2 Research recommendations

The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline.

2.1 Intensive monitoring for people at risk of diabetic foot problems

Does intensive monitoring of people at risk of diabetic foot disease reduce the morbidity associated with developing the disease and is such monitoring cost effective?

Why this is important

The evidence surrounding different monitoring frequencies for those at risk of diabetic foot problems was limited. It is proposed that a randomised controlled trial or cohort study is undertaken to explore this question. The proposed study would monitor and evaluate the rates of foot ulcer or infection resulting from diabetes, rates and extent of amputation (major or minor), health‑related quality of life, adverse events and hospital admission rates and length of stay as a result of different monitoring frequencies.

2.2 Referral criteria for the foot protection service and the multidisciplinary foot care service

When and with what criteria should people with diabetes be referred to the foot protection service or the multidisciplinary foot care service?

Why this is important

The evidence surrounding different referral criteria for those at risk of, or who have developed diabetic foot problems was limited. It is proposed that a prospective cohort study is undertaken to explore this question. The proposed study would monitor and evaluate the rates (and recurrent rates) of foot ulceration, infection and gangrene resulting from diabetes, resource use and costs (including referral rates), rates of hospital admission for foot problems resulting from diabetes, length of hospital stay, and the health‑related quality of life as a result of different referral criteria to these teams.

2.3 Education and psycho‑behavioural interventions for prevention

What is the role of educational models and psycho‑behavioural interventions in prevention of diabetic foot complications?

Why this is important

The evidence surrounding the role of educational measures for those at risk of diabetic foot problems was limited and inconclusive. It is proposed that new interventions are developed that target psychological and behavioural factors. The proposed study would monitor and evaluate the rates (and recurrent rates) of foot ulceration, infection and gangrene resulting from diabetes, rates and extent of amputation, rates of hospital admission for foot problems resulting from diabetes, length of hospital stay, and resource use and cost as a result of applying these interventions.

2.4 Prevention strategies for Charcot arthropathy

What strategies may be useful in the prevention of Charcot arthropathy?

Why this is important

The evidence surrounding Charcot arthropathy was limited and of low quality. It is proposed that a prospective cohort study is undertaken to explore this question. The proposed study would monitor and evaluate the rates of Charcot arthropathy resulting from diabetes, rates and extent of amputation (major or minor), rates and extent of deformity, health‑related quality of life, and hospital admission rates following strategies for the prevention of Charcot arthropathy or its sequelae.

2.5 Diabetic ulcer dressings

What is the clinical effectiveness of different dressing types in treating diabetic foot problems?

Why this is important

The evidence surrounding different dressing types for diabetic foot ulcer was often limited or inconclusive. It is proposed that more randomised controlled trials are undertaken to explore this question, but alternative methodologies may also be considered in the case of treating a complex wound. The proposed study would monitor and evaluate the cure rates of foot ulcer resulting from diabetes, rates and extent of amputation (major or minor), health‑related quality of life, adverse events and hospital admission rates and length of stay.

  • National Institute for Health and Care Excellence (NICE)