Diabetic foot ulcers in Port Moresby General Hospital 2003-2008: review of the principles of effective prevention and management of diabetic foot.

Background: In the recent decade in Papua New Guinea and other Pacific countries there has been an increasing trend of lifestyle diseases, including obesity associated with diabetes mellitus. Foot ulceration and infection leading to amputation are common and feared complications of diabetes. Yet these are potentially the most preventable of all complications in diabetic patients. Several studies have shown that half of all diabetic foot ulcers can be prevented by education and simple foot care. The primary goal of this study was to depict the scale of the diabetic foot as a community health problem. The secondary goal was to review the current literature on diabetic foot in order to develop a more effective preventive strategy.

Methodology: A retrospective study on the patients with diabetic foot admitted to the surgical unit at Port Moresby General Hospital (PMGH) in 2003 and 2008 was conducted. We also carried out an extensive online search on the prevention and management of diabetic foot ulcers.

Results: Our study showed an increasing trend of diabetic foot ulcers and infections from 1.4 to 2.2% of all surgical patients at PMGH over a 5-year period. Interestingly, over that period the representation of females increased from one-third to almost half of all patients with diabetic foot. Furthermore, the patients with diabetic foot complications showed a lower average hospital stay of 35 days in 2008 compared to 54 days in 2003. The literature review showed that the introduction of a diabetic podiatric team service providing simple education to diabetic patients in the form of one teaching session and/or preventive written materials, with a short explanation of diabetic foot pathology and simple preventive measures, reduced the number of amputations by half.

Recommendation: The introduction of a comprehensive foot care education program and organizing a specialist foot clinic for diabetic patients can reduce bed occupancy and health expenditure on diabetic patients as well as the number of amputations and subsequent disability.