NHS takes new look at diabetic foot care

Reviewed by Dr Rob Hicks
20th September 2010 – The National Institute for Health and Clinical Excellence (NICE) has issued new draft guidance on caring for diabetic foot problems in hospital.

NICE says Diabetes is one of the greatest health problems facing the UK today, with an estimated 2.6 million people having type 1 or type 2 diabetes.

The growing number of people with the condition leads to more complications, which includes foot problems like ulcerations, gangrene, foot deformities and infections.

These can reduce mobility, which in turn can affect employment, lead to depression and, in serious cases, loss of limbs.

Treating diabetic foot problems also has a considerable financial impact on the NHS through outpatient costs, increased bed occupancy and longer hospital stays.

New recommendations
The draft recommendations from NICE include:

Every hospital should have structured care for diabetic foot problems in diabetic patients who require hospital care
Patients should be offered consistent, relevant information and clear explanations that help with informed decision making. They should be provided with opportunities to discuss issues and ask questions
Within four hours of the patient being admitted to hospital, the initial examination should look for evidence of:
inflammation/infection
ulceration
deformity
neuropathy
When in hospital, patients with diabetic foot problems should have access to pressure reducing surfaces, to minimise the risk of pressure ulcer development on the affected limb
For the management of diabetic foot infections, each hospital should have antibiotic guidelines in place, appropriate for the severity of the infection

Huge health problem
Sharon Summers-Ma, Associate Director of the Centre for Clinical Practice Director at NICE, says in a statement: “Diabetes is a huge health problem in the UK, with growing numbers of people developing the condition. This increase brings with it more diabetic-related complications such as foot problems, which are the most common cause of non-traumatic limb amputation.

“It’s important, therefore, that the NHS is treating diabetic foot problems in the most clinically and cost effective way. This guideline will provide recommendations to hospital staff on the standard of care to be given to patients aged 18 years and above who are at a particularly high risk of diabetic foot problems. By providing advice based on the most up-to-date evidence of best practice, the guidelines aim to reduce variations in the level of care that patients receive when they are in hospital, leading to fewer amputations, a better quality of life for those affected and lower NHS costs.”

Reaction
Stella Valerkou, Senior Policy Officer at Diabetes UK, says in an email: “Diabetes UK greatly welcomes the development of NICE guidelines on this important topic and looks forward to commenting on the draft recommendations. We know the impact of diabetes related foot disease is far reaching; it is reported there are 100 amputations a week due to diabetes in the UK, and such amputations can often be avoided.

“We hope the final guidelines will support the implementation of high quality foot care for people with diabetes in hospital.”