Recent evidence has further exposed the variation in care for people with diabetes across England and Wales. (See OnMedica article 14/06)
The 2010-11 National Diabetes Audit report on care processes has revealed that in some parts of the country people with diabetes are up to four times more likely to have all nine essential care checks than patients in other areas of England and Wales.
Anna Morton, Director of NHS Diabetes, said: “We are urging healthcare providers to address the regional variations in diabetes care checks highlighted by [the] report as a matter of priority.
“Every person with diabetes should be receiving all of the nine care checks as a routine part of their care. To not do so could result in avoidable complications such as foot amputations or blindness, which early detection can prevent.”
“NHS Diabetes has a team of diabetes and commissioning experts who work with clinicians and managers in primary care to raise the standards of care for people with diabetes. If local NHS organisations recognise from [this] report that they need to address their diabetes services, we will help review improvement plans.”
Variations in foot care
Only a few months ago, a study1 already highlighted the regional variations in diabetes amputation rates.
BBC News 2 reported at the time that one of the main authors, Professor William Jeffcoate, a consultant diabetologist at Nottingham City Hospital, was wary of pinning blame on the areas with the highest amputation rates, though he said the variations were "shocking".
"Foot disease is very complicated and a single professional hasn't necessarily got the skills to manage every aspect of it,” he said.
According to BBC news, Prof Jeffcoate also said a lot of health staff are not trained to recognise the risks of foot disease.
"Maybe it's just that people don't like feet. Maybe it's related to the fact that foot care tends to occur in an older population. But for whatever reason, doctors and nurses have […] never had specialist training in foot disease and so it means that they don't necessarily have the skills to assess a new condition when it arises," BBC News quoted.
Diabetes UK’s ‘Putting Feet First’ campaign
In a bid to bring an end to preventable amputations, the Charity Diabetes UK has launched in March a major foot care campaign ‘Putting Feet First’ to reduce diabetes related amputations by 50 per cent over five years. Nikki Joule, Senior Policy Officer at Diabetes UK, explained in the magazine DiabetesUpdate:
“Poorly controlled diabetes is serious and costly; it can lead to foot disease and amputations. Clearly, amputation brings with it significant social and economic costs. However, 80 per cent of amputations are potentially preventable through access to good-quality structured care and improved awareness among people with diabetes about their risk status and what action to take.
“Through ‘Putting Feet First’, Diabetes UK hopes to make a significant difference to the long-term quality of life of thousands of people who have diabetes now and those who will be diagnosed in the future. The charity is campaigning so people with diabetes do not develop preventable foot problems which otherwise result in pain, depression, reduced independence, lost limbs and death. The goal is to halve the number of amputations over the next five years.
“Diabetes UK also wants to put an end to the widespread geographical variations in standards of foot care for people with diabetes.”
In order to support healthcare professionals to commission and plan a care pathway for foot care services for people with diabetes, Diabetes UK has provided a quick guide available to download here.
Diabetes UK’s footcare pathway for healthcare professionals
Further links to support effective foot care for patients with diabetes include:
- N. Holman & R. J. Young &W. J. Jeffcoate. Variation in the recorded incidence of amputation of the lower limb in England Diabetologia (2012) 55:1919–1925
- BBC News. Diabetes amputation rates show huge regional variation. 7 March 2012
Have your say
Do you think that there is a lack of training in foot disease or are foot problems simply a result of chronic poor diabetic control? Do you feel you feel confident managing foot care? Is there a role for increased patient education in recognising and reporting early signs of foot complications? Leave your comments below.