Prevention and treatment of diabetic foot ulcers

Abstract

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials

“…Diabetic foot ulcer (DFU) is a full‐thickness wound involving dermis in either ankle or foot with a 25% lifetime risk . DFU is associated with significant morbidity and the mortality ranges between 4 and 10% .…”

Towards a systems approach for chronic diseases, based on health state modeling

“…Complications of the foot typically present themselves clinically as ‘diabetic foot ulcer’, a type of non-healing, chronic skin wound, to a well-trained expert, such as a specialized wound nurse or physician ( Driver et al , 2010; Lim et al , 2017). Unfortunately, many patients carry such dangerous wounds for too long, and therefore have to face unfavorable outcomes, when it’s too late to manage the problem with currently available tools.…”

Cost‐effectiveness of prevention and management of diabetic foot ulcer and amputation in a health resource‐limited setting

“…Clinical studies have found that implementing evidence‐based foot care may prevent DFU‐related hospitalization, amputation, and overall disease burden . Based on guidance documents from the International Working Group on the Diabetic Foot (IWGDF), five key elements should be included in clinical practice to preventing foot problems: (i) identification of the at‐risk foot; (ii) regular inspection and examination of the at‐risk foot; (iii) education of patients, families, and healthcare providers; (iv) routine wearing of appropriate footwear; and (v) treatment of pre‐ulcerative signs.…”

“…Clinical studies have found that implementing evidence-based foot care may prevent DFU-related hospitalization, amputation, and overall disease burden. 6 Based on guidance documents from the International Working Group on the Diabetic Foot (IWGDF), 7 five key elements should be included in clinical practice to preventing foot problems: (i) identification of the at-risk foot; (ii) regular inspection and examination of the atrisk foot; (iii) education of patients, families, and healthcare providers; (iv) routine wearing of appropriate footwear; and (v) treatment of pre-ulcerative signs. Previous economic evaluations in developing countries have found that management and prevention of DFUs in patients with T2DM is cost-effective, 4 and the IWGDF believes that investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure.…”