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Saturday,
November 14, 2009 will be the third annual World Diabetes Day. This
day has been created by the United Nations to recognize the birthday
of Fredrick Banting, the co- inventor of insulin and to promote
awareness and education about diabetes that afflicts almost 100,000
of our fellow citizens in the United States, and over 230 million
people worldwide. World Diabetes Day is celebrated worldwide by the
212 member associations of the International Diabetes Federation in
more than 160 countries and territories, all Member States of the
United Nations, as well as by other associations and organizations,
companies, healthcare professionals and people living with diabetes
and their families.
World
Diabetes Day gives us an opportunity for both reflecting on the past,
and planning for the future. Today we recognize those researchers,
scientists, and clinicians who have contributed to expanding our
knowledge about diabetes and the co-morbidities that affect the foot.
We also appreciate that their work has led us to understand and
implement the best practices we use in caring for the foot problems
of our patients with this disease.
A Look Back At Doctors Who Cared
There are names that we all recognize and some that we don’t.
In 1552 BCE an Egyptian physician named Hesy–RA, made the first known mention of diabetes and describes remedies to combat “ the passing of too much urine.” In 120 CE, a Greek physician Aretaeus of Cappodocia gave the first complete medical description of diabetes, which likens to
“the melting down of flesh and limbs into urine.”
Moving on to more modern times, Elliott Joslin, MD was the first physician in the United States to specialize in treating diabetes. While attending Harvard Medical School both his Aunt Helen and his mother were diagnosed with diabetes. These events certainly provided him with strong personal motivation to investigate and treat patients with diabetes. He published his theories about diabetes in the first patient handbook called THE DIABETIC MANUAL FOR THE DOCTOR AND PATIENT. Dr. Joslin encouraged nurses to become educators, which led to the establishment of the modern profession of diabetes educators. Almost 90 years ago he was the first physician who advocated the now highly touted interdisciplinary team approach to caring for the patient with diabetes.
Fredrick Banting, in 1921, along with graduate student, Charles Best and chemist James Collip discovered insulin, forever changing for the better, the lives of patients with diabetes.
Dr. Paul Brand was a pioneer in developing tendon transfer techniques for use in the hands of those with leprosy. He was the first physician to appreciate that leprosy did not cause the rotting away of tissues, but that it was the loss of the sensation of pain which made sufferers susceptible to injury. His work was monumental in the understanding of the “gift” of pain and loss of protective sensation in the diabetic foot that is know today as diabetic sensory neuropathy. One of his best-known books is: Pain: The Gift Nobody Wants (1993).
Other milestones in diabetes history include the introduction of the standard insulin syringe in 1944, the first pancreas transplant that was performed at the University of Manitoba in 1966, and the patent for the first portable glucose meter that was filed in 1971.
A Look At Podiatrists Who Care
In Podiatric Medicine and Surgery we proudly acknowledge our peers, who have devoted special energy and focus in research and medical training that has benefited patients with diabetes.
Both Lee Sanders and Larry Harkless have the distinction of Chairs in their name at the University of Texas, San Antonio, honoring them for their outstanding work in amputation prevention.
Dr. Sanders is considered to be one of the country’s foremost leaders in the prevention of lower-extremity amputations and is the former President, Health Care and Education, of the American Diabetes Association. He has published "The Philatelic History of Diabetes: In Search of a Cure" an exciting chronicle of experimental research, therapeutic advances, and hope for a cure for diabetes. Dr. Sanders is also the coauthor of A Practical Manual of Diabetic Foot Care, which was the winner of the BMA book of the year in 2004.
Dr. Harkless is a world leader in diabetic foot research and is a well-known author on the subject. He has been the strongest proponent of residency training with a special focus on the diabetic foot and today his influence extends well into academia as the Dean of Western University’s College of Podiatric Medicine in Pomona CA.
The name David Armstrong is associated world wide with the diabetic foot. He has produced more than 270 peer-reviewed research papers in more than two-dozen scholarly medical journals. He has contributed to over two dozen book chapters and is co-Editor of the American Diabetes Association’s (ADA) Clinical Care of the Diabetic Foot. He is the co founder of the Southern Arizona Limb Salvage Alliance (SALSA) and is the co chair with Dr. George Andros of the DF Con, Diabetic Foot Conference held yearly in Los Angeles.
Lawrence Lavery is a Professor of Surgery at Texas A&M Health Science Center College of Medicine and is the co-Editor of the American Diabetes Association’s (ADA) Clinical Care of the Diabetic Foot. He is a researcher and has published multiple articles concerning the diabetic foot. He is the Editor-in-Chief of Foot and Ankle Quarterly and is a Reviewer for the most prestigious European and American medical journals and multiple American Podiatric Medical Journals. He has been instrumental in developing home monitoring devices of foot skin temperatures to prevent ulcerations.
Vickie Driver is a pioneer in limb salvage. She started her career at Madigan Army Medical Center then moved on to become the Director of clinical research, Chief, of the National Center for Limb Preservation at Rosalind Franklin University of Medicine and Science. She is now as Director, Clinical Research, Vascular and Endovascular Services Associate Professor of Surgery, Boston University School of Medicine. She is a co-author of Chronic Wound Care 4th Edition and has been deeply involved in postgraduate training and research. She is the author of multiple research papers on limb preservation.
James Wroble is an Associate Professor of Surgery at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, and Director of the Outcomes Research Program in the Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science a researcher and clinician from the VA and Dartmouth University.
