Foot care should be considered a “superspecialty” of diabetes care because of current poor outcomes, a journal article has suggested.
Researchers from the UK and US specialising in diabetes foot care say there is an “urgent need” to improve care and reduce lower limb problems.
The study teams came together to look at the issue of foot ulcers and why they remain a major problem within diabetes care.
Around 10% of people with diabetes develop a foot ulcer at some point, although the risk can be reduced by maintaining good control blood glucose control and living a healthy lifestyle.
The team was led by Professor William Jeffcoate, from the Nottingham University Hospitals NHS Trust, with the review looking at treatment effectiveness, numbers of major amputation and new ulceration after healing and strategies to reduce them.
The five-year survival rate of 50-60% following presentation of a new foot ulcer was worse than that of many common cancers, the authors said.
They suggested that there was evidence available that “suggests that very considerable improvements can accompany structural changes in the way professionals work and in the way that care is delivered”.
In response, they issued a series of recommendations, including more funding to carry out research and ensuring the “design and delivery of care for people with diabetic foot ulcers comply with such evidence-based guidance as is available”.
The experts concluded: “Available evidence suggests that such structural changes should focus on 1) the creation of clear pathways to enable early assessment of diabetic foot ulcers by a specialist multidisciplinary service and 2) the provision of structured surveillance and care for those who have had a diabetic foot ulcer and are in remission after healing.
“If communities embrace these initiatives, it should be possible to trigger substantial improvement in outcomes relating to diabetic foot ulcers. Care of the foot needs to metamorphose from a subspecialty to a ‘superspecialty’ of diabetes.”
The review appears in the journal Diabetes Care.

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