The Diabetic Foot Project of Flanders, the northern part of Belgium: implementation of the St Vincent consensus. Sensibilisation and registration in diabetes centres.
As a result of the St Vincent declaration, a Belgian "task force" was installed in 1992 and consequently 16 working groups were formed. They presented their objectives in 1995. The working group "prevention and treatment of diabetic foot lesions" started the implementation of a screening program to obtain an overview of the presentation of diabetic foot lesions, the amputation rate and the prevalence of patients with a foot at risk. This study reports the results from 43 out of 73 Flemish diabetes centres. 1653 patients were enrolled in this study (53% women, 47% men, median age 61). 34.6% were type 1 and, 65.4% type 2. One or more arterial pedal pulses were absent in 28%, 30.5% had an abnormal monofilament test, 35% skin lesions and 28% malformations. Still 19% smoked, 15.8% had visual problems and 11% had already developed an ulcer previously. Ulcers were reported in 8.7% of which almost 2/3 belonged to Wagner class I. 69 (3.87%) of the patients had had amputations. According to the four-risk categories-scale 46.3% of the patients belonged to the highest one; peripheral vascular disease, previous amputations, previous ulcers, and Charcot joints. In our region we didn't have previous data on the prevalence and morbidity of the amputation rate with diabetes patients. We observed 3.87% amputations, which is rather high in comparison with international data (0.44% - 2.4%). The general follow-up of diabetic foot problems can be organised in co-operation with other care providers. A national program therefore is going to start in the next months. We all have to be aware of the size of the problem to offer the best possible prevention. As we have seen, the use of inlay soles and podiatrist-made ortheses for example is very low. We hope that all care providers will participate in this important project, so that they will acquire a specific attitude towards these patients. In daily clinical practice there are some key-roles to be respected by all health care providers. In our opinion the next are of the utmost importance: take off your diabetic patient's shoes when they visit you; give specific education if your patient has a foot at risk; if an ulcer is present, carefully follow-up is mandatory and if no good evolution of the ulcer is seen, an early referral to a diabetic foot clinic is obvious. Together we can lower down the amputation rate of diabetic foot lesions. And that would be a marvelous implementation of the St Vincent declaration in Belgium.
Van Acker
K
K
Department of Endocrinology, Diabetic Foot Clinic, University Antwerp, University Hospital, Wilrijkstraat 10, B-2650 Edegem.
Weyler
J
J
De Leeuw
I
I
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001530:Belgium / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors