The Importance of Education in Reducing the Burden of Diabetes Mellitus in Less-Developed: A Case Report

History

Mr. Muhammed Hussein, a 40-year-old male farmer from a rural region in Tanzania was admitted to a national referral hospital after presenting with a four-month history of a left foot ulcer, loss of his 3 rd and 4 th toes, and atrophy of his left foot. Initial symptoms included itching between 2 nd to 4 th toes; there was no history of trauma and no other significant past medical history. He smoked 20 cigarettes per day for the past 20 years but does not drink alcohol. On admission he was diagnosed with diabetes based on random blood glucose of 35.2 mmols/l. On physical examination, the patient was found to have severe peripheral neuropathy. Peripheral pulses were palpable on his right foot, but not on the left. Popliteal and femoral were palpable bilaterally. The left foot was gangrenous (Wagner score 5); the 2 nd and 3 rd toes were absent due to auto-amputation. A foul smelling discharge oozed from the foot and underlying tendons were visible on the dorsal and plantar aspects of the foot (see photograph). Initial management of the patient included treatment with insulin and antibiotics. He eventually underwent a left below knee amputation.

Discussion

The above patient suffered foot symptoms for at least four months yet never knew that he had diabetes. The sole reason why he eventually presented to the hospital in the first place was because of the loss of his toes. Widespread ignorance and poor education about diabetes and its complication is causing unnecessary suffering, poor quality of life, and premature death for thousands of patients in rural regions of Tanzania .

Although education is the cornerstone of diabetes prevention and management, public awareness and understanding of diabetes remains unsatisfactory in many rural regions, especially among the poor. At present, four out of five people with diabetes in less developed countries do not know they have diabetes. The price of ignorance for those with diabetes is very high. Late diagnosis or poor management of the condition after diagnosis may result in unnecessary, preventable complications like we saw in Mr. Muhammed Hussein, who had already developed peripheral neuropathy, peripheral vascular disease and a foot ulcer at the time of presentation that required amputation.

Public awareness and understanding is a major factor in the early screening and early diagnosis of diabetes. Targeted education ensures that those at risk are identified, given appropriate follow-up, and taught as much as possible about managing their own condition in the home or work settings. That said, education should also be targeted towards healthcare professionals to enable more rapid identification of previously unrecognised diabetes patients. In addition, Government awareness of the true cost of diabetes needs to be enhanced so that proper resources for diabetes education could be allocated in the national health budget. Finally, public understanding of diabetes must be improved to avoid discrimination against affected persons.

In summary, education of patients on how to recognise early symptoms is likely to result in more early diagnoses before the onset of complications. Appropriately targeted education and screening blood or urine tests will prevent, delay, or reduce diabetic complications and amputations among patients like Mr. Hussein.