A series of recommendations to improve foot care and education, and to reduce the number of major amputations in people with diabetes have been put forward.
The position paper has been drafted by the Insights for Diabetes Excellence, Access and Learning (iDEAL) group, which is a team of multidisciplinary diabetes specialists with a keen interest in improving diabetes care outcomes across the UK.
Specialist help for foot problems is often delayed because people with diabetes fail to recognise that changes in the skin, swelling, redness or pain require medical attention. Those who do spot any changes are not sure what to do or whom to speak to. Some are unaware of the signs of infection and some just do not realise the seriousness of these events.
The National Diabetes Foot Care Audit reported that the longer it took for a person with diabetes who developed a foot ulcer to reach expert care, the greater the chance of the ulcer being severe and not healed after six months.
Also, the report suggested that it was more likely for the person to have a hospital admission within six months, involving foot disease, revascularisation and amputation.
As part of the paper, the team have drawn up a tool for all NHS primary and secondary care services to prompt rapid referral to specialist help from the multidisciplinary diabetic foot teams (MDFT) in secondary or community care.
The acronym ACTNOW has been devised to help recognise the warning signs that might lead to amputation which, if identified, should activate urgent referral to specialist care provided by MDFTs.
The breakdown of the acronym is as follows:
Accident: Recent or history of an accident or trauma?
Change: Is there any new swelling, redness or change of shape of the foot?
Temperature: If there is a change in temperature present? Could this be an infection or possible Charcot?
New pain: Is there new pain present? Is it localised or generalised throughout the foot?
Oozing: What colour is any exudate? Is there an odour?
Wound: New blister or skin break?
If persons living with diabetes have any of the symptoms or signs of the ACTNOW, they should be encouraged and given confidence to seek specialist help.
Some of the other recommendations include increasing awareness of the risks to all people living with diabetes to promote foot health, establishing a national education programme with practical information in an illustrated practical handout about foot self-care. It has also been suggested that there should be a standardisation of evidence-based provision of the MDFTs and the Foot Protection Team in all NHS Trusts and referral criteria to reduce postcode lottery and fragmented services across the NHS.
The authors wrote: “The impact of these recommendations will be to accelerate the healing of ulcers in people with diabetes and hence reduce the number of foot infections, hospital admissions and major amputations.
“If the recommendations in this position statement are put into practice, the iDEAL group believes that a 50% reduction in major amputations in people with diabetes within five years is achievable.
“The present situation has gone on for far too long and has resulted in an unacceptably high number of major amputations that could be prevented. This can no longer be tolerated: ACTNOW and save feet!”