pouring over thousands and thousands of papers and carefully coming to a final consensus conclusion for every recommendation that forms these guidelines. These guidelines then form the global gold standard for managing diabetic foot disease.
This recent IWGDF announcement of the expert authors to undertake this new guideline process highlights how far Australia has come in the world of diabetic foot disease. With Australia now providing nearly 10% of the global experts covering 75% of the chapters, and with Australia’s close ties with at least 50% of the IWGDF guideline editorial board, this announcement recognises the great progress the Australian diabetic foot community has made together over the last 4 years.
With the ongoing clinical and research collaboration of the Australian diabetic foot community, it is envisaged that many more Australians will be recognised for their global diabetic foot expertise in the 2023 international guidelines. And in turn Australia will begin to achieve one of its goals of being a recognised leading diabetic foot nation at the 2023 ‘Olympics of the diabetic foot conference’.
With more Australians with more global diabetic foot expertise this can only move us closer to our ultimate national goal of ending avoidable amputations in a generation.
FINAL REGISTRATIONS CLOSE THIS FRIDAY!
BRISBANE – TUESDAY 20TH FEB – 6PM TO 9:30PM
- Join us as special international speaker Professor Keith Harding (UK) discusses “New horizons in the management of diabetic foot disease”
- Participate in the workshop session with Keith, Bill and Pete “Case Studies: Approaching difficult cases”
- Be there as Dr Pete Lazzarini launches the “2018 Australian guideline on footwear for people with diabetes” just published in the Journal of Foot and Ankle Research
- Learn about URGO’s greatly anticipated randomised clinical trial in neuro-ischaemic DFU wound with Dr Bill McGuiness presenting the “Explorer Study Results”
Click here to secure your seat in Brisbane on Tuesday 20th Feb
MELBOURNE – THURSDAY 22ND FEB – 6PM TO 9:30PM
- Join us as special international speaker Professor Keith Harding (UK) discusses “New horizons in the management of diabetic foot disease”
- Participate in the workshop session with Keith and Paul “Case Studies: Approaching difficult cases”
- Be there as Dr Byron Perrin launches the “2018 Australian guideline on footwear for people with diabetes” just published in the Journal of Foot and Ankle Research.
- Learn about URGO’s greatly anticipated randomised clinical trial in neuro-ischaemic DFU wound with A/Prof Paul Wraight presenting the “Explorer Study Results”
Click here to secure your seat in Melbourne on Thursday 22nd Feb
SYDNEY- MONDAY 26TH FEB – 6PM TO 9:30PM
- Join us as special international speaker Professor Keith Harding (UK) discusses “New horizons in the management of diabetic foot disease”
- Participate in the workshop session with Keith, Bill and Pete “Case Studies: Approaching difficult cases”
- Be there as Dr Pete Lazzarini launches the “2018 Australian guideline on footwear for people with diabetes” just published in the Journal of Foot and Ankle Research.
- Learn about URGO’s greatly anticipated randomised clinical trial in neuro-ischaemic DFU wound with Dr Bill McGuiness presenting the “Explorer Study Results”
Click here to secure your seat in Sydney on Monday 26th Feb
These 3.5 hour events include a substantial selection of delicious food, alcoholic & non-alcoholic beverages, valuable networking time and a certificate of attendance that can be used towards your continued professional development. (subject to your governing/peak body.
Don’t miss this rare opportunity to participate in robust clinical discussion under the mentorship of Professor Keith Harding.
Get ready to start 2018 with a DFU educational bang!
Following the successful 2016 & 2017 “What’s New in DFU” event series and our 2-day 2017 Conference, Diabetes Feet Australia invites you to this premier event to learn about the latest research, evidence-based practice and new technologies featuring special international guest Professor Keith Harding.
- Learn from the leaders in diabetic foot disease
- Participate in ‘workshop inspired’ discussion promoting engagement in real-world problem solving and innovative wound diagnostics therapies
- Be there for the official launch of the much anticipated “National Footwear Guidelines”
- Learn about new research and technologies as our Platinum Partner URGO presents the results of their greatly anticipated randomised clinical trial in neuro-ischaemic DFU wounds
This 3.5 hour event includes a substantial selection of delicious food, alcoholic & non-alcoholic beverages, valuable networking time and a certificate of attendance that can be used towards your continued professional development. (subject to your governing/peak body)
Early-bird tickets are on sale now and strictly limited!
Click here to secure your seat in Brisbane on Tuesday 20th Feb
Click here to secure your seat in Melbourne on Thursday 22nd Feb
Click here to secure your seat in Sydney on Monday 26th Feb
Don’t miss this rare opportunity to participate in robust clinical discussion under the mentorship of Professor Keith Harding.
Well ladies and gentleman, what a year it’s been for our Australian diabetic foot community. This year has been one of the biggest and best this nation has ever seen when it comes to diabetic foot disease.
It’s seen the biggest diabetic foot conference ever held in the Southern Hemisphere on the sunny Gold Coast, as top of the bill after many What’s New in DFU education events. An all-encompassing Australian diabetes-related foot disease strategy was finally published. And of course many, many new Australian studies came out and were summarized right here, amongst many other highlights.
Yet, even with such a successful year, way too many of our fellow Australians still unnecessarily lose their limbs and lives because of preventable diabetic foot disease. So at this time of year for reflection we thought what would our Australian diabetic foot community wish for Christmas in 2017 and beyond?
And, as the evidence-based advocates we are, we found a partial answer for our clinical problem in a diabetic foot article. The article was published in the British Medical Journal a few years ago and was entitled ‘The 10 commandments of the diabetic foot’! Now we have taken a little artistic liberty (or perhaps clinical) from this excellent paper and made some “minor” festive modifications.
So based on the evidence, here are our wishes for our 50,000 fellow Australians with active diabetic foot disease this Christmas. We call this, ‘The Twelve Weeks of Christmas Healing Down Under’ Click here to enjoy!
We hope you concur with our Christmas wishes ladies and gentleman.
Before you go, and if you didn’t think your work was important and rewarding enough after that: did you know Santa has had previous diabetic foot ulcers and Charcot joints?
If you look closely enough he’s actually wearing two black CROW walkers!
Think about it for a second: male, 60-70 years old, large waist circumference, poor diet, increased alcohol intake, always on his feet, jumping in and out of sleighs, carrying heavy sacks, doesn’t complain, always thinking and caring for others but not himself …………. See it all makes sense now doesn’t it?!
And with that ladies and gentleman, we are off for 2017! We look forward to working with you in 2018 in what we think may just be an even bigger and better year than 2017 on our journey to end avoidable amputations in a generation.
Wishing you and your patients a wonderfully festive and safe break with your families.
Merry Xmas All and To All Good Night
From DFA