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Clinicians work to enhance diabetic foot program in Guyana.

It is a well-known fact today that the world is experiencing an accelerating pandemic of diabetes mellitus. This occurrence is a result of population growth, aging, and trends toward obesity, unhealthy diets, and sedentary lifestyles. Most of the projected doubling of the number of people with diabetes will occur in the low-income countries, where depleted health care systems are already inadequate to provide care to their people. The complications of diabetes result in significant morbidity and early mortality. One of the most important and common of these is diabetic foot ulcers (DFUs). People with diabetes experience a 15% or higher lifetime risk of developing DFUs, which precede 85% of amputations. In general, the diabetic population suffers amputation at a rate of 15 times that of the general public. Evidence-based practice exists to reduce the risk and successfully treat DFUs, thus forestalling amputation. Management of diabetic foot problems is best carried out by a multidisciplinary team that focuses on preventative practices, such as education, risk assessment, and foot care. Treatment of DFUs themselves requires assessment and treatment of infection and reduced blood supply, debridement of necrotic and infected material, and the application of measures to reduce plantar pressure. Although best practice recommendations, such as those suggested by the Canadian Association of Wound Care (CAWC), have been developed, the application of theseprinciples has been limited in low-income countries. ‘‘The Best Practice Recommendations for the Prevention, Diagnosis, and Treatment of Diabetic Foot Ulcers: Update 2006’’ begins on p. 655 of this issue.