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Preventing and managing diabetic foot problems

News and presentations from today’s conference focusing on implementing the updated NICE guidance for the prevention and management of diabetic foot problems.

NICE guidance

National Diabetes Foot Care Audit

Rachel Berrington, Diabetes Nurse Specialist and Senior Diabetes Specialist Nurse Foot Lead, University Hospitals of Leicester, and Member, Guideline Development Group, Diabetic foot problems, NICE

Pre-Conference Abstract

NICE published its new guidance entitled Diabetic foot problems: prevention and management 2015.  It combines the advice of previous NICE guidance with new evidence based guidance on the timing of care, foot screening, referral and protocols, management of diabetic foot ulcers, infections and how to diagnosed and manage Charcot Arthropathy.  The guidance looks at the evidence underpinning its recommendations, cost-effective care for reduction in diabetic foot complications, which will help to reduce the mortality associated with the condition.

Full PowerPoint presentation

In her presentation Rachel Berrington Stated: 

“We are seeing younger and younger and younger people in my clinic.”

“My youngest is a 19yr old, and he will probably end up losing his foot.”

“Just because someone is young don’t assume foot isn’t an issue.”

Putting Feet First: communicating the importance of diabetic foot care

Nikki Joule, Policy Manager, Diabetes UK

Pre-Conference Abstract

We know that people with diabetes are around 23 times more likely than a person without diabetes with diabetes to have a leg, foot or toe amputation. There are now over 8,500 lower limb amputations in people with diabetes in England each year, and diabetic foot disease (foot ulcers and amputations) reduces the quality of life of tens of thousands of people in England every year. It also costs the NHS hundreds of millions of pounds annually: at least £1 in every £140 of NHS expenditure in England is spent on foot care for people with diabetes.

Reducing ulcer duration is key to improving quality of life for patients, reducing NHS costs and reducing amputations. Clinical evidence and audit data suggest that there is a great deal of scope for improvement in the quality and outcomes of diabetic foot care in England. On the one hand, there is a large body of evidence indicating that targeted preventive services can identify those at risk of ulceration and improve outcomes, and that early access to multidisciplinary specialist care for patients with ulcers can reduce ulcer duration, improve healing rates, reduce amputations and increase survival rates. On the other hand, national diabetes audits indicate that many patients in England experience long waits for specialist foot care, and that appropriate specialist services do not exist in many areas. There is also a wide variation in amputation rates that cannot be explained by demographics alone.

We also know that those most likely to have amputations are men (over twice as likely as women to have a major amputation). Men are also more likely to present with foot ulcers.  Having diabetes for a longer time is also a risk factor.

We need to reach people with diabetes, and particularly older men, to encourage them to look after their feet, understand their risk of foot problems and to seek help urgently if they have a problem. GPs and primary care nurses need to know how to do a good quality annual foot risk assessment and when and where to refer someone with a foot problem. Commissioners and providers of foot care need to ensure that there is a local diabetes foot care pathway with a foot protection service, specialist multidisciplinary team and speedy referral across the pathway, and that this is well understood and promoted locally. 

For further information see:

Joule, N Expounding the economic case for change in diabetic foot care The Diabetic Foot Journal, 2017, Vol 20, No 2, pages 68–70

Full PowerPoint presentation

Future related events:

Nurse Clinics 2017
Monday 20 November 
De Vere West One Conference Centre, London

Demonstrating & Improving Nurse Prescribing Competence & Practice: Implementing the National competency framework for all prescribers
Friday 1 December 
De Vere West One Conference Centre, London

Pressure Ulcers Summit
Thursday 7 December 
Manchester Conference Centre, Manchester







6 October 2017


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