The International Working Group on the Diabetic Foot (IWGDF) Update: November, 2013

This, courtesy of Prof. Sir Karel Bakker, Director of the IWGDF


Please find herewith an overview of recent IWGDF and other important diabetic foot activities and some interesting reports and information.

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Content

In this November 2013 Newsletter you can find a report of the successful Train-the-Foot-Trainer course in Tobago June 2013 from the chair of the International faculty Dr Kristien van Acker.

The Rotary Club of Ledbury, UK have spearheaded a 10-year Caribbean Diabetic Foot programme in the Caribbean. Read about their extraordinary achievement.

The full IWGDF Diabetic Foot Guidelines 2011 have been translated in Spanish and were  launched in September 2013. Practical and Specific Guidelines could now be read also at the site.

Two new books were recently published.

Two prominent members of the global diabetic foot society have received an award.

Dr Dimitri Aerden, Brussels and Prof Ben Lipsky (Oxford/Seattle)  have written an intriguing and very instructive Foot note from Belgium (see Foot note on website).

Some new upcoming meetings are added to the agenda (see Future meetings on website).
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Train-the-Foot-Trainer Program NAC region

The second “Train-the-Foot-Trainer program, how to set up a Step-by-Step project” (TtFT) for the Caribbean and Central America region was held from 12-15 June 2013 in Tobago.

Organization

The IWGDF/IDF CS and the Rotary clubs of Ledbury, UK and RC Tobago Southwest organized this meeting. The sessions were chaired by Dr Kristien van Acker (international chair), Belgium with the assistant of Dr Stephan Morbach, Germany, Prof Dr Vilma Urbancic, Slovenia, Sr Podiatrist Neil Baker,  UK, Sr Podiatrist Simone McConnie, Barbados, Dr Nalini Campillo, Dominican Republic and Rotarian John Greedy from the Rotaru Club of Ledbury UK.
The local Faculty was represented by Dr Leslie Walwyn  from Antigua and Nurse Kevamae Belgrave from Barbados

Participation

Participants from no less than 22 countries (54 participants-27 doctors) from the Caribbean and Central American region took part in this very successful 3,5 days.
The attending counties were: Belize, Guatemala, Curacao, Venezuela, Guyana, Suriname, Trinidad, Tobago, Grenada, Barbados, St Lucia, Common Wealth of Dominica, Montserrat, Antigua & Bermuda, St Kitts and Nevis, St Maarten, BVI, St Thomas, Bermuda, Haiti, Cayman Islands and Jamaica.

Course

This second TtFT course was again a great success. It was an interactive programme. The workshops in smaller groups were very well received. A lot of attention was spent to ‘how to implement “ a national programme in a period of 2,5 years following the course. To all participants educational AV materials, flyers and books were given as well as a full set of medical equipment in order to install SbS programs in their own countries. Besides guidelines for the local implementation process and instruction to collect data to create sustainability were provided. IWGDF diabetic foot guidelines 2011 were also presented to all country representatives. The concept of working together in this region to strengthen sustainability, particular in a region with a lot of islands, was very well accepted.
As we had a patient Glynis, representative from the Diabetes Association from Guyana, we were more focused on the needs of our patients. Her comments were very positive and encouraged the teams and the faculty.
The participants felt inspired by the course and left Tobago with an action plan to implement. They will be guided in the coming 2,5 years by the regional IWGDF faculty members Podiatrist Simone McConnie from Barbados and Dr Nalini Campillo from the Dominican Republic. We expect the first implementation reports from January 2014 on.

    
Participant sings  a song on education.                                     Workshop

                           
              Radio and TV interview with faculty members Drs Kristien van Acker,  Maxwell Adeyemi and Stephan Morbach

    
Patient and participant getting the certificate from the              Podiatrist Luis Rodil  from  Guatemala get’s certifica
representative of the Min. of Health from Tobago

Sponsoring

This second TtFT program was financially made possible by the RC’s of Ledbury,UK and Tobago South-West and a Matching Grant of RI, by the IWGDF, IDF and with unrestricted grants from the following sponsors:

Podartis and Medical Monofilament Manufacturing (both are regular sponsor of the IWGDF/IDF CS TtFT programs) and Pharmtech Caribbean Ltd.

 

Launch of the IWGDF guidelines in Spanish at the IV Congreso Multidisciplinar de Pie Diabético: El pie diabético en España: presente y futuro.

At the IV Spanish Multidisciplinary Diabetes Meeting  held from   18-19 September 2013 in Sitges, Spain the complete Spanish “IWGDF Guidelines on the management and prevention of the diabetic foot 2011” were launched by Dr. F. Javier Aragón Sánchez, MD PhD, from Las Palmas de Gran Canaria, as chair of the meeting and the person who was responsible for the Spanish translation.

The Practical and Specific guidelines have also now appeared in Spanish at the website.

