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Research and Projects

Diabetic Footcare

Who is involved?

Theme: CLAHRC - Person-Centred Care
Status: Complete


The recently published The NHS Atlas of Variation in Healthcare (DaSilva and Gray 2010) identifies the South West of England as worst in relation to the incidence of major amputations in people with Type 2 diabetes, although this study did not take into account the prevalence of diabetes in a region, the number of specialist centres and the social, ethnic case mix.

Current NICE guidelines on type 2 diabetes on prevention and management of foot problems state that people with high risk of foot ulcers should be seen between every one to three months by a foot protection team. The guidance also suggests that research needs to be carried out to assess the appropriate level and combination of risk factors at which patients should be categorised as at high risk for ulceration and be offered attendance on a protection programme.

A paper by Donohoe et al (2000) suggests that provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services. This work suggests that patients who have been identified as at risk or high risk can benefit from additional support but in the longer term no implementation of a structured education package has been followed up.

The existing evidence suggests that the delivery of a structured education and follow up care package is required to educate and support patients and reduce incidence of acute foot complications. A trained member of a foot protection team could deliver this package of care, ideally a podiatrist or health care professional with specific foot health knowledge.

Project aims

To implement and evaluate a method for identifying patients at risk and provide them with a structured one to one education package that supports patients to perform daily preventive self-care and to encourage behaviours that minimize precipitating factors of foot ulceration.

Project approach

  • Establish the validity of the education package by examining how much of the information the patients have retained and put into practice after 6-12 months
  • Provide an education package and follow up at 5-10 years. This will be evaluated using data about incidence of acute hospital admissions for foot complications and presentation for foot care at GP surgeries to demonstrate the education packages validity. A questionnaire will be filled in by participants to evaluate quality of life factors.

The structured education package will include:

  • Inspection of patients feet
  • Vascular assessment/onward referral
  • Intensive foot care education – detailing internal/ external factors that may have a role in development of foot ulcers
  • Footwear and insole discussion
  • Positive self care foot care behavior
  • Contact details in case of emergency.

Project outcomes

  • Improved adherence to preventative self care measures of the diabetic foot
  • Reduction in presentation of foot ulcers and ultimately a reduction in minor and major amputations
  • Decrease in costs to NHS by reducing presentations at GP Surgeries and ultimately acute admissions for diabetic foot problems
  • Reduce cost of treatment of foot ulcers through earlier presentation of problem
  • Improved quality of life for patients and carers

This implementation project has been developed in partnership with and active involvement of members of the Diabetes UK North Devon Voluntary Group.