Diabetes is not a high profile disease but it is turning into a high-cost pandemic around the world and the Pacific is particularly affected.
In Fiji alone, the latest estimates show 1 in 3 people is affected by diabetes.
Complications can lead to blindness, heart disease, and kidney failure.
Diabetes is also behind a high rate of amputations, but as Isabelle Genoux has been finding out, a new foot care program aims to tackle that problem.
Presenter: Isabelle Genoux
Speaker: Dr Wahid Khan, Chair of Diabetes Fiji
GENOUX: In Fiji diabetes is a major cause of amputations with an average of 400 lower limb amputations conducted each year on diabetic patients.
Dr Khan is the chair of Diabetes Fiji which is about to launch a major diabetic foot care initiative aimed at preventing amputations.
KHAN: In terms of amputations the indigenous population, the i-Taukei have a higher level of amputations than the non-indigenous. We reckon there are several factors that are involved in this; firstly is that their first line of treatment would be to seek some herbal treatment, local village treatment before they come up for medical treatment or seek health care treatment. And by the time they do that the infection has settled in very, very deeply, and the digit or the foot or whatever is not recoverable and therefore they end up with more amputations than the other diabetics.
GENOUX: People with diabetes are 25 times more likely to lose a leg than people without the condition. Diabetes complications include nerve damage and poor blood circulation, and these problems make the feet vulnerable to skin sores which don't heal properly.
KHAN: The journey really starts with a small ulcer and if that person has longstanding diabetes then if there is superimposed neuropathy then ulcer which is painless, doesn't get noticed, and that is the major concern that I always come up with is the adage to the people that have diabetes is it doesn't belong to the doctors and nurses, it belongs to the patient. And the patient should take a responsibility for its control. Ultimately what we want to do is to tell the patient hey, you ought to be able to look at your feet and examine your feet on a regular basis and wash your feet and bathe your feet and conduct proper foot toilet and wear shoes to prevent any sores. One of the factors that we find is that our diabetics do not like wearing shoes when they're walking out. I guess it's got to do with humidity, it's very warm, they don't like closed shoes, they would prefer open slip-ons. So we have a big fight about changing their manner of protecting their feet.
GENOUX: The program which will be launched next year in coordination with Fiji's Ministry of Health, will target nurses and physicians as well as nursing and medical students.
KHAN: It's a multi-pronged program. Initially we start off with training nurses in foot care in diabetics. And then we arm them with foot care tips so that they can go back to their nursing stations in their communities and start actively looking at diabetic feet, actively looking for lesions and trying to prevent the onset of any infection at all. We're all for arming the primary care physicians, and we're also going to target the nursing students and the medical students. So that thinking about foot care starts in the medical schools and nursing schools and goes on after these young people graduate. One other problem that we have identified in Fiji is that the surgeons will have to change their modus operandi in terms of foot infection. There is a tendency for surgeons to amputate rather than to preserve the feet. There are many factors involved here; one of the factors is that instead of amputating at a lower level they would do higher level amputations. So if your toe was affected they would do a four-quarter, a quarter of a toe.
GENOUX: And why is that, so to prevent further infection?
KHAN: To prevent further infection and complications. One of the things that happens is that if that patient is lying, if you want to preserve the feet, the feet have to be looked after in a hospital setting. That takes a bed and that takes up manpower and it becomes very, very costly in terms of ... but it's a lot cheaper in terms of medical healthcare costs to have an amputation and go off home and we look after the stump at home. When we do get into this business of preventing it we will be conducting a thorough audit on all the amputations that are being done. If the criteria are not met then they'll be no amputations, we try and preserve as many feet as possible. The other thing that we are going to do is to post our surgeons into hospitals abroad who preserve feet rather than amputate.