May 2016
Dear Reader.
It has been a little while since the last newsletter, we apologise to all our readers and friends around the world for this. There have been some significant organisational changes within the IWGDF, which has led to this delay. These can be read below in the contents of this newsletter.  We also want to acknowledge and celebrate 20 years since the beginning of the IWGDF, and hope you join with us in saying thank you to its originator.  We know how important it is to share information and news with our foot family across the world. We hope that you all can help us by contributing to this newsletter with any news items, information etc. from wherever you are in the world. We look forward to hearing from you. Because of the recent changes this newsletter is not currently in its definitive presentation in relation to both layout and content. It is anticipated that there will be no further delays in future newsletters.
Neil Baker  
Announcement of some changes to the newsletter. 
Karel Bakker, past chief-editor

20 year Anniversary 1996-2016 IWGDF
Global Tributes to Karel Bakker

New changes in IWGDF:

The Executive Board of IWGDF
The IWGDF Constitution
IWGDF Organizational Structure
Additional news and further IWGDF developments
News from Washington, Diabetic Limb Salvage (DLS) conference 
Announcement of some changes to the newsletter
Karel Bakker, past chief-editor  
Karel Bakker writes “Neil Baker is known as an outstanding teacher and educator and has been an international IWGDF faculty member from the very first hour of the Step-by-Step Train-the Foot-Trainer and other IWGDF programs. 
By stepping down I wish Neil, as our new chief-editor a lot of success with the busy task to keep the website updated and to continue the regular publication of IWGDF Newsletters. I feel that without any doubts these projects will be in 'good hands'.”
20 year Anniversary 1996-2016 IWGDF
Photograph of the Organizing Committee ISDF 1st (International Symposium on the Diabetic Foot), Noordwijkerhout, the Netherlands May 1991.
Standing left to right: Andrew Boulton (UK), Karel Bakker Netherlands), Jan Rauwerda (Netherlands), Per Holstien (Denmark), Folke Lithner (Sweden), Bob Michels (Netherlands) Kneeling: Lawrence Harkless (USA) Standing: Arie Nieuwenhuijzen Kruseman (Netherlands) 
This year sees the 20th year birthday of the start of the International Working Group of the Diabetic Foot. What a fantastic milestone and some many incredible achievements have occurred as a result. The fact that you are sat reading this all around the world is testament to incredible dedication and exceptionally unyielding work of some remarkable individuals. 
I hope you all take great pride and delight whilst reading about a man who has been the main architect and bastion of this achievement. Karel we thank you and honour you for the incredible example you have set and for helping us relieve the suffering and burden of diabetic foot complications in corners of the world.  Understanding and reflecting upon history facilitates the growth of wisdom and maturity in all walks of life, in celebration of 20 years of IWGDF, Professor Andrew Boulton one of the founder members of our great diabetic foot heritage outlines below a brief account of the IWGDF entitled: 

 “Establishing the International Working Group on the Diabetic Foot: early history”

The early history of the establishment of the International Working Group on the Diabetic Foot (IWGDF) really goes back more than 20 years and I will start with the meeting that Henry Connor and I had at the British Diabetic Association meeting in Warwick, UK, in March 1985. It was at this time that we sat together to discuss the possibility of a national/international meeting on the diabetic foot as there was none in existence at that time. This was the birth of the Malvern diabetic foot meetings and our first meeting occurred in May 1986 at the Abbey Hotel, Malvern. I first met Karel Bakker at the second Malvern diabetic foot meeting in May 1988 and was impressed by his major interest in the diabetic foot and in establishing an international meeting and group. It was at a meeting organised by Bob Frykberg in Boston (a meeting of the Massachusetts Podiatric Medical Association) where I was an invited speaker, that I first formally met with Karel Bakker who was with Bob Michels, a diabetologist from Amsterdam and John Dooren, a podiatrist who worked closely with Karel in Heemstede. Karel requested a meeting with me and as a group we discussed the possibility of establishing a regular international meeting on the diabetic foot. His energy and enthusiasm was infectious and all 4 of us agreed to take this forward and our first planning meeting was held in the Netherlands in 1990. The organising committee comprised Karel Bakker (Chair), Jan Rauwerda (Amsterdam), Larry Harkless (USA), Per Holstein (Denmark), Folke Lithner (Sweden), Bob Michels (NL), Arie Nieuwenhuizen-Kruseman (Professor of Medicine and Dean at the University of Maastricht, NL) see photo above. The first meeting went ahead in May 1991 in Noordwijkerhout, the Netherlands and was a great success. Following the success of this meeting, it was decided that this should occur every 4 years and steps were taken to form the IWGDF during the second meeting in Noordwijkerhout, May 1995. At the 6th Malvern diabetic foot meeting in May 1996, a small committee met to establish and formalise the IWGDF and this was followed by a major meeting held in the winter of 1997 at the Bridge Hotel, Prestbury, near Manchester which I organised and Karel led. The founding steering committee included Karel Bakker as Chair, William van Houtum, Jan Apelqvist and Nicolaas Schaper. Those present at the Bridge Hotel meeting included (working from memory!) Gayle Reiber, David Steed, Jennifer Mayfield, Peter Cavanagh and Larry Lavery (USA), Henry Connor and myself (UK), Karel Bakker, Nicholaas Schaper, William van Houtum (NL), Per Holstein and Elizabeth Vang (diabetes specialist nurse) (Denmark), CV Krishnaswami (India), and Jan Apelqvist and Dr Falkenberg (Sweden). Thus, by 1997, the International Working Group on the Diabetic Foot was no longer in its gestation but actually in its infancy! Thereafter, of course, the IWGDF has gone from strength to strength and has a number of major publications, guidelines, etc, to its credit. No doubt it will continue to have a major influence on global policy on the diabetic foot.
Global Tributes to Karel Bakker
We invited a few people from around the world to write a few words of tribute about Karel. The response was unsurprisingly very swift and ….well you can read them. I know we could have filled this and future newsletters with similar tributes to Karel ...
David G. Armstrong - USA
DPM, MD, PhD Professor of Surgery and Director Southern Arizona Limb Salvage Alliance (SALSA) University of Arizona College of Medicine

