Review Article
Volume 5 Issue 3 - 2021
Diabetic Foot Infections and Problems in Guyana
Satyan Rajbhandari1,2, Carlin Hanoman2,3, Khemraj Rupee2, Sunil Rupee2, Jaipaul Singh3 and Rajini Kurup4*
1Department of Diabetology and Endocrinology, Chorley General Hospital, England, UK
2School of Medicine, College of Medical Sciences, University of Guyana, Turkeyen, Georgetown, Guyana
3School of Natural Sciences, University of Central Lancashire, Preston, England, UK
4School of Allied Health, University of Guyana, Guyana
*Corresponding Author: Rajini Kurup, School of Allied Health, College of Medical Sciences, University of Guyana, Guyana.
Received: January 10, 2021; Published: February 23, 2021


Diabetes mellitus (DM) is a major global metabolic disorder currently affecting more than 465 million people. If diagnosed late or left untreated, DM can induce a number of long-term complications which are due to DM-induced hyperglycaemia leading to nephropathy, cardiomyopathy, neuropathy, retinopathy, impotence, foot ulcers and amputations. Diabetic foot problems (DFP) are major concerns for the patients as they affect their quality of life and exert great financial burden on them, especially for people from a low income developing country as Guyana. In 2019, it was estimated that the expenditure for diagnosis, treatment and care for diabetic foot patients was USAD$75 million in Guyana. Both obesity and diabetes are on the increase in Guyana with almost 11 - 12% of the adult population have DM, due to obesity (diabesity) and more women compared to men. Moreover, there is an unacceptable high rate of amputations due to lack of organised foot-care programme and the absence of national guidelines in its management. There are various aspects of good diabetic foot care and this article reviews what has been achieved and what needs prioritisation to improve the management of diabetic foot problems in Guyana among patients with diabetes mellitus. ’The Guyana Diabetes and Foot Care Project” has made significant improvement in this area but the lack of specialist vascular surgical service is obvious.

Keywords: Diabetes Mellitus; Guyana; Diabetic Foot Infection; Ulcer; Amputation; Foot Care


  1. IDF (2020).
  2. Margolis DJ., et al. “Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008 (2021).
  3. Van Netten JJ., et al. “Definitions and criteria for diabetic foot disease”. Diabetes Metabolism Research Review 1 (2020): e3268.
  4. Jeffcoate WJ., et al. “Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers”. Diabetes Care 4 (2018): 645-652.
  5. NICE-NG19.
  6. Ostrow B., et al. “Clinicians work to enhance diabetic foot program in Guyana”. Advances in Skin and Wound Care 12 (2007): 640-641.
  7. Kurup R and Ansari AA. “A study to identify bacteriological profile and other risk factors among diabetic and non-diabetic foot ulcer patients in a Guyanese hospital setting”. Diabetes and Metabolic Syndrome: Clinical Research and Reviews 13 (2019): 1871-1876.
  8. Worldometer (2020).
  9. Statistics (2020).
  10. McKeigue PM., et al. “Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians”. Lancet8738 (1991): 382-386.
  11. Agyemang C., et al. “Obesity and type 2 diabetes in sub-Saharan Africans – Is the burden in today’s Africa similar to African migrants in Europe? The RODAM study”. BMC Medicine 14: Article 166 (2016): 12.
  12. Ke C., et al. “Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study”. BMJ Open Diabetes Research Care1 (2020): e001349.
  13. WHO (2020).
  14. Commonwealth Health systems in Guyana - Commonwealth of Nations (2021).
  15. Bus SA., et al. “Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)”. Diabetes Metabolism Research Review1 (2020): e3269.
  16. Housley A., et al. “Diabetes foot health in Chorley and South Ribble: a step in right direction”. Practice Diabetes International 23 (2006): 161-165.
  17. Lowe J., et al. “The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country”. International Journal of Endocrinology (2015).
  18. Armstrong DG., et al. “Diabetic foot ulcers and their recurrence”. New England Journal of Medcine 376 (2017): 2367-2375.
  19. UNESCO (2020).
  20. Lowe J., et al. “The Guyana Diabetes and Foot Care Project: A Complex Quality Improvement Intervention to Decrease Diabetes-Related Major Lower Extremity Amputations and Improve Diabetes Care in a Lower-Middle-Income Country”. PLoS Medicine4 (2015): e1001814.
  21. Soliman M and Rajbhandari SM. “Assessing outcome of diabetic foot ulcers and multidisciplinary foot clinic”. Current Diabetes Reviews5 (2013): 397-401.
  22. IDF (2021).
  23. Lewis J and Lipp A. “Pressure-relieving interventions for treating diabetic foot ulcers”. Cochrane Database System Review 1 (2013): CD002302.
  24. Nabuurs-Franssen MH., et al. “Total contact casting of the diabetic foot in daily practice: a prospective follow-up study”. Diabetes Care2 (2005): 243-247.
  25. Lim WT., et al. “The Real-Life Outcome of VACOped Boot in the Management of Diabetic Foot Ulcers”. The International Journal of Lower Extremity Wounds (2020).
  26. Lipsky BA., et al. “Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)”. Diabetes Metabolism Research Reviews1 (2020): e3280.
  27. Rayman G., et al. “Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update)”. Diabetes Metabolism Research Reviews1 (2019): e3283.
  28. Wu L., et al. “Dressings for treating foot ulcers in people with diabetes: An overview of systematic reviews”. Cochrane Database System Reviews 7 (2005): CD010471.
  29. Edmonds ME., et al. “Multi-center, randomized controlled, observer-blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes-ProNOx1 study”. Wound Repair Regen2 (2028): 228-237.
  30. Dolan NC., et al. “Peripheral artery disease, diabetes, and reduced lower extremity functioning”. Diabetes Care1 (2002): 113-120.
  31. Hinchliffe RJ., et al. “Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)”. Diabetes Metabolism Research Reviews1 (2020): 3276.
  32. NICE-CG147.
  33. Stabroek News (2020).
  34. Kurup R., et al. “Wound care knowledge, attitudes and practice among people with and without diabetes presenting with foot ulcers in Guyana”. The Diabetic Foot Journal3 (2019): 24-31.
  35. National Foot Audit (2021).
  36. Kurup R., et al. “A review on diabetic foot challenges in Guyanese perspective”. Diabetes Metabolic Syndrome2 (2019): 905-912.
  37. Cawich SO., et al. “The economic impact of hospitalization for diabetic foot infections in a Caribbean nation”. Perm Journal1 (2014): 101e4.
Citation: Rajini Kurup., et al. “Diabetic Foot Infections and Problems in Guyana”. EC Diabetes and Metabolic Research 5.3 (2021): 10-17.

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