Journal articlesHow can we improve the care of the diabetic foot

How can we improve the care of the diabetic foot

01/11/08 | Diabetic foot ulcers | Paul Chadwick, William Jeffcoate, Caroline McIntosh

Diabetes is an increasingly prevalent condition. In 2003 it was estimated that 4.5% of the developing world’s population had diabetes — this was expected to increase by 31% by 2025 (Narayan et al, 2006). There are as many as two million people in the UK diagnosed with diabetes and of these 300,000 will develop a foot ulcer, 45,000 of which will require amputation (Diabetes UK, 2006). With an increasingly ageing population, these figures are expected to double by 2010 and the challenges currently faced by diabetic foot care services will be intensified. Diabetesrelated foot complications are a major drain on the NHS — diabetic foot ulcers and the resulting amputations cost up to £502m per year, with a toe amputation costing £3,443, a foot amputation £7,786 and a leg amputation £10,979. Despite these depressing statistics there is disparity in service provision across the UK and the introduction of The National Service Framework for Diabetes (Department of Health, 2001) and guidance from the National Institute for Health and Clinical Excellence (NICE, 2004) have provided healthcare professionals with the standards required to provide a first-class service. The National Minimum Skills Framework (2006) also outlines the competencies that members of any diabetic foot care team should possess. Unfortunately, the ability to translate this guidance into clinical practice appears to be lacking. An audit of diabetes foot care services in the North West of England (Chadwick et al, 2007) revealed some serious deficiencies in provision. With these challenges in mind this debate asks: ‘How can we improve the care of the diabetic foot?’