“I think that when the final chapter is written after we have rid the world of the scourge of diabetes and its lower extremity complications, there will be a central place for good Sir Karel, our specialty's éminence grise. He is and was our Charles Talleyrand, Benjamin Franklin, and Ban Ki Moon all rolled into one. He created our own United Nations and set it on the solid course it is on today. If immortality is defined as the persistence of someone's personality and deeds in our collective memory, then he's a shoo-in”. -DGA  
Hermelinda C. Pedrosa - Brasil
MD Endocrinologista Presidente Eleita da Sociedade Brasileira de Diabetes - 2018-2019 Diretora do Departamento de Diabetes da SBEM | Assessora para Relações Governamentais da SBD Coordenadora - Polo de Pesquisa - FEPECS - Centro de Pé Diabético|Unidade de Endocrinologia - HRT SES-DF. Vice-President - Worldwide Initiative for Diabetes Education
I will never forget my first contact with Karel, it was a long time ago, in Malvern. I had just started to present preliminary data on the Brazilian Diabetic Foot Project, with our established foot clinics represented in our continent-size country map. This presentation had a significant impact because it showed the reality of our very scarce trained staff and tool resources. I developed further links with the IWGDF, being the first Latin American representative which, made a great change in my professional life and has become a source of motivation to carry on, despite the continuing difficulties we face in a developing and heterogeneous country. He has had a special firm way to conduct the "big foot family", now spread in the whole world, gathering everyone together by means of a very sweet "colonel"! I use to say in Portuguese, for people who have an important part in my heart, he is much "ventricular". Thank you deeply, dearest Karel, for being just an incredible leader!  
Dr Zulfiqarali G. Abbas- Tanzania
Consultant Physician, Endocrinologist, Diabetologist Chairman, Pan-African Diabetic Foot Study Group 
In 1992 when I started working with diabetic foot problems in Sub-Sahara Africa the government and health ministries did not consider these significant. Whereas HIV / AIDS, Tuberculosis and Malaria were given priority, prominence and thus resources compared with any non-communicable disease. In 2003 Dr Karel Bakker the chair of the International working group of diabetic foot, proactively raised and supported awareness of diabetic foot disease in the developing world. This was in response to the unacceptably high rates of morbidity and mortality due to preventable diabetic foot pathologies. Karel has been one of the instrumental people in raising awareness, helping to establish and support African foot clinics to support strongly in creating awareness and helping in establishing diabetic foot clinics through the innovative "Step by Step" foot projects. A pilot project was conducted in Dar es Salaam, Tanzania in two consecutive years (2004-2005). The immense success of this project resulted in further implementation occurring within other African countries, developing world and now to the developed world.
Dr. Lee J. Sanders - USA  
DPM, is a Consultant to the Lebanon VA Medical Center, where Dr. Sanders served as Chief of Podiatry Service from June 4, 1978 to June 30, 2008. Dr. Sanders serves as a Member of Scientific Advisory Board of Soluble Systems LLC. He is Adjunct Clinical Professor, Department of Podiatric Medicine and Orthopedics, Temple University School of Podiatric Medicine.
With wisdom, skill, and vision, Sir Karel Bakker has advanced awareness and management of the diabetic foot worldwide. His engaging personality and humor made collaboration a pleasure. We worked together on the editorial board for the IDF/IWGDF Time to Act publication Diabetes & Foot Care, commemorating World Diabetes Day 2005. Together with the ADA and the IWGDF we promoted international awareness of diabetes, the diabetic foot and amputation prevention on postage stamps in the USA, Brazil and Tanzania. My wife and I congratulate Karel on his many accomplishments, during 20 years at the helm, as chair of the IWGDF. Cordially, Lee
Sharad Pendsey - India  
Consultant diabetologist at Nagpur, India Chairman, Step-by Step foot care project- World Diabets Foundation ( WDF) Ex- president, research Society for the Study of Diabets in India ( RSSDI) Managing Trustee, Dream Trust, NGO, for welfare of diabetic children
I have known Karel since 1995 he has unique quality of leadership; he always makes it a point to reach each and every delegate in a mega conference. He was my mentor for step by step project and entrusted me chairmanship. The project was a game changer for Diabetic foot scenario in India. All these 20 year he has been always guide, friend and philosopher for me. He has charismatic personality, is always energetic with great leadership qualities and affectionate nature.  
Professor Abdul Basit - Pakistan  
F.R.C.P. (Lon) Director Baqai Institute of Diabetology & Endocrinology (BIDE) Professor of Medicine Baqai Medical University 
"Karel Bakker - The mentor of diabetic foot care in Pakistan"

