Diabetes is now one of the biggest health problems in the UK. In 2009, it was estimated that there were 2.3 million people with type 1 or type 2 diabetes.With rising numbers of people affected by the condition, the incidence of complications is also on the rise. These include foot problems such as ulcerations and gangrene, foot deformities, and infections which, if left untreated, can have a significant impact on a patient's quality of life. When a person is less mobile this may lead to loss of employment, depression, and damage to, or loss of, limbs. Each year in the UK, around 5,000 people with diabetes undergo leg, foot or toe amputations, equivalent to 100 a week. Treating diabetic foot problems also has a considerable financial impact on the NHS through outpatient costs, increased bed occupancy, and longer hospital stays. Up to 20% (£600m) of the £3bn the NHS spends on diabetes each year goes on treating diabetic foot problems, and at least £252m of this is spent on amputation. Currently there are some variation in the management of patients with diabetic foot problems. This variation is due to a range of factors, including differences in the organisation of care between patients' admission to an acute care setting and discharge. This variability depends on geography, individual trusts, individual specialties (such as whether the service is managed by vascular surgery, general surgery, orthopaedics, diabetologists or general physicians) and the availability of podiatrists with expertise in diabetic foot disease.
The NICE guideline comprises a clear, authoritative source of information for NHS hospitals which will help overall management of diabetic foot problems, aiming to reduce variations in practice. It includes the following key recommendations:
Each hospital should have a care pathway for diabetic foot problems in diabetic patients who require hospital care.
A multidisciplinary foot care team should manage the care pathway
of patients with diabetic foot problems who require inpatient care. The multidisciplinary foot care team should normally include a diabetologist, a surgeon with the relevant expertise in managing diabetic foot problems, a diabetes nurse specialist, a podiatrist and a tissue viability nurse.
At the initial examination and assessment, the patients' feet should be examined for evidence of: Inflammation/infection, Ulceration, Deformity
Neuropathy, Ischaemia, and Charcot arthropathy.
Refer patients with diabetic foot problems to the multidisciplinary foot care team within 24 hours of the initial examination of the patient's feet. Transfer the responsibility of care to a consultant member of the multidisciplinary foot care team if a diabetic foot problem is the dominant clinical factor for inpatient care.
When in hospital, patients with diabetic foot problems should have access to appropriate pressure reducing surfaces, to minimise the risk of pressure ulcer development on the affected limb.
New NICE guidelines aim to reduce variations in the level of care that patients receive when they are in hospital, in the expectation these lead to fewer amputations, and a better quality of life for those affected and lower NHS costs.