A man checks the health of his foot

Dutch researchers say that a paradigm shift in the way footcare treatment is approached will ease the burden of diabetic foot disease.

Foot complications are common in people with diabetes and it has been estimated that 10% of people with the condition will have a diabetic foot ulcer at some point in their lives. Left untreated they can cause severe complications, which in turn can lead to drastic treatment options such as amputation. treatment approaches. In fact, foot ulceration is thought to precede 85% of diabetes-related amputations.

Because of the huge burden that foot ulcers can put on both the health services and the severe health impact they have on the patient themselves, a research team from Amsterdam wanted to further investigate why greater prioritisation of foot ulcers is not given.

The researchers, from the Department of Rehabilitation Medicine at the University of Amsterdam, say there are five barriers which they believe are preventing better footcare, one of which is that clinicians are currently more focused on ulcer healing instead of prevention. They posit that focusing on the prevention of ulcers, as opposed to the current treatment-focused strategy, will reduce the burden of diabetic foot disease on the health services.

Another barrier is that the research surrounding the prevention of foot ulcers is limited, and where there are studies carried out, they are mostly industry‐driven, whereas “ulcer prevention trials are investigator‐driven”.

They also said that from an “epidemiological perspective” the understanding of ulcer development is “limited at best”.

However, the researchers do not think solving all the barriers individually is the answer. Instead, they want to see a major shift in the approach to treatment. Moving from a stratified healthcare, where patients are seen as groups, towards a personalised treatment approach could help prevent ulcers from developing in the first place, provide better care, and ease the burden of diabetic foot disease on healthcare services and patients.

The researchers concluded: “Diabetic foot ulcer prevention is still underexposed in research and clinical practice, despite that all working in diabetic foot care agree that it is highly important. In this article, we identified a number of barriers that, in our opinion, prevent prioritizing ulcer prevention.

“To overcome these barriers, we propose a paradigm shift from stratified healthcare towards personalised medicine, to get the right treatment to the right patient at the right time. We hope to see more discussion around this paradigm shift, and increasing investments of energy and money in diabetic foot ulcer prevention in research and clinical practice.”

The researchers’ paper was published in Diabetes Metabolism Research and Reviews.

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