How to manage the diabetic foot

2 April, 2011
Diabetes-related complications have a major financial impact on the NHS. A gideline offers
advice on managing patients in acte settings
Diabetes is one of the biggest health challenges facing the !". #n 2010, 2.$ million people in
the !" %ere registered as having diabetes, %hile an estimated $.1 million have either t&pe 1
or t&pe 2 diabetes. '& 20$0, more than (.) million people cold have the condition.
As the longevit& of the poplation increases, so does the incidence of diabetes-related
complications *Anderson and +o,is, 200-.. /hese inclde foot problems, the most common
case of non-tramatic limb amptation *'olton et al, 2000..
Diabetic foot problems inclde neropath&, peripheral arterial disease, deformit&, infections,
lcers and gangrene. /he& can have a major financial impact on the NHS throgh increased
bed occpanc&, prolonged sta&s in hospital and otpatient costs. /he& can also have a
considerable impact on patients1 2alit& of life, for e3ample, damage to or loss of limbs can
lead to redced mobilit& that can reslt in loss of emplo&ment and depression.
/his ne% National #nstitte for Health and 4linical 53cellence gideline provides
recommendations on the essential components of inpatient care of people %ith diabetic foot
problems from hospital admission on%ards.
Implications for nursing practice
/he gideline recognises the importance of effectivel& managing diabetic foot problems. #t
provides evidence-based recommendations to ensre optimm treatment for patients in acte
healthcare setting, and sggests a coordinated and s&stematic approach to patient care, to
minimise the ris, of complications.
A ,e& recommendation is that hospitals shold have a care path%a& in place for patients %ith
diabetic foot problems %ho re2ire inpatient care, and that this shold be managed b& a
mltidisciplinar& foot care team. /his team shold normall& inclde6 a diabetologist, a
srgeon %ith the relevant e3pertise in managing diabetic foot problems, a diabetes nrse
specialist, a podiatrist and a tisse viabilit& nrse. /he role of the tisse viabilit& nrse is
ac,no%ledged, bt importantl& as an addition to, rather than a replacement, for the podiatrist.
7henever possible a podiatrist shold be involved %ith an acte foot care team, as the& often
provide an important lin, bet%een practitioners involved in the acte and primar& healthcare
settings.
/he gideline recognises the importance of treating diabetic foot problems as an emergenc&
and of offering spport for patients %hile the& are in hospital. #t recommends6 8/he patient
shold have a named contact to follo% the inpatient care path%a& and be responsible for
offering patients information abot their diagnosis and treatment and the care and spport that
the& can e3pect9 commnicating relevant clinical information : inclding docmentation
before discharge, %ithin and bet%een hospitals and to primar& and;or commnit& care.<
+ecommendations for appropriate patient management are given %ithin a frame%or, of t%o
main phases of care6 %ithin the first 2( hors9 and ongoing management.
/he gideline considers specific adjnctive therapies, %hich it recommends are sed onl& as
part of a clinical trial. /hese therapies comprise6 dermal or s,in sbstittes, electrical
stimlation therap&, atologos platelet-rich plasma gel, regenerative %ond matrices and
deltaparin. /he& also inclde gro%th factors *granloc&te colon&-stimlating factor, platelet-
derived gro%th factor, epidermal gro%th factor and transforming gro%th factor beta. and
h&perbaric o3&gen therap&, or as part of a clinical trial or as resce therap& *negative pressre
%ond therap&..
/he clinical and cost effectiveness of negative pressre %ond therap& and h&perbaric
o3&gen therap& are recommended as areas for frther research. /his is needed before these
treatments can be adopted as evidence-based practice.
Conclusion
/his gideline gives an overvie% of the importance of effective management of patients %ith
diabetic foot problems %hile in acte healthcare settings, and provides evidence-based
recommendations for managing them. #t aims to help nrses assess their patients, be activel&
involved in providing appropriate treatment, and give tailored information as re2ired. #t also
aims to redce variations in the level of care that patients receive %hen the& are in hospital,
leading to fe%er amptations, a better 2alit& of life for those affected and lo%er NHS costs.
N/
The guideline, Diabetic Foot Problems: Inpatient Management of Diabetic Foot Problems
and other implementation resorces are available for do%nload at
%%%.nice.org.,;gidance;4=11>
References:
Andersen CA, +o,is /S *200-. /he diabetic foot. Surgical Clinics of North America; ?-6 0,
11(>-11--.
Boulton J et al *2000. /he global brden of diabetic foot disease. The Lancet;126 $)), 1-1>-
1-2(.