No abstract

The prevalence of diabetes is increasing globally, particularly in the developing world. The diabetic foot is one of the most devastating chronic complications of diabetes. The Step-by-Step project was initiated in India, with participation from neighboring countries and Tanzania, to improve diabetes foot care in the developing world. The goal was to train health care professionals in basic foot care, improve their educational skills, and encourage them to set up minimum model diabetic foot clinics.

Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.

Diabetic foot infection (DFI) is a serious and common complication of diabetes mellitus. These infections are potentially disastrous and rapidly progress to deeper spaces and tissues. If not treated promptly and appropriately, DFI can be incurable or even lead to septic gangrene, which may require foot amputation. Mostly, these infections are polymicrobial, where Gram-positive pathogens mainly Staphylococcus aureus play a dominant causative role. Methicillin-resistant Staphylococcus aureus (MRSA) is present in 10% to 32% of diabetic infections and is associated with a higher rate of treatment failure, morbidity, and hospitalization cost in patients with DFIs. The increasing resistance of bacteria and the adverse effects pertaining to the safety and tolerability towards currently available anti-MRSA agents have limited the available treatment options for patients with DFI. Infection control, antimicrobial stewardship, and rapid diagnostics based on the microbiological culture and the antimicrobial susceptibility testing results are important components in helping curb this disturbing trend. Emphasis to revisit a vigorous research effort in order to improve the therapeutic options for the increasingly resistant and highly adaptable MRSA is the need of hour. Through this review article, we have made an attempt to explore the ongoing therapeutic trends in the management of DFI and highlighted the challenges in treatment of DFI. We have also given a brief overview of a few novel drugs that are under development to treat MRSA infections.

The increase in the prevalence of diabetes and its complications is alarming. The incidence of diabetic foot disease, which leads to foot amputations far too often, is unacceptably high. This is particularly true for developing countries.Worldwide, every 30 seconds a lower limb is lost as a consequence of diabetes.The International Diabetes Federation (IDF) Consultative Section and the International Working Group on the Diabetic Foot (IWGDF), together with the Diabetic Foot Society of India (DFSI) and the Muhimbili University College of Health Sciences Dar es Salaam, Tanzania (MUCHS), have initiated a foot care project called ‘Step by Step, improving diabetic foot care in the developing world’. Participating countries were India, Bangladesh, Sri Lanka and Tanzania. Teams, consisting of a doctor and a nurse or paramedic, were invited to attend a basic and an advanced course. The goal was to improve educational skills and the management of diabetic foot problems. An experienced national and international faculty was responsible for teaching and the practical sessions.This article describes the design and the execution of the project. The outcome looks very positive. It is expected that the acquired knowledge and skills of the teams will sustain and that the effect of the courses will cascade from the teams to the local community. We expect that the setup of the project can ultimately help reduce the number of lower extremity amputations. The authors feel that this project is ready to be carried out in other developing countries.This pilot study was generously supported by the World Diabetes Foundation. Copyright © 2006 John Wiley & Sons.