Local NHS team sets the national standard for improving foot care for patients with diabetes

Diabetes is one of the most common chronic diseases in the UK and its prevalence is increasing.

In 2013, there were almost 2.9 million people in the UK diagnosed with diabetes. By 2025, it is estimated that more than 5 million people in the UK will have diabetes.

In England, the number of people diagnosed with diabetes increased by approximately 53% between 2006 and 2013, from 1.9 million to 2.9 million. The life expectancy of people with diabetes is shortened by up to 15 years, and 75% die of complications i.e. stroke and heart disease.

The risk of foot problems in people with diabetes is increased, largely because of either diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply due to diseased large and medium‑sized blood vessels in the legs), or both.

Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50. Diabetes is the most common cause of non‑traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes. After a first amputation, people with diabetes are twice as likely to have a subsequent amputation as people without diabetes.

Mortality rates after diabetic foot ulceration and amputation are high, with up to 70% of people dying within 5 years of amputation and around 50% dying within 5 years of developing a diabetic foot ulcer.

If the early signs of an ulcer developing are not picked up or acted upon swiftly, the possibility of more significant problems leading to amputation can occur.

Against this background, a team from the Wessex Cardio-Vascular Network which is based in the local Southampton office of NHS England and covers Hampshire, the Isle of Wight and Dorset, reviewed all local services for good practice and to identify potential gaps in service.   The aim of this was to reduce the overall incidence of patients’ suffering from ulceration and amputation.

The team’s work has now been recognised by the National Institute for Health and Care Excellence (NICE), the body which provides national guidance and advice to improve health and social care.  NICE has published this work as the standard foot care guidance that should be followed by clinicians nationally, when providing care to people with diabetes.

As part of the National Diabetes Treatment and Care Programme, NHS England invested £42 million in 2017/18 in proposals to improve the treatment and care of people with diabetes, and is one of four key priority areas targeted by NHS England for diabetes transformation funding.

Sally Rickard, Associate Director, Clinical Senate and Networks, NHS England South, said:  ” The team here, working with a number of our clinical colleagues across the area, have done a fantastic job in standardising what is now acknowledged by NICE as the best, standard practice for providing foot care to diabetic patients.  This work will make a tremendous difference to patients, and at the same time will save the NHS significant time and money, through improved efficiency and effectiveness.  We are all very proud of their achievement.”




  • Further details available on the NICE website.
  • Diabetes and its complications cost over £10 billion every year to treat and one in six patients in hospital has diabetes. Around nine out of 10 people with diabetes have Type 2 which is closely linked to obesity and there is strong evidence that in many it is preventable.
  • A lack of exercise, poor diet and being overweight are all risk factors for developing the disease. The programme is designed to stop or delay onset through a range of personalised lifestyle interventions, including: education on lifestyle choices; advice on how to reduce weight through healthier eating; bespoke physical activity programmes.
  • Recent projections show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke.
  • The national Diabetes Prevention Week commences w/c 1 April 2019.
  • Over 17,000 people have now completed the NHS Diabetes Prevention Programme nationally and have achieved a combined weight loss of over 50,000 kg, equivalent to the weight of four double decker buses.  The NHS Long Term Plan announced that the programme which sees people at risk of developing Type 2 diabetes given help to lose weight, will double in size over the next few years to treat around 200,000 people a year.
  • From July this year, online versions of the programme, which involve wearable technologies and apps to help those at risk of Type 2 Diabetes, will be provided for patients who find it difficult to attend sessions because of work or family commitments.
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