About 16.7 per cent of the Maltese population is living with diabetes (9.2 per cent) or impaired glucose tolerance (7.5 per cent). This high prevalence in the population is responsible for one in four deaths of the Maltese people before the age of 65.

The problems associated with diabetes mellitus in Malta seem to have come to the fore in the latter part of the 20th century, even though Maltese medical practitioners were familiar with the disease since earlier centuries.

This higher rate of diabetes may be due to a combination of factors including changes in lifestyle, an ageing population and genetic factors. Maltese culture is broadly Mediterranean, but it is at the same time very distinctive: it has its own unique blend of historical and economic traditions which in turn have influenced the values, motivations, expectations and practices that characterise the Maltese people.

Although most argue that their country sits within a wider European culture, certain factors remain exclusive to Malta. In particular, the Maltese are very reluctant to relinquish certain traditions related to social life, family work and feasts. Malta’s historical diversity, climate, religion and culture have resulted in a nation that values eating out with families, especially on weekends.

Patients living with diabetes are in urgent need of screening, assessment and intervention

In addition, the Maltese engage themselves all year round in religious-oriented public or family-oriented feasts and celebrations that are all traditionally marked by large parties and an abundance of food. The type of food available for consumption during these occasions is high in fats, sugars and carbohydrates and thus significantly contrary to the successful prevention and management of diabetes.

Diabetes has various direct and indirect consequences such as major economic effects for both patients and their families and a reduction in the quality of life.

Diabetic foot complications and ulcerations are also a global concern since they are said to precede lower extremity amputations, lower the quality of life of individuals living with diabetes and account for a large proportion of hospitalisations and a substantial amount of incurred hospital costs.

Patients living with diabetes are in urgent need of screening, assessment and intervention because of the vast complications which this condition imposes if not managed correctly.

In the absence of a formal foot screening programme made available to all people living with diabetes both at diagnosis and also throughout the course of the disease, it is likely that people at risk of foot deterioration and ulceration will go unrecognised, thus leading to foot amputations and poor quality of life to both patients and their family members.

Foot care specialists’ input is crucial to proper management of the diabetic foot. To decrease complications, patients should seek professional advice as early as possible and healthcare professionals need to adopt the culture of always screening and educating patients with diabetes.

Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidisciplinary medical specialty care may decrease the rates of ulcerations and amputations and improve the survival rates in this high-risk population.

Cynthia Formosa and Alfred Gatt are founding member and chairman respectively of the Diabetes Foot Research Group at the University of Malta.

For more information on diabetic foot research in Malta, contact the Podiatry ­Department on 2340 1838, or visit www.um.edu.mt/healthsciences/diabetesfootresearch for local research ­conducted on diabetes.