Historical Background

The last century made great inroads into improving the management of diabetes. The early work of pioneers such as Nicolas Paulesco in Rumania and Georg Zuelzer in Germany culminated in the work of Banting, Best, Collip and Macleod in Canada who produced a pancreatic extract which was used successfully in patients and ended the

Plamen Kamenov

Fig. 6 International visitors at the King's Diabetic Foot Clinic: left to right, Dr Kamenov (Bulgaria), the Authors, Dr Harkless (USA) and Dr Plamen (Bulgaria).

Fig. 7 The Khartoum Diabetic Foot Clinic.

patients, spreading the word to Carville, USA, Basingstoke, UK, and Sydney, Australia. The popular biennial Malvern diabetic foot conferences began in 1986, and in 1991 Karel Bakker of The Netherlands established the regular International Symposia on the Diabetic Foot at Noordwijkerhout in The Netherlands. Bakker's work led to the establishment of International Working Group of the Diabetic Foot, which produced the International Consensus on the Diabetic Foot, published in 1999 (and now translated into 20 languages). Lee Sanders, who has contributed the chapter on surgery to this book, was the first podiatrist to be elected President for Healthcare and Education of the American Diabetic Association.

Professor Mohammed Rasheid, a surgeon, established one of the first African diabetic foot clinics in Khartoum, Sudan, in 1998 (Fig. 7). Dr Hermelinda Pedrosa in Brazil has organized a national programme of diabetic foot care. Dr Theresa Que established the first diabetic foot clinic in The Philippines. The fall of the 'Iron Curtain' across Eastern Europe in the 1990s enabled the setting up of diabetic foot clinics in many countries including East Germany (Fig. 8) Russia, Romania and Lithuania (Fig. 9) The late Jacquie Lloyd Roberts, a UK podiatrist, established a successful chain of diabetic foot clinics in Ukraine before her untimely death.

The work of diabetic foot clinics, operating in different parts of the world, in very different conditions, has clearly demonstrated that outcomes for diabetic foot patients can be improved when dedicated and enthusiastic clinicians organize a multidisciplinary diabetic foot service. With a flexible approach, most problems can be overcome.

inevitable 'death sentence' hitherto attached to a diagnosis of type 1 diabetes. Insulin became widely available, and the subsequent development of oral hypoglycaemic agents and blood glucose monitoring also led to improved outcomes for type 2 patients. However, many diabetic patients lived longer only to develop diabetic complications, including peripheral neuropathy, peripheral vascular disease, ulceration, foot sepsis and gangrene.

The work of Elliott Joslin (USA) and R.D. Lawrence (UK) during the first half of the twentieth century was concerned with all aspects of diabetes management including the management of the foot. Since then there has been activity on all continents to attempt to reduce amputations and improve outcomes in diabetic foot patients, which have been particularly evident over the past 15 years.

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