 I would not be able to forget the memories of the moments spent with Karel - a daring leader, a sincere friend, a helpful colleague and a caring host. The guidance and the direction of Karel have been pivotal to the diabetic foot care activities and endeavors of my team, since I first met him about 12 years back. The very active participation of Karel in our “International Diabetes Conference” in 2006 at Karachi was a turning point as he laid down the foundation of “Pakistan Working Group on the Diabetic Foot”. “Step by Step” foot care program was inducted in Pakistan by the help and support of Karel. Be it the training programs or the establishment of foot care clinics, his guidance was everywhere. I would wish to dedicate “diabetic foot care in Pakistan” to our mentor- Karel Bakker.
Professor Michael Edmonds - UK  
Consultant Physician at King’s College Hospital London UK 
Karel Bakker had the great wisdom to appreciate that there was a need for an international set of definitions and guidelines on the prevention and management of the diabetic foot. He created the International Working Group on the Diabetic Foot (IWGDF), a unique multidisciplinary team of experts on the diabetic foot that included general practitioners, diabetologists, podiatrists, diabetic nurses, as well as, general, vascular and orthopaedic surgeons Through a process of consensus and regular update, which Karel brilliantly masterminded, this group produced the International Consensus on the Diabetic Foot, which has been translated into many languages and has transformed the care of the patient with diabetes and foot problems throughout the world .We all owe him a massive debt of gratitude and wish him a very happy and well deserved retirement.
Per Holstein - Denmark  
MD, DMSc, Consultant orthopedic and vascular surgeon Consultant orthopedic surgeon, Bispebjerg Hospital, Copenhagen
I am extremely grateful for being involved in the Dutch approach to the diabetic foot at a very early stage – at a time, when foot complications really were “cindarella”. Karel`s great organizational talent and never resting, intense activity has brought this matter to an advanced stage, where it belongs - in as much as the actual epidemiologic world -wide increase in diabetes. I am very proud of having been working with Karel for many years and my sincere thoughts also go to his dear supporting wife Anneke.  
Nicolaas Schaper- Netherlands
MD, PhD, Diabetologist, Endocrinologist at the University of Maastricht, the Netherlands. He is chair of the International Symposium on the Diabetic Foot and he is also chair of the Guidance Document of the International Working Group on the Diabetic Foot.
The IWGDF was and is a unique initiative, with its guidelines translated in so many languages and with so many successful projects world-wide. This was only possible because of the unique personality of Karel Bakker. He keeps on going with relentless energy, with all his charms as ambassador of the diabetic foot, inspiring so many experts-in-the-fields to share his dream to improve the care for patients with a diabetic foot ulcer.
Shigeo Kono - Japan  
Director WHO-collaborating Centre for Diabetes, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
Our “Great Father”, Dr. Karel Bakker “International Consensus on the Diabetic Foot” by the International Working Group on the Diabetic Foot published in 1999 opened the door to the scientific awakening for the healthcare providers in Western Pacific Region (WPR). It was a historical liberation from a chaotic world and indeed good news to the patients in WPR. Vincent van Gogh’s “The Sower” always reminds us of Dr. Karel Bakker. The seeds he planted in WPR are now sprouting up all together. On behalf of the people in WPR, we would like to express our sincere gratitude to him.   
Dr Kristien Van Acker - Belgium
Current chair of IWGDF ,PHD .MD Diabetologist in Belgium and started the first Interdisciplinary Diabetic Foot clinic in Belgium
Dear Karel there are no words enough to thank you for what you have done for so many patients with diabetes and suffering from a diabetic foot problem. When you asked me to take over your job as chair of IWGDF at Melbourne December 2013 (see newsletter march 2014), it was clear that nobody could do this. You had so many heads, so much wisdom and you are THE pioneer of implementation. We will do our out-most best with a big team from the next generation of “your diabetic foot family” to replace you and to look already for a devoted and enthusiastic next generation to continue your great work, done with passion. We hope that you can find the so deserved time with Anneke and your family and will enjoy being in the lovely garden.  
New changes in IWGDF
As many of you may have heard or be aware of there are some significant changes that have occurred within the IWGDF. Firstly we would like to introduce you to the executive committee members. 
The Executive Committee of IWGDF consists of: 

