Help Notes for Nurses No. 5 -- A British Organization, Diabetes UK, calls for a "national frame

• ❑ New initiatives in Britain and Canada are among the highlights of recent developments in programs that address foot care issues related to diabetes. This topic is important because of the growing threat of major disease burdens and costs emerging in nations and regions. First let's review the developments, and then outline why they are very important.

• ❑ A "National Diabetes Foot Care Audit (NDFA)" has been launched in Britain by Healthcare Quality Improvement Partnership (HQIP), with the blessing of the national Department of Health. Its purposes include measuring (1) compliance with case management guidelines in the area of diabetic foot disease, and (2) outcomes of the care regimes that are in place. (See Health & Social Care Information Centre 2015 among the References below).

The project involves the use of an online data collection tool, which became available on August 3. Current plans are to release local and national aggregated results in March 2016.

Several supporting documents in PDF format are available for download on the Internet at—footcare . They include guidelines on procedure, an information leaflet to be provided to patients, a consent form, a data collection form, a user registration form, and a list of frequently asked questions and their answers.

• ❑ A second notable initiative has started in Britain. An organization named "Diabetes UK" has launched a campaign entitled ‘Putting Feet First". Its purposes include: (1) wide dissemination of information to promote a reduction in the rate of amputations associated with diabetes, (2) stimulating local health services to take steps to enhance their diabetes education programs, (3) providing more incentives to clinicians to perform foot checks and advised there patients about diabetes care .

'Putting Feet First' also advocates the formation of a "national framework for care ...", and the framework would aim to stimulate clinicians to speak about the risks of diabetic foot ulcers with patients". (See Wounds UK 2015)

• ❑ There is also a recent notable development in Canada. Health Sciences North/Horizon Santé-Nord (HSN), based in Sudbury, has begun a study on diabetes foot care. The study aims to examine the nature and effectiveness of foot examinations and related services performed by registered nurses, dieticians, and chiropodists, using a sample of patients at its Diabetes Care Service. The ultimate goal is to promote improved screening practices and the development of benchmarks for use in determining when patients need to be referred to specialists.

Concerning the value of the study, lead medical researcher, DR. Boji Varghese, is quoted as follows: " 'The value of this study is that it emphasizes the importance of foot screening as a preventative measure to avoid some of the more serious complications of diabetes … [and it will] help reduce wait times for patients who need the specialized care of a chiropodist, …' .” (See Health Sciences North - Horizon Santé-Nord. 2015)

❑ Why are these developments important? The related disease burden and cost at the population level is already very large and could become a major health care and health policy issue. Here is some relevant information:

• ❑ Canada: "It is estimated that approximately 9 million Canadians and 15,000 people in the Greater Sudbury area are living with diabetes or pre-diabetes." (Health Sciences North - Horizon Santé-Nord. 2015)

• ❑ Britain: "In England alone, over 6,000 amputations were performed in 2009-2010 and the rate is expected to rise to over 7,000 by 2014-2015, if no preventative measures are taken." (Wounds UK. July 2015).

• ❑ USA: Foot problems are common in the 12 million diagnosed and undiagnosed United States

diabetic subjects, and result in extensive hospitalization, disfiguring surgery, lifetime

disability, and a diminished quality of life." (Relier 1992)

"The lifetime risk of a person with diabetes developing a foot ulcer may be as high as 25%, whereas the annual incidence of foot ulcers is ∼2%. Up to 50% of older patients with type 2 diabetes have one or more risk factors for foot ulceration. ( (Boulton A.J., and others 2008) [Note: the incidence rate is the rate of appearance of new cases, and is far lower than the prevalence rate. The latter is the proportion of the designated base population that has foot ulcers.]

• ❑ References:

• Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719-1724.

• Boulton AJ, and others, 2008. "Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31(8): 1679–1685. A free full text is available at—1679.full.pdf+html .

• Health Sciences North - Horizon Santé-Nord. 2015. HSN Launches Study on Diabetes Foot Care.—hsn-launches-study-on-diabetes-foot-care.aspx

• Health & Social Care Information Centre (2015). National Diabetes Foot Care Audit (NDFA).—footcare

• Reiber, Gayle E. 1992. Diabetic Foot Care: Financial Implications and Practice Guidelines Diabetes Care March 1992 15:Supplement 1 29-31.

• Wounds UK. July 2015. Diabetic foot campaign is launched to raise awareness—diabetic-foot-campaign-is-launched-to-raise-awareness

A Help Note for Nurses

By Foot Care Academy


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