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Structured educational courses to help people living with diabetes manage their condition are not working.
 
A few closed service providers dominate diabetes education in the UK, and according to the last National Diabetes Audit, less than 2% of the 3.8 million diagnosed with diabetes attend any form of structured education.
 
The non-dramatic, insidious and chronic nature of diabetes masks the fact that it has become a global epidemic with the potential to overwhelm national health systems, if education can't halt its progress. 
 
Although advances in diabetes research are significant, the horizon for a cure is still distant. At this moment in time, the best option to halt the progression of diabetes is convenient, fast and effective education.
 

In October 2014 Harvard professor Douglas Melton announced a breakthrough in the treatment of type-1 diabetes by creating stem cells that produce insulin.

Melton demonstrated that mice treated with transplanted pancreatic cells are still producing insulin months after being injected. Testing in primates is now underway at the University of Chicago, and clinical studies in humans should begin in just a few years.

"Most patients are sick of hearing that something's just around the corner," says Melton, but he's convinced that his research represents a significant turning point in the fight against diabetes.

Type-1
Type-1 diabetes, which usually occurs in children, is an autoimmune disease in which the body attacks its own beta cells of the pancreas and destroys their ability to make insulin. It's a devastating lifelong chronic condition, which affects some three million Americans and 400,000 English people. Treatment is daily insulin doses, a healthy diet and regular physical activity.

Diabetic foot ulcers (DFU) are responsible for more hospitalizations than any other complication of diabetes, and the biggest cause of amputation. Of the 26 million people in the US, and some 3.8 million in the UK diagnosed with diabetes, as many as 25% may experience a DFU in their lifetime. 
 
People living with diabetes are at risk of nerve damage (neuropathy), and problems with the blood supply to their feet (ischaemia). Nerve damage results in a reduced ability to feel pain, and therefore injuries often go un-noticed. Ischaemia can slow down wound healing. Both ischaemia and neuropathy can lead to DFUs. Infections in DFUs can lead to amputation.
 
The burden of DFUs
DFUs impose a substantial burden on public and private payers, doubling care costs per patient compared with diabetic patients without foot ulcers. In the US, ulcer care adds around US$9 to US$13 billion to the direct yearly costs associated with diabetes, and in the UK, around £650 million is spent on DFUs and amputations each year.
 
The five-year recurrence rates of DFUs are as high as 70%. People with diabetes with one lower limb amputation have a 50% risk of developing a serious ulcer in the second limb within two years. People with diabetes have a 50% mortality rate in the five years following an initial amputation. These numbers have not changed much in the past 30 years, despite significant advances in the medical and surgical therapies for people with diabetes.