Secondary Prevention of Diabetic Foot Infections in a Caribbean Nation

Abstract

Most countries have instituted measures to limit the complications of diabetes. We evaluate secondary prevention strategies for diabetic foot infections in a Caribbean country. We performed a prospective questionnaire study evaluating all patients admitted to tertiary care hospitals across Trinidad and Tobago from July 2011 to June 2012. Primary study end points were the number of patient-detected injuries and the time interval between injury and presentation. Secondary end points included the practice of regular foot inspection (≥2 foot examinations per week) for early detection and the use of self-directed nonmedical therapies to treat foot infections. There were 446 patients admitted with diabetic foot infections at an average age of 56.9 ± 12.4 years. Three hundred and fifty-six (80%) were previously hospitalized with foot infections and 226 (51%) had already sustained end organ injury from diabetes. There were 163 (36.6%) patients walking barefoot at the time of injury and 189 (42.4%) had footwear-related injuries. In 257 (57.6%) cases, patients identified their foot injury shortly after the event. Despite early detection, they presented to hospital after a mean interval of 6.2 ± 5.03 days, with 78 (30.4%) having tried some form of home therapy first. Overall, 190 (42.6%) patients did not practice regular foot examinations. There is room for improvement in secondary preventative measures for diabetic foot infections in this setting. Educational campaigns may be beneficial to educate diabetics on the dangers of walking barefoot, the importance of appropriate footwear, regular foot inspection, and the importance of seeking immediate medical attention instead of experimenting with home remedies.

Epidemiology of tetanus in Jamaica, 1993–2010

“…Public health educational campaigns have been shown to reduce the risk of injuries in other high-risk groups, such as people with diabetes mellitus, and it also positively influences their wound care knowledge. 9 In this series, there were no cases of neonatal tetanus and the mean age to contract tetanus was 59 years. It is likely that the infant immunisation programmes have shifted the susceptible population toward the older age groups.…”

The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados

“…14 However, a higher prevalence and rate of amputation is seen in the Caribbean. This increase risk in the region is particularly related to inadequate footwear and care, 15 which has been found to triple the risk in Barbados. 2 Therefore, professional and patient education is imperative if this is to be improved.…”

Wonder of Life (kalanchoe pinnata) leaves to treat diabetic foot infections in Trinidad & Tobago: a case control study

“…Similar practices have been reported from the African continent, where the plant is also used to treat earaches, diarrhoea, dysentery, epilepsy and umbilical stump wounds. 6 Kalanchoe pinnata is a member of the plant family Crassulaceae. 7 The leaves are rich in vitamin C, vitamin E (tocopherol), potassium, calcium, phosphorus and citric acids.…”