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The number of diabetic foot lesions and consequently
amputations is increasing in the Western Pacific region
(WPR). However, there are quite a few foot care specialists
such as podiatrists or chiropodists in WPR and there is much
ignorance amongst medical staff as to how to identify and
educate those at risk and treat those who develop problems.
Furthermore, the regional characteristics of diabetic foot,
especially the risk factors for amputation and the methods of
cost-effective interventions, remain unknown.
In order to combat against this devastating problem, we laun-
ched International Diabetes Federation (IDF)-Western Pacific
Region (WPR) Diabetic Foot Care Project (IDF-WPR DFC)
meeting in 2011 which was succeeded to AASD Diabetic Foot
Care Project in 2016. We have invited the doctors and nurses
every year from Mongolia, China, the Philippines, Taiwan,
Vietnam, Cambodia, Thailand, Malaysia, Singapore, Indone-
sia, Australia, and Fiji to share the knowledge and expertise in
the management of diabetic foot problems. Besides the
meetings, we held the practical training course of diabetic
foot care for doctors and nurses in Kyoto and Osaka, Japan.
Through IDF-WPR DFC project, we have collected the clinical
data of diabetic foot from those countries in order to develop
regional clinical guidelines directly applicable to the regional
lifestyle.
In my presentation, I would like to introduce the regional
problems based on these data.
S31-2
Foot care in diabetes in Australia
Stephen M. TWIGG
1,2
.
1
Sydney Medical School and Charles Perkins
Centre, the University of Sydney,
2
Department of Endocrinology,
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia
There is evidence that major amputations due to diabetes
are reducing in some diabetes high-risk foot care services
in Australia, yet diabetes remains the main cause of non-
traumatic lower limb amputations domestically and it
appears to be relatively underfunded compared with other
diabetes complications. Well-established contemporary evi-
dence-based clinical care guidelines in foot care in diabetes
exist in national and state-based formats including from
leading medical and scientific bodies such as the Australian
Diabetes Society and NHMRC Australia. Educational pro-
grams in diabetes foot care for patients and for health care
professionals have been developed including on-line and
these complement the IDF-WPR educational initiatives.
Ongoing challenges remain in broadly geographically
mapping high risk foot care services in diabetes in Australia,
in defining optimal local health care pathways for patients
with foot problems who have varying risk and needs and are
managed in mixed public and private health care systems, in
accreditation and credentialing diabetes high risk foot care
services, and in developing a national database plus collab-
orative sites for multicentre studies. This presentation will
address some current key data, progress being made, and
challenges to come, in this country, which has a well-
developed health care system yet where demands in delivery
of care by geographical size including the need for rural and
regional care, add complexity. Some of the vehicles to aid
realizing systematised delivery of foot health care in diabetes
will be highlighted, including bodies such as the National
Association of Diabetes Centres, Diabetes Australia, stratified
care and online health pathways, multi-disciplinary organ-
isational input, and telemedicine. Finally, some novel multi-
centre studies in diabetes high risk foot care will also be
addressed. It is planned that this presentation will support a
blueprint for equity of access to quality care in all aspects of
diabetes foot care, including in aiding leadership across the
region.
S31-3
From multidisciplinary care for limb-threatening diabetic foot
ulcers in a university hospital to the ongoing diabetic foot
working group in Taiwan
Yu-Yao HUANG
1
.
1
Medical Nutrition Therapy and Endocrinology &
Metabolism, Chang Gung Memorial Hospital and Chang Gung
University, Taoyuan, Taiwan
Diabetic foot ulcers are the leading cause of non-traumatic
amputation. According to a nationwide cohort study in
Taiwan, approximately 4,500 diabetic patients undergo
lower-extremity amputations annually. The aim of this study
was to share 30 years of experience of multidisciplinary care
for patients with diabetic foot ulcers in Chang Gung Memorial
Hospital, and discuss difficulties in cooperation between
departments in real-world practice. We also summarize the
characteristics, classification, treatment strategies and out-
comes of our patients with diabetic foot ulcers, and review
studies of factors associated with lower-extremity amputa-
tions, in-hospital complications, and long-term survival. We
use data on diabetic foot ulcers from the national health
insurance claims database to examine trends in foot ulcers
in Taiwan. In addition, we present data from the ongoing
diabetic foot working group of the Diabetes Association in
Taiwan with regards to improvements in limb preservation,
not only in treatment but also prevention.
Pancreas Transplantation
S09-1
Pancreas transplantation in Korea
Duck Jong HAN
1
.
1
Department of Surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea
Background:
Diabetes mellitus has been treated with oral
diabetic drug and/or insulin. However the increased mor-
bidity and mortality even under insulin treatment is largely
attributable to the diabetic complications that occur over
time. Pancreas transplantation (PT) is an ultimate treatment of
insulin requiring diabetes. Currently much improvement
in patient and graft survival, and decrease of post-operative
morbidity have been brought by technical refinement, better
immunosuppressants, and better post-operative manage-
ment. We hereby report the outcomes of PT performed in
Korea.
Methods:
All the recipients who underwent deceased donor
or living donor PT from July 1992 to December 2015 in Korea
were enrolled in this study. We reviewed retrospectively.
We analyzed graft and patient survival with Kaplan-Meier
method.
Results:
Totally 475 cases of pancreas transplantation have
been performed from July 1992 to December 2015 at 14
transplant centers in Korea. Indication for pancreas trans-
plantation was type I diabetes in 399 (84%) patients and type II
diabetes in 76 (16%) patients. Pancreas donor was deceased
donor in 453 cases (95.6%) and living donor in 22 cases (4.6%).
Type of transplantation was simultaneous pancreas kidney
transplantation in 294 recipients (61.9%), pancreas transplant-
ation alone in 126 (26.5%), and pancreas after kidney trans-
plantation in 55 (11.6%). Median follow-up duration was 108.0
months post-transplantation (range 0
–
281 months). Overall
patient survival rates at 1, 5 and 10 years were 95.3%, 91.3%,
and 87.8%. Overall graft survival rates at 1, 5, and 10 years were
87.4%, 77.3%, and 67.6% respectively. Since 2000, Overall graft
survival rates at 1, 5 and 10 years were 93.8%, 87.7%, and 85.9%
respectively.
Conclusion:
Recently graft outcomes have been improved and
post-operative morbidity decreased. Considering the quality of
life and long-term patient survival, PT can be an effective
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