           
     Dr. Javier Aragón Sánchez handing over the        The hosts                               The DVD’s distributed
     translated guidelines to the IWGDF chair
     Karel Bakker

New books published

Contemporary Management of the Diabetic Foot – Editor Sharad Pendsey

In September 2013 Dr Sharad Pendsey, Nagpur, India has launched his new book with a foreword of Marvin E Levin and Karel Bakker. Together with several  of our colleagues he has published a well written, beautiful, instructive  and handsome new book.

                                                      
                                                Cover of the book                      Dr Pendsey with his new book

Neuropatias e Pé Diabetico – Editors Hermelinda C Pedrosa, Lucio Vilar and Andrew JM Boulton

During  the  XIX Brazilian Diabetes Society Congress held from 9-11 October 2013 with 3.000 participants, the book: Neuropatias e Pé Diabetico  “Neuropathies and the Diabetic Foot” was launched at 10 October at the XVII national  Neuropathy and the Dabetic Foot Symposium. Editors are Hermelinda (Linda) Pedrosa, Lucio Vilar and Andrew Boulton. Among the chapters, the IWGDF participated authoring two chapters: The International Diabetic Foot Consensus: an update and the IWGDF Practical Guidelines on the management and prevention of the Diabetic Foot. For the first time neuropathy and the diabetic foot were linked together in a book  and published in Brazil. It was the bestseller of the 2013 Congress. The next step will be a translation in Spanish.

                                          
                                   Cover of the book                   Linda Pedrosa and colleagues endocrinologists
                                                                                  Alessandro Paim, Patricia Carvalho and Andre
                                                                                  Mascarenhas at the congress bookstore.

Awards

DFSG lifetime achievement award for Professor Michael Edmonds

On 21st  September 2013 at  the  DFSG Europe meeting in Sitges, Spain Professor Michael Edmonds, from King’s College Hospital London, UK has received the lifetime achievement award for his diabetic foot services.

        
Prof Michael Edmonds honored with the DFSG        Mike Edmonds amidst his colleagues from King’s College Hospital
Lifetime Achievement Award  which was
presented by Prof Andrew Boulton, Chair EASD
and Prof Ralf Lobmann, Chair DFSG (right)

The Thomas Fuchsberger Award 2013 presented to Dr Sharad Pendsey 

Dr. Sharad  Pendsey, Nagpur, India IWGDF representative for India and co-founder of the successful „Step-by-Step“ initiative for diabetic foot care in developing countries was  honored at 24 October 2013 in Berlin, Germany, for another of his pioneering projects:  DREAM Trust is a charitable institution aiming to make the life of diabetic children, especially female diabetics, more bearable. Based on two shocking incidents of losing diabetic girls whose parents had stopped giving insulin as they simply could not afford it any longer, this trust was created to ensure insulin supply especially for diabetic girls in India. As various factors in India continue to discriminate against women, the trust gives priority to girls, but of course is not exclusive.
For his continuous efforts in this project, Dr. Pendsey was awarded the 2013 Thomas Fuchsberger Award on the 24th of October 2013 at the German Diabetes Charity Gala  evening  in Berlin. This award is conferred for active engagement in the care and support of the people with  diabetes. Thomas Fuchsberger was very popular German musician and died in 2010 .  He had long time type 1 diabetes and his death was by drowning in a little creek during a hypoglycemic episode. His father, Joachim („Blacky“) Fuchsberger (86), a famous German film and television celebrity, presented this award in memory of his son.

                 
        Mr. Joachim Fuchsberger presenting the                                     Sharad Pendsey and Joachim Fuchsberger
        Thomas Fuchsberger Award to Dr. Sharad Pendsey

New representative New Zealand

Our IWGDF Representative from New Zealand Podiatrist Ms Angela Bayley is moving to Europe. She will be succeeded by Dr Nigel Willis, orthopedic surgeon.

                  

Ordinary Rotarians doing extraordinary things, the amazing Rotary Club of Ledbury, UK: From a chance meeting to legs saved

The Ledbury Rotary Caribbean Diabetic Footcare project developed as a result of a chance meeting with Rotarians on the island of Tobago in 2000.  Ledbury Rotarian John Greedy, on business, had been delayed on Tobago.  He visited the Rotary Club of Tobago and met local doctor Rotarian Lloydan Joseph. Lloydan expressed his worries about the number of local people suffering from Diabetes on the island and the huge problem with foot ulcers.  He urged the necessity for further training into the treatment of the diabetic foot ulcer for local doctors and nurses. Lloydan asked whether Rotary Clubs could help in financing a group of Canadian podiatrists to come to Tobago and train his fellow clinicians.

