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NICE publishes guideline on diabetic foot problems

8040961-article-diabeticfootNICE has published a guideline for the care of people with diabetic foot problems in hospital, as the number of people with diabetes continues to rise.

In 2009, it was estimated that there were 2.3 million people in the UK 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.

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 per cent (£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.

The NICE guideline aims to help overall management of diabetic foot problems, and to reduce variations in practice, by recommending that each hospital has 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.

NICE recommends that at the initial examination and assessment, the patients' feet should be examined for evidence of inflammation, ulceration, deformity, neuropathy, ischaemia and charcot arthropathy.

Patients with diabetic foot problems should be referred to the multidisciplinary foot care team within 24 hours of the initial examination of the patient's feet.

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.

Dr Fergus Macbeth, Centre for Clinical Practice Director at NICE, said: “It's important that the NHS is treating diabetic foot problems in the most clinically and cost effective way.

“This guideline provides clear, evidence-based recommendations for hospital staff treating patients, aged 18 years and above, who are admitted to hospital with diabetic foot problems or who develop them whilst in hospital.

“The guideline aims 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.”

Dr Gerry Rayman, Consultant Physician and Head of Service, The Diabetes and Endocrine Centre and Diabetes Foot Clinic and Research Unit, Ipswich Hospital NHS Trust added: “I was pleased to be involved in the development of this guideline because I have seen first-hand the very serious problems that can result from diabetic foot complications.

“This guideline will be a useful aid to all those involved in the treatment of such patients in NHS hospitals, and will, I'm sure, result in better care for patients.”

Implementation tools, including a podcast, slide set, costing report and baseline assessment, are available to help healthcare professionals put this guidance into practice.

23 March 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.