Diabetic amputations on the rise during Covid-19 pandemic: experts

Diabetic amputations have increased across the world, including Pakistan, as a result of Covid-19 as foot care is delayed, wound care centres and clinics remain closed, and available beds for non-coronavirus-related illness have reduced, experts said on Wednesday, claiming that in some parts of developed countries, the rates of major amputations tripled during the pandemic.

They warned that with 33 million people living with diabetes in Pakistan, diabetic amputations were on the rise, and if appropriate measures were not taken immediately, 300,000 to 6,00,000 people might lose their legs because of diabetic foot ulcers in 2022 in the country.

“The amputation rate among people living with diabetes is between 20 and 40 per cent in our part of the world, and as per the International Diabetes Federation (IDF), there are around 33 million people suffering from diabetes in Pakistan. At the rate of 10 per cent, it is estimated that around 330,000 people would get their lower limbs amputated, and in the worst-case scenario, around 660,000 people would lose their legs in 2022,” Dr Zahid Miyan, president of the Diabetic Foot International, said.

He was speaking at a ceremony 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 an early recognition, management and referral system.

On the occasion, a memorandum of understanding was signed between the Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, and local pharmaceutical firm High-Q Pharma for the establishment of 30 diabetic foot clinics in Karachi, where general practitioners and family physicians will 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.

Renowned diabetology and Ramzan Study Group head Prof Yakoob Ahmedani, NADEP president Dr Saif-ul-Haq, Dr Zafar Abbasi, Dr Riaz Memon, Irum Ghafoor and High Q officials Dr Naumanuddin and Ahmar Asad also attended the ceremony.

Dr Zahid Miyan maintained that with the help of diabetic foot clinics and training of doctors in Karachi, Baqai Institute of Diabetology and Endocrinology (BIDE) had managed to reduce the diabetic amputation rate by up to 7-8 per cent in Karachi, and that the amputation rate was still between 10 and 20 per cent in different parts of the country due to a shortage 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,” he said while quoting the reputed health journal Lancet.

Calling for the establishment of at least 3,000 diabetic foot clinics throughout the country, BIDE Director and renowned diabetologist Prof Dr Abdul Basit said Pakistan could save billions of rupees by providing standardised diabetic foot care in every nook and corner of the country as the prevalence of diabetes was constantly on the rise, and most patients had already developed peripheral neuropathy when they came to know about their diabetes status.

“A vast majority of Pakistan patients of diabetes come to know about their disease when their organs have already been 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 specialised diabetic foot clinics throughout the country,” he said in his online address at the MoU-signing ceremony.

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

High Q Managing Director Pharma Atif Iqbal said it was a proud moment for them to become part of ‘Fast Track Pathway”, an initiative of the Diabetic Foot International, BIDE, National Association of Diabetes Educators of Pakistan (NADEP), Pakistan Working Group on the Diabetic Foot (PWGDF) and corporate partners, who have joined hands to control the diabetic amputations in Pakistan.

“We are proud to be part of this initiative and today signing the MoU as part of pledge to establish 30 diabetic foot clinics in Karachi. Our plan is to establish 500 such clinics through the country and prevent diabetic foot amputations to save our people from disability,” he added.