                                K. Van Acker                    S.Morbach                     Z.Abbas                     S.Kono                           V.Urbancic
Kristien Van Acker, Belgium 
Stephan Morbach , Germany
Z. Abbas, Tansania
Shiego Kono, Japan
Vilma Urbancic, Slovenia

In the next newsletter we will introduce you to each of them more fully by asking each to share more information about themselves, where they work and what they do. They have been working hard already producing the official legally required papers necessary to establish an International Institution, whereby auditing can occur.
The IWGDF Constitution/by laws:  
IWGDF now has a legal and organizational framework for its activities, which are underpinned by constitutional by laws. More information will be given and a full version of these will be available upon the website near future.Other boards will be created within this new organisation to perform specific tasks and duties to help support the executive board and promote the activities and work of the IWGDF. 
The proposed organisational structure is shown below. 
IWGDF Organizational Structure  
The IWGDF organisational structure will consists of:

  • Executive committee (EC) 
  • Scientific Board (SB)
  • Advisory Board (AB)
  • Projects Boards (PB)
  • Regional working groups (RWG) 

We are happy to inform you that currently Prof. Andrew Boulton, Mike Edmonds and Jan Appelqvist have accepted to be our scientific advisors.
In the coming newsletters we will give you an update of the members from each of the boards. It is our mission to have all of the chairs from each of the 7 regions very actively involved during their term of office 
We have started a journey to get a strong and democratic organization set up in a step-by-step procedure. We would like to share with you that currently our network is reaching delegates from 130 nations. This is an increase of 40 nations since the end of 2013.
Other important organisational news
In order to run more effectively and efficiently we made a decision to become a partner with the AGADA Institute based in Slovenia. This institute is a diabetes education and research institute and is a non governmental, non-profit organization dedicated to advance in excellence and quality of diabetes education, research, patient care and clinical practice. More information about AGADA is to be found on their website, please visit it and learn more about them:  
Additional news and further IWGDF developments include  
A Guidance Document Group led by Nicolaas Schaper.  
Following a meeting in Almelo in January the members of the Guidance Document Group are the following:
Nicolaas Schaper, Jan Apelqvist, Sicco Bus, Ben Lipsky, Jaap van Netten, Rob Hinchcliffe. It is planned that in one of the next newsletters, Prof. Nicolaas Schaper will share with us, his own experience of implementing the guidance document in his own countery - the Netherlands.   
Collaboration with IDF   
For those of you who are not aware there have been  significant changes in the relationship between the IDF and IWGDF, Dr Kristien van Acker explains below: 
Following their recent meeting in January the new IDF board, decided to stop all collaboration with two of their long-term Consultative Sections –the Education group, and Diabetic Foot group, who served the IDF for 20 and 15 years respectively. This unilateral decision was given at very short notice and was hard to believe particularly as it was accompanied by inaccurate and unwarranted rumours. In response a very clear reply and document was sent addressing these issues to the present, former and future IDF board members and our IWGDF key opinion leaders, accounting for the voluntary work we have performed over the many years. As a result there are some practical consequences we would like to share with you.
IWGDF is definitely going to continue its work with the important focus on our mission statement raising awareness and advocacy related to diabetic foot disease with one main goal: “providing patient centred care for the reduction of ulcers and amputations worldwide”
As IDF clearly states its’ work is “all united”, we strongly condemn their approach to actively try to recruit our key persons in the Diabetic Foot care on global level to start a parallel working group with the new IDF board. We understood that Ammar Ibrahim, from Dominican Republic is taking the lead of the new installed Task Force. We wish this working group good luck and hope that cooperation will occur in the future. 
IWGDF developed the Guidance Documents for many years and initiated many implementation programs together with a unique Data collection system, all of which have intellectual property rights of the IWGDF. There was an agreement that IWGDF should disseminate programs in collaboration with the IDF. The most important collaborative projects where agreements were established with the IDF were Train the Foot Trainer Programs (TtFT- programs in the Caribbean region, SACA region and in Europe region) and the Diabetic Foot Care assistants Projects (for example in Dubai for the Middle East). 
