Diabetes, Endocrinology & Diabetic Footcare

The Centre for Endocrinology and Diabetic Foot Surgery is the only full-fledged endocrinology centre in the entire state of Kerala and provides advanced care for diabetes mellitus as well as complex endocrine diseases. There are full facilities for the investigation and treatment of endocrine problems in adult, paediatric, and adolescent patients and all the complications of diabetes. The Centre consists of a dedicated and well-qualified team of healthcare professionals comprising consultant endocrinologists, endocrinology specialists, diabetic foot surgeons, diabetic fellowship trainees, diabetic educators, physiotherapists, podiatry assistants, medical social workers, dieticians and support nursing, administrative and research staff. 

The Diabetic Foot Surgery provides comprehensive care in all aspects of diabetic lower limb surgical problems. This integrated team approach, important in the proper management of diabetic lower limb problems, is available in only a few centers worldwide. Our evaluation and management techniques are of world standards.  
The concept of surgical correction for diabetic foot and ankle deformity has recently evolved as a means to correct foot deformities secondary to long standing diabetes. This re-shaping of a deformed foot or toes by surgical correction is presently being done in a large way in a few countries only like in US, UK, Russia, Germany, Spain, and Australia. These surgeries help to prevent the formation of calluses and ulcers of the foot and thus, these surgeries can prevent amputations in diabetics. We are the only major center in India where these reconstructive surgeries are being performed routinely in high-risk diabetic foot patients. By employing these novel surgical techniques, a large number of amputations are being prevented. 

The cases we manage include large numbers of extensive lower limb necrotizing fasciitis, various types of foot infections and Charcot’s cases, some with marked destruction of the foot and ankle bones, and many others with grossly deformed toes and foot. We have a footwear factory, with trained staff, making diabetic footwear, providing high quality preventive, post–operative and rehabilitative footwear. 

The Centre for Endocrinology and Diabetes was established in September 1999. In 2001, the Diabetic Foot Surgery division was introduced as a specialized service within the center. The department was initially set up by Dr. Harish Kumar, Dr. Vasantha Nair, and Dr. R.V. Jayakumar, who played instrumental roles in its establishment. Dr. Arun Bal later joined the team and spearheaded the development of the Diabetic Foot Surgery division. 

Milestones 

• The diabetic foot surgery which opened in 2000, is the best only existing clinic of its kind in South India. 
• In 2001, the department initiated a community-based organization, Amrita Diabetes Welfare Association (ADWA) in order to better serve diabetes living in Kochi. 
• In 2002, started DNB Endocrinology. 
• In 2003, started Diabetic fellowship and Podiatric Surgery and also started Paramedical courses. 
• In 2006, started Bone Densitometry Scan (DXA scan) 
• In 2008, conducted national Conference ‘ESICON’. 
• In 2009, started DM Endocrinology 
• In 2010, started Thyroid carcinoma Clinic 
• In 2014, the department conducted the International Conference ‘AOTA’. 
• In 2015, ultrasound thyroid was started within the department. 
• In 2023, started Lipid Clinic  
   

Goal and Objective: 

•  To provide community care in the field of diabetes/endocrinology through ADWA. 
•  To create   specialist in the field of Endocrinology through DM course in Endocrinology training. 
• To provide comprehensive state of the art care to all types of diabetes and endocrinology patients at affordable cost. 
• To contribute scientific advancements in the field of diabetes and Endocrinology by conducting research activities. 
• Training to Diabetes Educator, Physician assistant, Podiatry Assistant and paramedical staff to assist physician in delivering quality care to patients.  

India’s First  

• The Diabetic foot surgery fellowship programme is the only one of its kind in India. 
• We are the only Department in India where Endocrinologists and Diabetic foot surgeons worked together as a team, and we have set up the largest and most comprehensive Diabetic foot service in the Country.  

Kerala’s First  

• First department in Kerala to start the DM Endocrinology programme. 
• Kerala’s First Lipid Clinic 

Phone: 0484 - 2851030, 0484 - 6681030 

Email: [email protected] 

• Comprehensive Diabetes Care Program 
• Obesity Management Program 
• Thyroid Cancer Care Clinic 
• Paediatric Endocrinology Clinic 
• Osteoporosis and Metabolic Bone Disease Programme 
• Insulin Pump Therapy 
• Rhythm disorder surgery 
• Pituitary Diseases Clinic  
• Adrenal Disorder Assessment  

