title: The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country.
abstract: 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.
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Julia
authors.identifier: 0000-0002-7162-6057
authors.initials: J
authors.lastname: Lowe
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: R Gary
authors.initials: RG
authors.lastname: Sibbald
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Nashwah Y
authors.identifier: 0000-0003-0097-342X
authors.initials: NY
authors.lastname: Taha
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Gerald
authors.identifier: 0000-0003-3540-3339
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Institute of Health Science Education, University of Guyana, Georgetown, Guyana.
authors.forename: Madan
authors.identifier: 0000-0003-0004-7696
authors.initials: M
authors.lastname: Rambaran
authors.affiliation: Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martin
authors.affiliation: Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana.
authors.forename: Indira
authors.identifier: 0000-0001-9010-0846
authors.initials: I
authors.lastname: Bhoj
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5.
authors.forename: Brian
authors.identifier: 0000-0002-4957-2769
authors.initials: B
authors.lastname: Ostrow