Global Diabetes Foot Training Programme

Management of the foot in diabetes is an oft-neglected condition, the world over. The nexus of synchronous factors: infection, ischaemia, glycaemic control, neuropathy, bony deformities, ulceration, issues of gait and footwear; make it one of medical science’s most challenging disorders. In particular, the presence of ulceration and the process of healing requires special attention. If neglected, the condition could rapidly deteriorate and lead to amputation. In spite of recovery and rehabilitation, the risk of subsequent morbidity and mortality is high, following amputation.

The Christian Medical College at Vellore has 7 decades of experience in the medical management of the Diabetic foot. Stemming from the legacy of Dr. Paul Brand, rooted in the treatment of leprosy since the 1940’s, this knowledge has been progressively transcribed to the management of the foot in diabetes. Timely and thorough treatment of foot ulcers, and neuropathy, combined with the principles of offloading, and appropriate footwear/prosthesis can make a life-changing difference to the prognosis. The integrated management of the foot in diabetes involves the collaborative capacity of doctors along with nurses and paramedics. Worldwide, the weakest link in this wholistic chain of care is the dearth of hospital-associated technical units to manufacture customized footwear and prosthesis.

Our Mission:

The Global Diabetes Foot Training Programme is being organised by the Department of Endocrinology, Diabetes & Metabolism, the Distance Education unit & the Missions Department at the Christian Medical College, Vellore, India, in collaboration with Vascular Surgery, General Surgery‐1, Prosthetics & Orthotics, Plastic Surgery, and Physical Medicine & Rehabilitation. Our aim is to improve global footcare and footwear by: training, guiding and supporting the creation of multidisciplinary teams, that are equipped to effectively manage the treatment of the diabetic foot. Each team of healthcare professionals would work in tandem with technical support staff who are skilled in the manufacture of customised footwear.

Objectives:

The Global Diabetes Foot Training Program is to be conducted in the following phases:

Phase 1: Online Preliminary Training Phase

Foundational Online training for Doctors, Nurses, and Physiotherapists on the judicious management of the diabetic foot and utilization of footwear. The course is hosted on the CMC Endo training portal, participants will receive unique login credentials to access the same. The training sessions will be conducted online, via Zoom, by experts in the respective areas. (2 hours a week for 4 weeks).

The Curriculum includes:

• Peripheral Neuropathy
• Pre-ulcer state
• Peripheral Vascular Disease
• Osteomyelitis of Foot
• Charcot Foot
• Medical Offloading
• Necrotising fasciitis & common surgeries of the diabetic foot Along with a detailed Pre‐test and Post‐test evaluation.

Criteria for participation:

• Participation as a team is compulsory: there should be at least one Doctor AND one Nurse/Physiotherapist as part of the team.
• Once this criterion is met, there is no ceiling on the number of registrations per institution; provided each individual registers and remits the training fee.

At the end of the course, participants will have acquired the basic skills in preventive and therapeutic aspects of handling the diabetic foot; individually and through an integrated team approach.

The Course material

The Course material will include online presentations and videos. Plus, a copy of the book: DIABETIC FOOT: A COMPREHENSIVE GUIDE FOR CLINICIANS by Dr. Felix Jebasingh K. and Dr. Nihal Thomas: First Edition: 2023, ISBN No.9789354655456, Publisher: Jaypee Brothers Medical Publishers

Certification: 

100% attendance of all 8 hours of the course, successful completion of all compulsory programme tasks (attendance registration, pre-test, post-test, and feedback submission), pass marks (50%) as an aggregate of all the Post tests conducted, and pass marks (50%) in the Online team assessment (Mega Test) are required to attain the: Foundational Certificate in Diabetes Foot Care.

The Mega test is an Online team assessment that will serve as a mandated gateway leading up to the In-person, intermediate level training in Diabetes Care (Phase 2A).

The objective is to ascertain the capacity of each team based on performance.

THERE WILL BE NO COMPENSATORY SESSIONS FOR PARTICIPANTS WHO DO NOT ATTEND/ COMPLETE THE COMPULSORY PROGRAMME TASKS, AS PER THE PROGRAMME MANDATE, ON THE SPECIFIED DATES.

Phase 2a: In-person Hands-on Training Phase

Intermediate to Advanced level training in management of the diabetic foot.

To qualify for this phase, participants will need to acquire the Foundational Certificate in Diabetes Foot Care through Phase 1 of this training programme. Attendance to this programme will be on a team basis [one Doctor AND one Nurse/ Physiotherapist per centre]. Participants will have to organize their travel and stay in Vellore; however, the entire training programme will be subsidized.

The course will be a hands‐on programme with patients, and parallel education on some theoretical concepts, along with online modules, assignments and project work. Sessions will be conducted by faculty from the departments of Endocrinology, Vascular surgery, General surgery, Prosthetics and Orthotics, Plastic surgery and Physical medicine and rehabilitation. The programme will run for 4 full days from Tuesday to Friday and will involve experience in the diabetes foot clinic, vascular laboratory, orthotic centre and Physical medicine and rehabilitation centre. There will be a theoretical and a practical evaluation at the end of the programme.

Apart from attending the in-person training, the online modules, assignments, project work and final exam are compulsory programme tasks that must be completed. Participants who have successfully completed all mandated Programme tasks will be presented the Completion Certificate in Diabetes Foot Care at the Programme Graduation ceremony which will take place at Vellore.

Additionally, participant performance across the board will be evaluated and the top 3 teams will be awarded at the Programme Graduation ceremony. There will be mementos for the teams with the best projects.

Certification: 

Completion Certificate in Diabetes Foot Care.

Phase 2b: Continuing In-Team Education by The Vellore Staff in The Targeted Participating Centres

Two‐day workshops and continuing medical education with practical demonstrations will be conducted by the team from CMC, Vellore at peripheral centres across the country. Centres will be identified as potential training partners with CMC, Vellore in the professional management of the diabetes foot. These centres will subsequently serve as trainers/training hubs to impart knowledge and skills in the management of diabetes, to other health care professionals.

Phase 3a: In-person Training of Prosthetic & Orthotic Personnel

The focus is on rigorously training prosthetic & orthotic personnel, technicians and shoemakers to work with health care providers in improving the management of the foot in diabetes. It is a capacity-building exercise and they will receive extensive technical guidance and support on the nuances of diligently crafting custom footwear and devices.

Phase 3b: Setting Up Manufacturing Units to Produce and Distribute Custom Footwear and Prosthetics in Targeted Participating Centres

This in a sense is the most unique and vital part of the programme. The prosthetic and orthotic centres in CMC Vellore will develop a blueprint to enable the manufacture and provision of footwear and prosthesis. This is to be achieved by nurturing the capacity of existing prosthetic and orthotic centres, and collaborating with the nearest purveyor of key raw materials: MCR, EVA etc. in order to streamline the supply chain.