A national audit has reinforced the importance of early intervention in the management of diabetic foot disease, with patients who receive expert care most quickly having the best outcomes.
It also revealed that the basic framework for effective prevention and management of diabetic foot disease in England and Wales was “often missing”.
“We know that those who wait the longest have worse healing”
The National Diabetes Foot Care Audit 2014-16, published by NHS Digital and Diabetes UK, collected data on 173 specialist foot care services and on 11,000 individuals with acute diabetic foot ulcers.
Of commissioners that responded, only 43% confirmed that all three of the nationally recommended care structures were in place in their area – training for routine diabetic foot examinations, a foot protection service pathway and one for assessment within 24 hours if necessary.
Patients who referred themselves directly to a specialist foot care service had the highest healing rates after 12 weeks at 56%, compared to 32-48% in groups referred by a health professional.
Other findings from the audit included that, excluding self-referral, 40% of patients with foot ulcers waited for two or more weeks before being seen for a referral by a specialist foot care service.
Those with ulcers that waited two or more months to be seen by the specialist foot care service were more likely to have severe ulcers when assessed – 58% of ulcers were severe, compared to between 34-51% in other groups.
“Poor or untimely treatment can lead to an amputation”
Half of all people with ulcers were alive and ulcer-free at 12 weeks, and 66% were alive and ulcer-free at 24 weeks.
Professor William Jeffcoate, consultant diabetologist and clinical lead for the audit, said the audit had identified “inconsistences in the services available to people with foot disease in diabetes”.
“There is also wide variation in the time which elapses before people with new foot disease are assessed by a specialist service,” he said. “We know that those who wait the longest have worse healing.”
Diabetes UK chief executive Chris Askew said: “Good quality foot care for people with diabetes is vital, given that poor or untimely treatment can lead to an amputation.
“In many areas of the country, people with diabetes and their GPs are left in the dark about where to go for the best specialist treatment,” he said. “Information about local services is sadly lacking and in some areas specialist foot services aren’t being commissioned.”
“Every clinical commissioning group in the country needs to ensure they’re providing adequate foot services and information about where they’re located,” he added.
It is estimated that 5-7% of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated overall cost of £935m to the NHS.