Diabetes mellitus is a chronic metabolic disease characterized by a high sugar level in blood. It can be caused by low production of insulin, resistance to insulin or both causes. The so called Diabetes type 2 is much more often than the type 1, roughly corresponding to 90% of all diabetic persons, usually present at adult ages. The World Health Organization (WHO) has reported a prevalence of 371 million of diabetics in 2013, value that will be higher than 400 million by the year 2030. Therefore, it has been argued that this disease could cause more death that AID, and it is currently the fourth cause.
The insufficient healing of diabetic wounds is an unmet medical problem at global scale. It has been argued that 4 – 10% of diabetic patients develop a DUF at any moment of their lifetime. Nearly 50% of the amputated population can suffer a second amputation of the counter-lateral extremity in a period 2 - 5 years, which involves the loss of the patients' quality of life, in addition to considerable expenses for the health system. This problem is unfavorably exacerbated by the fact that less than 69% of amputated patients (major amputation) will survive in the following 5 years.
In USA, the amount of diabetic patient reached 24.1 million in 2012, and 68 000 amputations were performed in 2009 (according to CDC), and the cost of management of these lesions for the USA health system is in the order of billions of USD. In Spain, there are 3 249 500 de diabetic people (7.2% of population), more than 250 000 patient develop a DFU, and more than 10 000 suffer major amputations. The most common cause of hospitalization in Spain is DM, and the most frequent complication is DFU. According the magazine Diabetes Voice, in June 2005, an amputation related to diabetes complications was performed in any place of the world, every 30 seconds, which demanded 40% of available health resources in developing countries. For example, in Argentine, 8% of hospital beds are devoted to diabetic patients, being DFU the primary complication. Additionally, 19 amputations/day and 7000 per year are performed, and 7 of 10 patients are diabetic.
In Cuba, the diabetic population is 3 – 6% of the total, and the amount of people susceptible of any amputation was 1500 – 3000, before national extension of Heberprot-P® was started. These data are enough to show the magnitude of the challenge that DM represents, and DFU as the major related complication that represent a significant source of morbidity and mortality in diabetic patients. In spite of conventional treatments and the management of this disease, a significant amount of diabetic patients do not respond, and are susceptible of amputations.
In that sense, the Cuban Ministry of Health is working to reduce the mortality rate due to DM from 11 to 7%. To this end, the Ministry supports the work of hospitals with medical expertise and resources for the attention of this disease. The key issues are performing screenings, finding early the hidden DFU, implementing a suitable intensive treatment, and controlling the patient metabolism to avoid later complications of this disease.