The Guyana Diabetes and Foot Care Project: A Complex Quality Improvement Intervention to Decrease Diabetes-Related Major Lower Extremity Amputations and Improve Diabetes Care in a Lower-Middle-Income Country

Lowe, Julia; Sibbald, R. Gary; Taha, Nashwah Y.; Lebovic, Gerald; Martín, Carlos; Bhoj, Indira; Kirton, Rolinda; Ostrow, Brian

doi:10.1371/journal.pmed.1001814

Cited by 16 publications

(23 citation statements)

References 13 publications

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“…Treatment of diabetic foot requires a multidisciplinary team to address the infection, swelling, pain, metabolic disorders, nutritional deficit, co-morbidities and surgical revascularization [ 4 ]. Several intensive-care strategies have been developed recently to avoid amputation, including the use of Photodynamic Therapy (PDT) protocols [ 5 , 6 ]. It is important to point out that for any strategy used to treat diabetic foot there is always the risk of amputation, which is still not well defined by the medical community.…”

Section: Introductionmentioning

confidence: 99%

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

et al. 2015

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Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2–1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

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Section: Introductionmentioning

confidence: 99%

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

et al. 2015

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“…The MoH embraced the model, which is described in detail elsewhere [ 10 ], and approved in the new MOH Strategic Plan 2013–2020: Integrated Prevention and Control of Non Communicable Disease in Guyana [ 20 ]. Despite the many challenges facing the MoH, a significant change in the approach to evaluation of the diabetic foot and diabetes management occurred.…”

Section: Resultsmentioning

confidence: 99%

“…The key interventions are detailed elsewhere [ 10 ]. In brief, the intervention comprised development of a key opinion leader (KOL) team, this following a train the trainer model.…”

Section: Methodsmentioning

confidence: 99%

The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

Lowe

Sibbald

Taha

et al. 2015

International Journal of Endocrinology

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Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P < 0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.

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“…There are very few projects in diabetic foot in different parts of the world like the Brazilian save the diabetic toot project [4], the Guyana project [5,6], the Step by step project [7,8] etc . Each of these project aimed at preventing amputation in diabetic foot in their respective country/continent.…”

Section: International Diabetic Foot Pro-jectsmentioning

confidence: 99%

“…In phase I, an inter-professional diabetic foot care centre was established and phase 2 involved regionalization to cover 90% of Guyanese population. In this project, 14 key opinion leaders were educated and 340 health care professionals from 97 facilities were trained [5,6]. The Guyana diabetes and foot care project costs were funded by the Canadian International Development Agency [CIDA].…”

Section: International Diabetic Foot Pro-jectsmentioning

confidence: 99%

Amit Jain’s Project For Diabetic Foot Care- A National And International Initiative To Improvize And Standardize Diabetic Foot Practice Around The World

Jain

2016

IJMSCI

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Diabetic foot is a devastating complication of diabetes mellitus. It is unfortunately a neglected condition often leading to amputation which can render a person immobile or can affect his day to day work. In spite of advances in field of medicine, there has not been much improvement in diabetic foot care in India. Very few countries have implemented programs or project to improve diabetic foot care. Each of them have some aims through this program. The Amit Jain's project is one such largest independent project on diabetic foot which is an Indian diabetic foot surgeon's vision to improvise and standardize diabetic foot practice both in India and also around the world.

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The Guyana Diabetes and Foot Care Project: A Complex Quality Improvement Intervention to Decrease Diabetes-Related Major Lower Extremity Amputations and Improve Diabetes Care in a Lower-Middle-Income Country

Abstract: Julia Lowe and colleagues describe the Guyana Diabetes Foot Care Project, a quality improvement intervention for improving diabetes care in a low-income setting.

Cited by 16 publications

References 13 publications

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

Amit Jain’s Project For Diabetic Foot Care- A National And International Initiative To Improvize And Standardize Diabetic Foot Practice Around The World

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