The number of diabetic patients seeking wound care on Guam and the Philippines is alarming, according to local and international health care professionals.
Four local physicians and two visiting health care providers were guest speakers during the 19th annual Guam Diabetes Conference on Sunday at the Hilton Guam Resort & Spa.
This year's theme was "Diabetes Control Saves Your Legs," since most diabetic wounds infect the feet and can lead to necessary leg amputation if severe.
The driving point of the conference, a consensus between the physicians, is that Guam's diabetic patients can avoid trips to the hospital and serious health conditions by making small lifestyle changes.
Lifestyle, genetics to blame
The major changes needed are rooted in Guam's culture, which at first surprised Guam Regional Medical City wound care specialist Dr. Edna Acuna, who moved to Guam from Texas in 2012.
"When I first came, I was so surprised, because I found out the culture in Guam is so different from that in the mainland," Acuna said.
"The culture here is eating, eating, eating all the time. You always find a purpose to eat: rosaries, graduations, etc."
Guam residents eat a lot of rice and processed foods, which aren't healthy in excess, Acuna said, in addition to Guam having high cigarette-smoking rates compared to the states.
She said that while walking barefoot around the house is common on Guam, it isn't safe or smart for diabetic patients trying to avoid infection.
These cultural factors, in addition to Guam residents living a "sedentary lifestyle," cause diabetic ulcers to deteriorate and become progressively worse, Acuna stated.
"This is the kind of thinking that we need to change. The rate of diabetic care is of epidemic proportions. One out of every five people here has diabetes," she said.
The average Guam resident's genetic makeup is also to blame, Acuna said, nodding to 90 percent of Guam's population being of Asian or Pacific Islander descent.
CHamoru and Filipino residents made up about 66 percent of Guam's population with other Asian and Pacific ethnicities contributing a combined 17 percent, according to the 2010 census.
"These two together gives you 90 percent of risk of diabetes," Acuna said.
Twelve percent of Guam's adult population have type 2 diabetes, according to the Guam Diabetes Association, which states diabetes is the sixth leading cause of death on Guam.
Encouraging proactive attitudes
Dr. Gene Tiongco, who oversees the Wound Care Center at St. Luke's Medical Center in the Philippines, said a significant number of Guam patients seeking treatment at the hospital have diabetic wounds.
He said 80 percent of Guam patients at St. Luke's, at any given time, are visiting for wound care due to diabetes, adding that the hospital sees at least one Guam patient a day for diabetic infections.
He said the vast majority of diabetic injuries he's seen with Guam patients could have been avoided if they had been proactive.
Dr. Phillip Tutnauer, a podiatrist at GRMC, said feet are largely subject to diabetic wounds due to diabetic neuropathy, which leaves feet numb and susceptible to infection.
"Let's not let things get to a wound. If you can't check your feet daily, have someone check your feet daily," Tutnauer said. "An ounce of prevention is worth a pound of cure. In (diabetes), it's a 100 percent cure."
Tending to a local diabetic patient who had cleaned outdoors after a recent typhoon, Tutnauer said the patient ended up with a severe infection because he was wearing slippers instead of proper footwear.
"I had to take him to the operating room to clean out the infection. All it takes is one time to not be careful," he said.
Diabetic patients also don't often realize they might be wearing ill-fitting shoes or socks, he added, which could constrict arteries in the feet.
Tutnauer advocates that patients with Medicare take advantage of free, annual diabetic foot exams and one pair of free, therapeutic shoes via the Medicare Therapeutic Shoe Program.
Wound care technology advancing
"You do have a clinic you can go to in case you have a wound. It's not the end of the line," Acuna said, referring to wound care services offered at GRMC.
"However, I wish you would come to me earlier in the stage. Not when you're ready to have an amputation. Be proactive with your diabetic care, so you won't have to stay with me for a long time."
Tiongco said advances in wound care have opened doors for diabetic patients, who now have better chances of saving their legs from amputation.
"As much as possible, we want to save the limb," Tiongco said. "As far as wound management is concerned, it has really evolved."
Progress in diabetic wound care technology, according to Tiongco, includes foam dressing with embedded antibiotics, a blood spray that delivers oxygen, hyperbaric chambers that deliver oxygen throughout the body, improved supplements that increase immunity and facilitate faster wound care, and more.
He said all of these new technologies, U.S. Food and Drug Administration-approved, are available at St. Luke's Medical Center, and some at Guam's hospitals.