Addressing Cambodia's Growing Diabetes Crisis: Focus on Foot Health

November 14 marks World Diabetes Day, a time to reflect on the pressing diabetes situation in Cambodia, which demands urgent attention.

Staggering Diabetes Statistics

According to a recent survey conducted by the World Health Organization, approximately 6.7% of over 4,400 adults surveyed in Cambodia were aware of their diabetes status, while an additional 9.3% were living with the condition unknowingly. This indicates that a significant number of Cambodians, roughly three out of five, are unaware they have diabetes. Furthermore, around a quarter of all adults fall into the pre-diabetic category.

The International Diabetes Federation highlights that nearly 720,000 adults in Cambodia currently live with diabetes, a staggering increase from approximately 200,000 in 2011. Projections suggest that this number could surpass one million by 2050, making it a pressing public health challenge.

The Impact of Diabetes on Foot Health

Diabetes is often perceived as a condition primarily related to sugar levels. However, over time, it becomes a vascular disease. Elevated sugar levels can damage the nerves in the feet, making one oblivious to cuts or blisters. This damage can also harden and narrow arteries in the legs, thus hindering the blood supply necessary for healing.

The connection between diabetes and foot complications is stark. For instance, the Eurodiale study, which monitored over 1,200 diabetic foot ulcer patients across Europe, revealed that almost 49% had narrowed arteries in their legs. Among those patients, only 69% saw their ulcers heal within a year, compared to an 84% healing rate for those with normal blood circulation. The guidelines indicate that around 50% of individuals with diabetic foot ulcers suffer from peripheral artery disease, which is a significant risk factor for amputations.

Insights from Clinics in Phnom Penh

While Cambodia does not systematically track the prevalence of diabetic foot issues, local clinics are beginning to quantify the challenges. For example, at a public hospital's diabetic foot clinic in Phnom Penh, patients typically sought care an average of five and a half weeks after their ulcer onset, with some waiting for years. Alarmingly, 70% of patients visited only once for treatment.

At the Cambodia-Korea Diabetes Centre, nearly one-third of patients presented with wounds affecting tendons, joints, or bones, and about 50% of these wounds were already infected. Sadly, only two government facilities currently provide specialized diabetic foot care.

The barriers to care are many. Most individuals reside in rural areas where specialized services are scarce and costly to access. Additionally, the common practice of trying traditional remedies first leads to delays in seeking necessary medical attention, compounded by the stigma associated with amputations.

Proactive Steps to Combat Foot Issues

For Cambodians diagnosed with diabetes or for caregivers, one important piece of advice is to have foot circulation checked annually, regardless of the presence of any wounds. This can be done without requiring a visit to a major hospital.

A trained healthcare provider can check the pulses in the ankle and foot. Using a handheld Doppler device, they can compare blood pressure between the ankle and the arm. A low ratio indicates narrowed arteries, and if pulses are weak, an ultrasound can be conducted to locate the blockages.

Additionally, the “four-week rule” should be adhered to: any diabetic foot wound that hasn’t improved after four weeks of appropriate care warrants a closer examination of circulation. Early intervention can prevent severe complications.

Restoring Circulation to Promote Healing

When blockages are identified, they can typically be treated through minimally invasive procedures. A doctor can navigate a fine wire through an artery to clear the blockage, often under local anesthesia. Patients can often walk the same day and return home shortly thereafter. While open bypass surgery remains a viable option for certain cases, most patients benefit from these less invasive techniques.

Restoring blood flow not only heals existing wounds but also helps reduce the likelihood of future complications. However, foot ulcers recur in approximately 40% of individuals within a year and about two-thirds within five years. Regular monitoring of feet and maintaining proper footwear can significantly mitigate these risks.

A Vision for the Future

While Cambodia may not establish vascular units in every province in the near future, there are effective steps that can be taken to address this looming crisis.

First, conducting foot and pulse checks should be a standard part of diabetes management at health centers, paralleling standard blood sugar assessments. Second, equipping local healthcare providers with portable Dopplers and training will enable earlier detection of circulatory issues, even before wounds develop. Finally, a clear protocol for referrals should be established: any foot ulcer that does not show improvement in four weeks should be directed to specialists who can evaluate arterial health.

Diabetes is becoming an entrenched issue in Cambodia. However, with proactive strategies and enhanced awareness, the dire outcomes associated with the condition are preventable.