• Expert Team of Healthcare Professionals: Our centre is staffed with a dedicated and well-qualified team of healthcare professionals who specialize in endocrinology. From consultant endocrinologists to diabetic foot surgeons, diabetic educators to dieticians, our multidisciplinary team ensures that you receive holistic and personalized care. 
• State-of-the-Art Facilities: We offer full facilities for the investigation and treatment of endocrine problems in adult, pediatric, and adolescent patients. Our advanced infrastructure and cutting-edge technology enable us to provide accurate diagnoses and effective treatment plans. 
• Comprehensive Diabetes Care: We understand the complexities of diabetes and its associated complications. Our centre provides comprehensive diabetes care, addressing not only the management of blood sugar levels but also the prevention and treatment of complications such as diabetic foot problems, cardiovascular issues, and more.  
• Specialized Clinics: We offer a range of specialized clinics to cater to specific endocrine and diabetes-related conditions. These clinics include the Diabetes Care Programme, Diabetic Foot Care Program and Vascular Clinic, Paediatric and Adolescent Endocrine Clinic, Lipid Clinic, Exercise and Dietary Programme, Bone Clinic, Comprehensive Diabetes Care, and Obesity Clinic. These specialized clinics ensure that you receive focused care tailored to your unique needs. 
• World-Class Podiatric Surgery: Our Department of Endocrinology and Diabetic Foot Surgery provides comprehensive care for diabetic lower limb surgical problems. With an integrated team approach and world-class evaluation and management techniques, we offer solutions that are at par with global standards. This specialized service is available only in a few centres worldwide. 

• The only department in India where Endocrinologists and Diabetic foot surgeons work together as a team 
• Established the largest and most comprehensive Diabetic foot service in India 
• Established a Thyroid Cancer clinic with a comprehensive database 
• The only comprehensive paediatric Endocrinology service in Kerala 
• Annual outpatient attendance ranges from about 60 – 70 thousand patients 
• Performs around 1000 Diabetic foot surgeries per year  

Community Services

• Diabetic awareness classes and exhibitions 
• Free medical camps 
• School health programmes for diabetic awareness 
• Free insulin distribution for poor patients 
• Publication of DIABEAT – a quarterly magazine on diabetes care for patients 
• Supply of glucometers and walkers on a rental basis 
• Documentaries for creating awareness of diabetes and its complications

At the Centre for Endocrinology and Diabetic Foot Surgery, we are guided by a patient-centered philosophy. Our approach encompasses holistic care, collaborative relationships, continuous improvement, and community engagement. With a focus on our patients' well-being, we strive to deliver comprehensive and personalized care, continuously enhance our expertise, foster teamwork, and actively engage with the community to promote awareness and empower individuals to make informed health decisions.

• Unique programmes such as B.Sc and M.Sc Diabetes Science programmes and a Diabetes Foot care Assistant course 
   

 Programs

• D.M. Endocrinology 
• M.Sc. Diabetes Sciences 
• B.Sc. Diabetes Sciences 
• Fellowship in Diabetic Foot Surgery 
• Fellowship in Diabetology

We are also conducting a post MS one year fellowship in podiatric surgery and a two-year podiatry assistant paramedical course. We are the only institute in Asia to conduct these two courses. 

• The Amrita Sling Technique 
  To avoid the serious complications of pin-tract infections, wire breakage and others associated with the application of external fixators in diabetic patients, we have devised an entirely new and novel technique of foot and ankle stabilization for the reconstruction of destroyed Charcot foot and ankle, called ‘The Amrita Sling Technique.’ This has been published in ‘The Journal of Diabetic Foot Complications,’ from the United States, in February 2009. In the past two years, we have successfully operated on over 20 cases of destroyed rare hind-foot Charcot's cases, using this technique, with excellent results. We are also using polymethyl methacrylate as a replacement prosthesis for unsalvageable Charcot's foot bones. We have also synthesized a new polymer-based footwear for diabetic patients. 
  By comprehensive management, we have been able to maintain a limb salvage rate of 91.5%, in diabetic foot and ankle diseases, comparable to the best centers in the world. 
• Amrita Diabetic Foot Conference 
  Our institute has been conducting the international “Amrita Diabetic Foot Conference’ (A.D.F.C.) since 2009. The conference features talks and live surgical demonstrations by well-known podiatric surgeons from the United States. We also invite endocrinologists from other countries who have special interest in the management of diabetic foot problems. 
•  Milestones Achieved 
  • Devised the ‘Amrita Sling Technique’, a new and novel technique of foot and ankle stabilization for the reconstruction of destroyed Charcot's foot and ankle—first in the world. 
  • Using polymethyl methacrylate as replacement prosthesis for unsalvageable Charcot's foot bones. 
  • Synthesized a new polymer-based footwear for diabetic patients. 
  • Lower limb salvage rate of 91.5%, in diabetic foot and ankle diseases, comparable to the best centers in the world. 
  • An integrated team approach, so important in the proper management of diabetic lower limb problems, is available in only a few centers worldwide. 
  • We are the only major center in India where reconstructive and corrective foot and ankle surgeries are being performed exclusively in high-risk diabetic foot patients. 
  • We conduct a post MS (post-doctoral) one year fellowship in podiatric surgery and a two-year podiatry assistant paramedical) course. We are the only institute in Asia to conduct these two courses in diabetic foot. 
  • Over 5000 high risk diabetic lower limb surgeries carried out in the past eight years with excellent results. 