Warren Joseph a world recognized specialist in antibiotics and foot infections. Warren has had dozens of peer-reviewed articles in publications such as Drugs, Infections in Surgery, Journal of Foot Surgery, Clinics in Podiatric Medicine and Surgery, “Proceedings of the 85th American Society for Microbiology Meeting,” Journal of the American Podiatric Medical Association, Current Infectious Disease Reports, Drugs & Aging, Clinical Infectious Diseases, and Cutis. He is the editor of the American Podiatric Medical Association Journal. He is a ham radio operator and is an airplane pilot who has achieved his instrument rating, multi-engine rating. He has lectured on all 50 of the United States.
Steve Kravitz, a visionary Podiatrist who saw the need for an interdisciplinary organization in the field of wound care and founded the American Professional Wound Care Association. Through his efforts there has been an increased awareness of wound care issues for all patients and all types of wounds, but especially for those with diabetes.
Jeffrey Robbins is Director of Podiatric Services for the Department of Veterans Affairs. The VA system under his direction produces that greatest number of residency-trained podiatrists in the world who go on to provide foot care across the globe for patients with diabetes.
John Steinberg is a Podiatrist who has devoted most of his adult life to education and training to care for the diabetic patient. Along with Christopher Attinger, MD at Georgetown University he has established the model that has become the benchmark for interdisciplinary care for the diabetic foot.
Robert Frykberg is a Podiatrist with the some of the world’s finest credentials and experience to match. He has published many peer-reviewed articles and lectured internationally on the diabetic foot. He is deeply involved in residency training and research. He has traveled to China in the past 5 years to speak at that country’s most prestigious medical conferences on the diabetic foot. He has been called the “master of amputations,” due to his extensive experience in limb salvage. He attended Harvard Medical College's New England Deaconess Hospital in Boston for his podiatric surgical residency. He has been Dean for Clinical Affairs at the College of Podiatric Medicine and Surgery, Des Moines University Osteopathic Medical Center. He has served as a member of the Board of Directors of the American College of Foot and Ankle Surgeons and Chair of the American Diabetes Association's Foot Care Council.
What About the Future?
And what about the new generation of Podiatrists who will carry on the legacy of research and caring for patients with diabetes? Lee Rogers in California and Kathya Zinszer in Philadelphia have the training, the energy and desire to become the future leaders in Podiatry and the diabetic foot. Yes, the profession of Podiatry has every right to be proud of its contribution of World Diabetes Day.
There are now more than 6 annual conferences on diabetes and limb salvage in the United States that bring international attention and training to the issues of the diabetic foot. The future of limb salvage and amputation prevention lies in the education and awareness of the options for diabetic patients that these conferences highlight.
On the International Scene there is no one more dedicated to the issue of the diabetic foot than Dr. Karel Bakker of the Netherlands. In 1987 he founded the first specialized Diabetic Foot Clinic in the Netherlands. He is chairman of the IDF Consultative Section and International Working Group on the Diabetic Foot (IWGDF), which published the International Consensus and Practical Guidelines on the management and prevention of the diabetic foot in 1999. Dr Bakker has chaired a number of International Symposia on the Diabetic Foot at Noordwijkerhout, The Netherlands.
Edward J Olmos, the intense, Academy Award-nominated star of Stand and Deliver, Battlestar Gallactica, and Miami Vice, is known for his activism as well as his acting―and he’s particularly engaged in the fight against diabetes. His father and all four of his uncles, plus two of his aunts, have died of complications of the disease, and Olmos’ sister and brother are both dealing with it. One uncle committed suicide rather than have his legs amputated. The actor is a spokesperson for the Diabetes Research Institute Foundation, the Juvenile Diabetes Foundation, and the Diabetic Foot Conference, which focuses on reducing the incidence of amputation in diabetics. But better still, he serves as an example of how you can dodge the genetic bullet of type 2 diabetes by living a healthy lifestyle.
A Time For Searching
It is time for searching. Searching for answers to the devastating co morbidities of the disease that affect the eyes the kidneys and the feet and legs of these special patients. It is a time of celebration for our successes and a time of sadness for our non-successes. I do not say failures as we as Podiatric physicians only play a part of the ultimate resolution of our diabetic patients foot problems. The success or non-success of our work depends deeply upon or patients’ desire and willingness to become our partners in the future of their own health. The search also will need a realization of the political and economic drivers that this is a disease that needs their support and attention, for without it the resolution of it will only be delayed. Medication must be available world wide and at an affordable price. Prevention must be embraced as part of the solution. I believe that stem cell research or the Human Genome Project will discover the ultimate solution of the problems of the diabetic foot. But until then, we must do our best to continue the research, education and creating the awareness to bring future energy and effort to solving the puzzle that is diabetes
In my 33-year career of being Podiatrist I have provided care for well over 118,000 patients. No group of patients has affected me and challenged my skills as a physician and surgeon of the foot more than those patients with diabetes.
Education is the Answer
Over the years I have come to recognize that education about diabetes and its co-morbidies of vascular and neurological disease that affects the foot is the keystone of prevention. And education is not only for patients; it is for caregivers, for physicians, for allied health care providers and for administrators, too.
When I have the opportunity to share information with a patient in my treatment chair, I can help one person. But realizing the tragedy that affects so many people I felt inadequate realizing that people all over the world could be helped if only they had the knowledge about diabetes and how to successfully prevent the complications we know with surety will happen due to chronically elevated blood glucose levels.
The theme of World Diabetes Day from 2009-2013 is Diabetes Education and Prevention. In order to educate the most people as quickly as possible and prevent as much pain and suffering from the co- morbidities of diabetes to the foot, I have written, Keep The Legs You Stand On, the first book for patients with diabetes and their caregivers with a focus on foot health and ulcer foot infection and amputation prevention and have established a website in support of this belief, http://www.amputationprevention.com.
Lastly let us not forget to recognize and thank the patients that we serve and learn from and for who this day is dedicated.
-Dr. Hinkes
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