Sumpio Bauer E, McConnie Simone, Maharaj Dale
Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America.
Comfeet Foot Care Clinic, Christ Church, Barbados.
PLOS Glob Public Health. 2022 May 13;2(5):e0000446. doi: 10.1371/journal.pgph.0000446. eCollection 2022.
The prevalence of diabetes mellitus, diabetic foot (DF) disease and, as a result, lower extremity amputation rates remain high in the Caribbean. This study was undertaken to determine whether Caribbean countries have designated individuals that monitor DF disease and whether there are DF protocols consistent with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. Relevant DF health care personnel(s) from the CARICOM and Dutch Caribbean countries were called or sent questionnaires regarding the presence of structured programs to monitor and manage DF problems in the population. All 25 countries (100%) responded. 81% of respondents could not identify any Ministry, Hospital or individual initiatives that monitored the DF. Only 9 (36%) countries had any guidelines in place. Only 3 countries with guidelines in place utilized IWGDF guidelines. Only 6 (24%) countries had podiatrists and 10 (40%) had vascular surgery availability. 7 (28%) countries had the components for a multidisciplinary team. The presence or the appointment of a designated individual and/or a multidisciplinary approach within the countries for DF disease was absent in the majority of respondent countries. Only a minority of countries implemented DF guidelines or had expertise available to organize a DF multidisciplinary team. Vascular surgery and podiatric care were noticeably deficient. These may be critical factors in the variability and reduced success in implementation of strategies for managing DF problems and subsequent amputations amongst these Caribbean countries.
在加勒比地区,糖尿病、糖尿病足(DF)疾病的患病率以及由此导致的下肢截肢率仍然很高。本研究旨在确定加勒比国家是否指定了人员监测DF疾病,以及是否有与国际糖尿病足工作组(IWGDF)指导文件一致的DF诊疗方案。来自加共体和荷属加勒比国家的相关DF医护人员收到了关于是否存在监测和管理人群中DF问题的结构化项目的电话或问卷。所有25个国家(100%)都做出了回应。81%的受访者无法确定有任何部门、医院或个人举措对DF进行监测。只有9个(36%)国家制定了相关指南。只有3个制定了指南的国家采用了IWGDF指南。只有6个(24%)国家有足病医生,10个(40%)国家有血管外科服务。7个(28%)国家具备组建多学科团队的要素。大多数受访国家没有指定人员和/或针对DF疾病的多学科方法。只有少数国家实施了DF指南或具备组建DF多学科团队的专业知识。血管外科和足病护理明显不足。这些可能是导致这些加勒比国家在管理DF问题及后续截肢策略实施方面存在差异且成功率降低的关键因素。