                                                             

On his return to the UK, John brought the problem home to the Rotary Club of Ledbury.  The Ledbury Club agreed and fund raising started.  Canadian Podiatrists Melanie and Graham Curryer agreed to go to Tobago and set up two, one week courses over two years on Tobago with the agreement of the Tobago Health Authority.  The first course was held in 2002 and the second in 2003.  Such was the acceptance of the courses by clinicians that the Tobagonnian Health Authorities agreed to further the Diabetic Footcare Training on the island and develop and finance similar training on Trinidad.  Leg amputations on Tobago and Trinidad were dramatically reduced.  Successful diabetic footcare courses were held on Montserrat and Nevis using Rotary International Match Funding      .

            
    Ledbury Rotarian John Greedy with two                     Karel Bakker, Phil Riley (IDF) and Andrew Perry,
    colleagues from BVI                                                    visit to Ledbury

In 2006 Rotarians in Ledbury heard of the IWDGF conference in Malvern UK. A deputation was sent to Malvern and Dr Karel Bakker approached.  Hearing about the Footcare project on Tobago, Dr Bakker agreed to return to speak to the Ledbury Rotary Club.  In the meetings which followed and with the aid of a 50,000 Euro grant from IDF a partnership developed with IWDGF and Karel Bakker and his team.  The primary aim of the partnership was to highlight the plight of those suffering from diabetic foot ulcers and to train doctors and nurses in proven treatment techniques to reduce the number of lower limb amputations within the Caribbean region.

Contacts were made with the Rotary Clubs in the Caribbean detailing the work of the Ste-b-Step (SbS) programmes and asking whether local Rotary Clubs would be prepared to complete a questionnaire in conjunction with their Health Authority. The questionnaire was designed to ascertain the level of Diabetes on the islands and to determine the effect of diabetes particularly in relation to the number of ulcers and the level amputations caused through diabetic foot ulcers.

The questionnaire asked for local contacts and to seek the help of the local Rotary Club in assisting in the provision of a SbS programme on their island.  These Rotary Clubs were asked to provide support in the organisation of the SbS programme on their island, to publicise the programme and to invite doctors and nurses to attend through the local health authority.
 


Welcome to the IWGDF faculty at the Tobago Airport

At the same time Ledbury Rotarians set about raising the awareness of the tremendous problem of Diabetes and particularly the level of lower limb amputations in the Caribbean within the Rotary community.  36 Rotary Clubs have provided funding and support from the Caribbean, Canada, USA and the United Kingdom.  Presentations have been made throughout the UK to Rotary Clubs and to Rotary District, National and International  Conferences.  Using monies raised and with several other UK Rotary Clubs acting as the lead club, the project gained further funding from Rotary International on a match funding basis for each SbyS programme.  To date a total of Diabetic Footcare programmes have been established on 12 different islands throughout the Caribbean.  Countless ulcers have been treated and many legs have been saved.  Well over $300,000 Dollars have been raised to facilitate these programmes.

The Rotary Club of Ledbury Caribbean Diabetic Footcare Programme is recognised among Rotarians throughout the world.  In 2007 the team received an official “Special Service Recognition Award” from Rotary District 1100 and later that year an award “Ordinary Rotarians Doing Extraordinary Things” from the President of Rotary International Great Britain and Ireland was given after a question and answer session with the incoming President at the RIBI National Conference in Blackpool.

                                              
Dr Kristien van Acker, Chair of the IWGDF International Faculty instructing the health care providers of St Maarten.

The International Faculty headed by Dr Kristien Van Acker volunteered their time to lead the programmes on what has proved to be very successful projects.  Their time on the islands has been spent dedicated and working to provide a full and comprehensive training course to the local medical staff on a very strict time basis.  It has certainly been no holiday in the sun!  Data on the numbers of patients treated has been collected from the participant health authorities showing a very significant fall in the number of amputations since the programmes started.  We are extremely grateful for the participation of all the IWGDF International Faculty on these courses.

Due to Rotary International Grant rules flights to and from Europe for the SbS faculty have not been allowed for matching grant purposed and IDF have been responsible for the cost of those flights and also for the provision of medical equipment and training documentation for participants. We gratefully acknowledge their support.  

After the very successful Train the Foot Trainers (TtFT) course in Brasilia held in December  2012, a further TtFT course was held on Tobago in June 2012 with funding from the Ledbury Rotary Club and Rotary International and supported by the Rotary Club of Tobago Southwest and external sponsors. The TtFT course was held to promote the SbS Programme and to train doctors and nurses from the Caribbean to set up their own local SbyS programmes.  59 delegates from 21 Caribbean and also Latin American countries took part.  By using trained, local expertise and with the ongoing support of IWGDF and IDF the SbS programmes can continue and expand across the Caribbean and Latin America in a sustainable way (see also the TtFT Tobago report in this Newsletter).
     
Since his first visit to Tobago, John Greedy, now with a villa, on Tobago, has been able to act as an ambassador for SbyS in the Caribbean and among the islands.  John has been able to attend and has been involved in all of the SbyS programmes.  He has been a very hard working link between Ledbury Rotary Club, the International Faculty and the islanders.

Andrew Perry , Ledbury Rotary Club Diabetic Footcare Project
 

    

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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