What is the St. Vincent Declaration?

Representatives of government health departments and patients' organisations from all European countries met diabetes experts in St. Vincent in Italy in 1989. They agreed a number of recommendations for member states to adhere to in order to improve diabetes care for their citizens. The main target set for feet was to "reduce the numbers of limb amputations for diabetic gangrene by 50% in a five year period"

The British Department of Health and the British Diabetic Association jointly set up a task force in 1992. It produced a number of reports. It produced some "Key Facts" and some "Priority needs" as set out below:

The St. Vincent Declaration 1989

4.09 Preventing foot complications in diabetes

Reduce the rate of limb amputations for diabetic gangrene by half.

Key facts

• Half lower limb amputations, other than those following trauma, are a consequence of diabetes. In people with diabetes, the risk of amputation is increased 15-fold
• Some risk factors- smoking, high blood pressure, abnormal blood lipids - are reversible. Others, such as diabetic nerve disease and foot deformity, can be detected early and countered effectively.
• Systematic and regular foot care has been shown to reduce the risk of chronic ulceration and amputation in the lower limb by 50% or more.
• Admission for diabetic foot/leg disease is the single largest component of hospital bed usage by people with diabetes. Almost half of all diabetes-related admissions are for lower limb disease.

Priority needs

• Regular, systematic screening of feet and legs for detection of and correction of reversible risk factors.
• Immediate access to qualified foot care for those at high risk.
• Systematic patient education in foot care to reduce chronic ulceration and need for surgery.
• Establishment of multidisciplinary teams, including podiatrist, shoe fitter, nurse surgeon and physician to provide care for those with special needs.

Most health districts in the UK have set up Local Diabetes Service Advisory Groups to try and achieve these aims.