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About diabetes

1 in 11 adults are living with diabetes2

Diabetes is a chronic disease that occurs when the pancreas doesn’t produce enough insulin, or when the body can’t effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and works like a key to open cells, so that the glucose can be absorbed and converted into energy.

If the body produces insufficient insulin, or when it can’t use the insulin it produces, the glucose levels in the blood rise (hyperglycaemia).

There are two main types of diabetes:

Type 1 diabetes can develop at any age, but occurs most frequently in children and adolescents. When you have Type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control


Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have Type 2 diabetes, your body does not make good use of the insulin that it produces. The cornerstone of Type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with Type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.

  • Gestational diabetes develops sometimes during pregnancy but usually disappears afterwards.
  • Other rarer types of diabetes also exist.

Over the long-term, high glucose levels are associated with damage to the body and failure of various organs and tissues.

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.


Diabetic foot is one of the most common,
costly and severe complications of diabetes.

There are several factors that lead to diabetic foot
ulceration and low likelihood of ulcer healing:

Loss of Protective Sensation (LOPS)

Diabetes is associated with LOPS due to neuropathy. Indeed, high blood glucose can cause damage to the nerves throughout the body (leading to neuropathy). Peripheral neuropathy is the most common form of diabetic neuropathy. It allows injuries to go unnoticed, leading to ulceration.

People with LOPS can cut themselves on the foot when stepping on a glass without noticing it.

Foot deformities

For a person living with diabetes, foot complications are an ever-present risk. This risk further increases if you have foot deformities; damage to the nerve supply of foot muscles causes weakening of the muscles and a change in shape of the feet. This creates abnormal pressure points and bony prominence which can cause sores and ulceration.
The most common foot deformities in people living with diabetes are: hammer toe, claw toe, hallux valgus…

Peripheral arterial disease (PAD)

Sometimes called poor circulation, PAD usually refers to the narrowing of arteries in the legs, leading to less blood flow to the muscles. It’s caused by cholesterol plaques, which harden and narrow the artery. The high blood sugar level present in diabetes can indeed over time damage blood vessels. This makes them more likely to become narrow or to weaken.

When an artery is blocked or narrowed, the part of the body it supplies doesn’t get enough oxygen. The condition is called ischaemia.

Previous history of foot ulceration or amputation

After successful healing, the recurrence rates of diabetic foot ulcers are 40% within a year and 65% within 3 years.3

“Thus, it may be more useful to think of patients who have achieved wound closure as being in remission rather than being healed”

3. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-2375
These factors can lead to different types of foot ulcers.

the consequences of diabetic foot


1 in 4

1 in 4
with diabetes will potentially develop a foot ulcer

every 20

every 20
diabetes causes a foot amputation

70% of amputated

70% of amputated
will not be alive in 5 years


Due to diabetic foot, people with diabetes are 15 times more likely to undergo amputation than other people.
Diabetes has become the leading cause of amputations worldwide. The lives of people after an amputation are profoundly affected: many are unable to work, become dependent upon others and cannot pursue an active social life. Physical, emotional and social functions are all affected and depression is a common occurrence.
Five years after a lower extremity amputation, up to 70% of people may have died.

1. Setacci C, de Donato G, Setacci F, Chisci E. Diabetic patients: epidemiology and global impact. J Cardiovasc Surg (Torino). 2009 Jul, 50(3) : 263-73

2. International Diabetes Federation Atlas – 9th edition 2019

3. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-2375.

4. Whiting, D. R., Guariguata, L., Weil, C., and Shaw, J. 2011. “IDF Diabetes Atlas: Global Estimates of the Prevalence of Diabetes for 2011 and 2030.” Diabetes Res. Clin. Pract. 94 (3): 311-21.

Fortunately, clinical studies have shown that foot ulcers can be prevented and successfully treated through more prevention, early identification of people at higher risk for foot ulceration and appropriate referral by doctors of patients presenting with a diabetic foot ulcer to specialised settings.