The consequence of this separation means that the IDF logo can’t be used anymore in the follow up from these programs.
It is clear that IWGDF will further support the regions where we had an engagement. The programs are also intellectual property of IWGDF, what was recognised by IDF office. 
Planned programs 
The TtFT course planned for Africa in August 2016 will not be held as planned but will be postponed till February 2017. 
The TtFT course for the Western Pacific region for November 2016 is in full discussion for further action and fund raising. 
e- Learning package:   
An education group of the IWGDF consisting of a small group of experts collaborating with the UNMF ( team headed by Line Kleinebreil and supported by an unrestricted grant from URGO has developed the first of two sections of an e- learning package that will help the TtFT courses in the future for dissemination and also support the development of young professionals in the diabetic foot. Neil Baker together with Kristien Van Acker was the co-ordinator of the content. We were nicely assisted by the team of UNMF and more precisely by Thomas Barratier. Our actual contributors were: Pod Neil Baker ,Dr Claas Lüdemann, Germany; Dr José Luis Garcia-Klepzig, Spain, Prof Mike Edmonds, Prof Vilma Urbancic, Dr Kristien Van Acker, Dr Stephan Morbach and Prof Jan Appelqvist. The content consists of video recorded PowerPoint presentations and videos of practical skills. Currently this is available to those who have trained on the TtFT programs and some Urgo foundation junior doctor training program. 
It is anticipated that it will be available to all sometime in the near future but for now you can see (above) two screen shots to give a flavour of some of the current content. 
GATE Project   
The “Gate project” of the WHO and the contribution of the FLIRT group and many of you, our IWGDF network. Recently we became partners of World Health Organisation, WHO for the “Gate project”. 

Neil Baker and Kristien Van Acker were invited at the Consensus Meeting for Priority Assistive Products list ( biggest achievement is the recent work from all of you, who were extremely active in helping us in distribute a survey related to the WHO/ Gate project on Assisted Living products. The feedback and input of the IWGDF network was extremely respected by the WHO “Gate project” board. As representatives of the IWGDF we were one of approximately 50 delegates representing all different disabilities. We are pleased to say that therapeutic footwear and lower limb orthoses and prostheses are now identified amongst the 50 most essential assisted living products worldwide. This means that WHO will endorse and push for footwear as an essential product, which is fantastic news for our patients and should be helpful in lobbying health ministries. WHO Priority Assistive Products List (APL) was launched on 24 May 2016 during the World Health Assembly side event, ”Assistive Technology for all” 
News from Washington, Diabetic Limb Salvage (DLS) conference
Under the lead of Christopher Attinger and other co- chairs, John Steinberg, Cameron Akbari and Nelson Bernardo, a successful conference took place in, April 2016. On their website we can read the following: “Limb Salvage Is NOT Enough: Function, Quality of Life and Cost Determine Successful Outcomes” Highly regarded as one of the world’s finest limb salvage events, DLS brings together the most eminent lower limb specialists for an unforgettable meeting. In its 9th year, the DLS conference equips each member of the health care team with the education and resources needed to heal wounds and prevent amputations.

Karl Bakker recived the 2016 Medstar Georgetown distinguished achievement award
"From left to right George Andros and his wife Karel Banker with his daughter and wife "
At this conference our Immediate Past Chair IWGDF received an achievement award: “the 2016 Medstar Georgetown distinguished achievement award”
"Dr Bakker's work has proven itself invaluable time and again in the field of diabetic foot care," said. Christopher Attinger. "His dedication extends far beyond the hospital to some of the most remote parts of the world Dr John Steinberg continued Dr Attinger's sentiments saying, "Dr Bakker's work with improving diabetic foot care in developing countries has opened the door for us to continue to improve treatment of a global epidemic. He has proven that with proper training and dedication, world-class care can be provided in less than ideal conditions." 

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