Covid-19 lockdowns increase diabetic amputations

Covid-19 lockdowns that forced foot care to be delayed, wound care centers and clinics to remain closed and least space for non-Covid-19-related illness have increased diabetic amputations, experts revealed.

They also disclosed that even in some parts of the developed countries, the rates of major amputations tripled during the pandemic.

With about 33 million people living with diabetes now in the country, diabetic amputations are on the rise and, they warned, if appropriate measures are not taken immediately, 3,00,000 to 6,00,000 people may lose their legs because of diabetic foot ulcers by 2022 in the country.

“Amputation rate among people living with diabetes is between 20 to 40 percent in our part of the world and as per International Diabetes Federation (IDF), there are around 33 million people suffering from diabetes in Pakistan. At the rate of 10 percent, it is estimated that around 3,30,000 people would get their lower limbs amputated, and in the worst-case scenario, around 6,60,000 people would lose their legs in 2022”, said Dr. Zahid Miyan, President of the Diabetic Foot International.

He was speaking at a ceremony on Wednesday regarding the establishment of 30 diabetic foot clinics throughout Karachi to provide an evidence-based standard of diabetic foot care to people living with diabetes within or close to their own vicinity and the application of a fast-track tool for early recognition, management, and referral system.

A memorandum of understanding was signed between the Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi and local pharmaceutical firm to establish 30 diabetic foot clinics in the city, where general practitioners and family physicians would be trained on the identification of diabetic foot ulcers, their treatment and referral to a tertiary-care facility in case the wound requires surgery or vascular treatment.

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Dr Miyan said that with the help of diabetic foot clinics and training of doctors in Karachi, BIDE had managed to reduce the diabetic amputation rate up to 7-8 percent in Karachi adding that the amputation rate was still between 10 to 20 percent in different parts of the country due to absence of trained and qualified physicians.

“Rates of amputations have increased across the world including Pakistan as a result of Covid-19 as foot care is delayed, wound care centers and clinics remained closed, and available beds for non-Covid-19-related illness reduced. In some parts of the developed countries, the rates of major amputations during the pandemic have tripled”, Dr Miyan said while quoting the reputed health journal Lancet.

Calling for the establishment of at least 3000 diabetic foot clinics throughout the country, Director BIDE and renowned diabetologist Prof. Dr. Abdul Basit said Pakistan could save billions of rupees by providing standardized diabetic footcare in every nook and corner of the country as the prevalence of diabetes was constantly on the rise and most of the patients already develop peripheral neuropathy when they come to know about their diabetes status.

“A vast majority of Pakistan patients of diabetes come to know about their disease when their organs are already affected. Many diabetics already develop peripheral neuropathy when they are diagnosed with diabetes. In these circumstances, there is a need for creating awareness about foot care for diabetics and establishment of specialized diabetic foot clinics throughout the country”, Prof Basit said.

He said that in collaboration with global health bodies like International Diabetes Federation (IDF) and Diabetic Foot International, they are not only training physicians and surgeons but also training Diabetic Foot Care Assistants (DFCA) who are performing the job of trained podiatrists and saving limbs of hundreds of people in Pakistan.

Published in The Express Tribune, December 30^th, 2021.