A new framework to help improve patient care including avoiding unnecessary amputations and deaths in people with diabetic foot disease has been published.
The report, by a host of the main organisations who care for people with diabetic foot disease, aims to make sure patients with acute diabetic foot disease receive high quality care wherever they present.
Foot complications are common in people with diabetes with between five and seven per cent of people with diabetes having a current or previous foot ulceration.
Professor Jonathan Valabhji, NHS England’s National Clinical Director for Diabetes and Obesity, worked with a number of key organisations to produce the report including: the British Orthopaedic Association, the British Orthopaedic Foot and Ankle Society, the Vascular Society, Diabetes UK, the Association of British Clinical Diabetologists, Foot in Diabetes UK; and the British Association of Prosthetists and Orthotists.
“If we can ensure patients with diabetes have the appropriate, high quality care they deserve across the country then we can prevent amputations,” said Professor Valabhji.
“There are several steps we can take to ensure this happens, one of which is to ensure that those presenting with active diabetic foot disease have rapid access to a multidisciplinary diabetic foot service. Higher mortality rates are thought to be related to heart disease and therefore we also need to ensure the all-round health of the patient is cared for, including addressing their overall cardiovascular disease risk.”
Diabetes is the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80 per cent of amputations in people with diabetes.
Around 50 per cent of people die within five years of developing a diabetic foot ulcer.
The framework, for the operational delivery of hospital trust based diabetic foot services, recommends service provision is geared towards meeting patient priorities including:
- To get better, as quickly as possible, whilst reducing risk of further morbidity.
- To avoid hospital admission if possible, and certainly admission to a hospital that is distant from home.
- To avoid major and minor amputation.
- To be managed speedily, effectively and efficiently with management plans focused on the patient’s individual circumstances and their personal needs.
- To have their diabetes and other medical conditions well managed at the same time that their foot disease is being assessed and treated.
High mortality after amputation is believed to be associated with cardiovascular disease, and emphasises the importance of good diabetic and cardiovascular risk management.
These are joint recommendations from: British Orthopaedic Association, British Orthopaedic Foot and Ankle Society, Vascular Society, Diabetes UK, Association of British Clinical Diabetologists, Foot in Diabetes UK and the British Association of Prosthetists and Orthotists.
The whole pathway has three areas: foot screening, foot protection for those identified through screening to be at high risk of foot disease, and a multidisciplinary foot care service for those with active diabetic foot disease – all consistent with the new NICE guidance which details the process.
The recommendations say commissioners should make sure all patients with diabetic foot problems have rapid and equal access to services, regardless of location, in order to optimise care and reduce amputation rates.
They describe the key systems, processes and standards needing to be in place to achieve this goal.
The recommendations cover:
- Service design
- Foot screening
- Foot protection
- Multi-disciplinary foot care service
- Outpatient Management of Acute Diabetic Foot Complications
- Management of Diabetic Foot Emergencies, including discharge Planning
- Management of the patient undergoing major amputation
- Monitoring implementation using the National Diabetes Footcare Audit (NDFA)