The Reduction of Diabetic Foot Amputations Starts with Preventing Foot Ulcers
Bibliographic record
Abstract
As many experts predicted, the worldwide prevalence of diabetes continues to increase. About 425 million people worldwide now have diabetes; half of these are undiagnosed.1 Complications of diabetes, especially foot ulcers and lower limb amputation, are of great concern.2 While this issue’s fascinating continuing education article reports on diabetic myonecrosis (a rare complication of diabetes), the prevention of diabetic foot amputations is a more common and pressing concern that requires global attention. The 5-year survival rate following amputation is lower than that of breast cancer in females or prostate cancer in males.3 The United Nations and others have taken note and are discussing diabetes and other noncommunicable diseases this month in New York City.4 Scientists from the University of Toronto sold the patent rights to insulin for Can $3 so it would be available to all persons with diabetes requiring insulin. Despite this gift to the world, the cost of insulin is unaffordable to people in Africa and other low-income regions. In 2016, two Cape Town Declarations of Action on the reduction of diabetic foot amputations and insulin access for all were signed by a group of nongovernmental organizations. These declarations were designed to galvanize people into action for improved diabetes foot care and insulin access. The vast majority of diabetic foot amputations are preventable. A patient-centered approach by a coordinated interprofessional team can be an effective management plan by implementing the 5 S’s: 1. Screening: Health providers and systems should use validated screening tools including the Simplified 60 Second Diabetic Foot Screening Tool.5,6 2. Smoking cessation: Tobacco use is a known risk factor associated with diabetes-related lower limb amputations. Make appropriate interventions available to patients. 3. Shoes: Shoes, as well as socks and offloading devices, are an essential part of diabetic foot ulcer prevention and treatment. Provision at point of care and affordability of these devices are essential. 4. Systemic blood glucose and blood pressure control: Lowering hemoglobin A1c, controlling blood pressure, and diabetic foot screening are all potential solutions to the diabetes pandemic.7 Improving access to insulin and other essential medicines is key to avoiding diabetic foot amputations. 5. Skin temperature assessments: Infrared thermometry is a simple, inexpensive, and effective tool for clinicians to assess infection even in low- and middle-income populations.8 Research has validated that commercial, nonmedical devices are just as effective as medical-grade infrared thermometers.9 The editors ask Advances in Skin & Wound Care readers two things: What can you do in your local communities and practice to prevent diabetic foot amputations? And how can you move policy makers and politicians in your community toward evidence-based action to reduce diabetic foot amputation?FigureR. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JMFigureElizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".