• The first department in Kerala and South India to start the DM Endocrinology programme 
• Offers a post MD Diabetes Fellowship and a post MS Diabetic foot surgery programme 
• The Diabetic Foot Surgery fellowship programme is the only one of its kind in India 

• Published over 500 papers in national and international journals 
• Completed around 150 international multicenter clinical trials 
• Conducted research on the effect of antifungal treatment in Diabetic foot, leading to a change in management approach 
• Partnered with the Biotechnology Institute at AmritapuriVallikkavu to patent an Insulin Pump 
• Conducted the first field trials on Integrated Amrita Meditation Technique (IAM) in normal people and Diabetic patients 
• Published the first community Diabetes data from Kerala and the first community Thyroid data from India 

Diabetes Care Programme 

The Diabetes Care Programme provides intensive management of diabetes and diabetes related problems: 

• Retinopathy 
• Nephropathy 
• Neuropathy
• Ischaemic Heart Disease 

The Programme also offers: 

• Management of gestational diabetes 
• Paediatric diabetes clinics 
• Psychological and social worker consultations
• Assessment of family risks of developing diabetes 

Diabetic Foot Care Program and Vascular Clinic 
The Department of Endocrinology and Diabetic Foot Surgery at Amrita Hospital, Kochi is the most comprehensive one stop centre for the evaluation, treatment and rehabilitation of preventive and therapeutic aspects of diabetic foot. The diabetic foot division of the Department of Endocrinology is fully equipped with the most modern equipment to assess the function of nerves and blood vessels. The department provides all services under one roof, including special customised footwear. The foot care programme is the only one in Asia to carry out reconstructive surgery in deformed diabetic foot – an emerging strategy for preventing diabetic foot-related amputations. 

Paediatric and Adolescent Endocrine Clinic 
This clinic provides specialised care for children and adolescents with growth disorders, early or delayed puberty, thyroid diseases, bone diseases, diabetes or other endocrine disorders. 

Lipid Clinic 
The Lipid Clinic is devoted exclusively to treating patients with high cholesterol and high triglyceride levels. 

Exercise and Dietary Programme 
The Exercise and Dietary Programme is aimed at full-fitness, utilising treadmills, exercise bicycles, and other equipment under the guidance of a trained physiotherapist. The amount of exertion is gradually increased depending on each individual’s capability. 

Bone Clinic 
Metabolic bone diseases are a relatively less-recognized aspect of endocrinology. These diseases include osteoporosis (an age and menopause-related thinning of bones,) osteomalacia (weakening of bones due to vitamin D deficiency,) hyperparathyroidisrn (a disease with bone pains and kidney stones, caused by excess parathyroid hormone levels resulting in dangerously high calcium levels in blood) and other complex bone diseases. The Centre has the best Bone Densitorneter, the DEXA Dual Energy X-ray Absorptiometry, in the state to evaluate these complex disorders. Unexplained bone pains and early onset fractures are diseases investigated and managed by the department. 

Comprehensive Diabetes Care 
In addition to the routine out-patient based care of diabetic patient, the department has also initiated comprehensive diabetic care programme, focused on providing an annual diabetes check up to patients. Diabetes is known as a silent killer, and if left untreated, can cause kidney, nerve, eye, heart and foot problems. The annual checkup assesses the degree of glucose control and also measures the presence of diabetic complications. If detected early, many of these complications can be treated, and their progression can be stopped. 

Obesity Clinic 
A common example of an under-treated endocrine disease is obesity. In this regard, Amrita Hospital, Kochi has started a multidisciplinary obesity clinic. The clinic is conducted primarily by the endocrinology team, in coordination with the departments of Gastrointestinal Surgery and Plastic Surgery. Amrita Hospital, Kochi is probably the only obesity centre in the country to incorporate endocrinologists, GI surgeons and plastic surgeons working together for a common cause under the sphere of obesity management. In addition to hormonal assessment of obesity, our centre also has state-of-the-art facilities for body fat assessments, preoperative assessments and postoperative follow up for obesity patients. We have a comprehensive medical nutrition programme, exercise counselling, drug therapy and plastic surgery, as well as bariatric procedures.