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How to handle Diabetic Foot Enquiries
People with diabetes are inclined to having foot problems, often because of two complications of diabetes - nerve damage (neuropathy) or poor circulation (peripheral vascular disease) or a combination of these two.
Neuropathy can cause loss of feeling in the feet, taking away a person's ability to feel pain and discomfort, meaning people they know . not detect injury or irritation. Poor circulation on feet reduces the capacity to heal, making it hard for even a tiny cut to resist infection.
Diabetic foot problems will have a significant impact on a patient's quality of life as they can reduce mobility, lead to regarding employment, depression and harm to or loss of branches. They often have a significant financial impact using the NHS through outpatient costs, increased bed occupancy and prolonged stays in doctor's.
Despite a number of publications on strategies to prevent and manage foot problems, and the commissioning of specialist services in this regard, there is several variation in practice the particular prevention and management of diabetic foot problems, in both an outpatient and inpatient setting. This variability depends upon the level of awareness of healthcare professionals, geography, individual Trusts and which individual medical specialities are involved, ie orthopaedic surgeons, general surgeons, vascular surgeons or general consultants.
In 2004 the National Institute of Clinical Excellence published guidelines on the prevention and management of foot problems in Two diabetes diabetics (NICE Clinical Guideline 10, 2004). This targeting the detection, general management and treatment of diabetic foot ulcers and the concern pathway from this ends at referral to a multi-disciplinary team.
There is no doubt that it is recognised that patients with diabetes should have an annual diabetic check, and this is the standard which is aspired to in general practice. Such a diabetic check should include such factors as cardio-vascular aspects, blood pressure, lipids, diabetic control as well as retinal screening for diabetic retinopathy, and testing for diabetic neuropathy.
In past years the vast majority of diabetics were not subject to annual checks and some GP experts that all of us instructed then were of the opinion that it had not been a failure your duty of take care of a General Practitioner to not have organised a regular annual check-up even without any knowledge of any diabetic foot along with other complications. Things are now changing with a greater awareness of diabetes and its associated complications. On any view, we think the duty of care is higher if there tend to be pre-existing diabetic or foot complications; and if there has, the converter should have an agreed management plan which comprise of foot care education and also regular review, which incorporate an inspection of a patient's feet, an appraisal of footwear and also the potential need for vascular assessment.
It is generally accepted that, if either as part of an one-off attendance or as part of an annual or regular review, your foot care emergency has been identified (such as new ulceration, swelling or discolouration) then there needs to be referral to a multi-disciplinary foot care team within twenty four hours. That team would normally be within a specialist unit at a hospital and would come with a number of experts within specialities such as vascular surgery, podiatry, orthotics, nurses trained in diabetic foot wounds and diabetologists with expertise in lower limb complications.
The team would assess the foot care emergency and choose whether or not referral, ultimately either to a physician specialising in diabetes or to a vascular surgeon should be made, and in any event closely monitor the wound and assist in changing dressings regularly, carefully remove dead tissue from foot ulcers and advise located on the use of intensive systemic antibiotic therapy, and manage with a high risk when the ulcer is healed.
Unfortunately diabetic foot complications are often not managed appropriately in general use. It is rare to see a consistent annual review or an understanding of the seriousness of a diabetic foot complication on initial referral, and you often see General Practitioners prescribing antibiotics direct without referral and these are often completely inappropriate. The results from this can be disastrous and may result in an unnecessary amputation.
It may possibly the worsening of meals and drinks and the a direct referral the diabetes specialist or to a vascular surgeon as an emergency, rather than say a referral with regard to an A&E Department of a hospital.
Sometimes Accident and Emergency employees often do not appreciate the importance of diabetic foot complications, and again will often even create a misdiagnosis of athlete's foot or make an inappropriate prescription for contra-indicated antibiotics rather in comparison with referral for inpatient care to the appropriate specialist.
The NICE organisation has recently published guidelines for the management of inpatient diabetic foot problems which provides evidence-based clinical guidelines utilized in England and wales.
Amputation rates can vary up to 4-fold in england and wales because in the place of number of factors, including varying professional opinions inside the field and inconsistent management as different hospitals have different anti-microbial protocols for diabetic foot ulcers.
If you might be a diabetic, or indeed develop some involving diabetic foot care emergency, contact your present Practitioner immediately. If you are diabetic an individual should insist on, in the very least, an annual review; and in case you have got soreness or redness or open wound on your foot suggest you contact your GP immediately and refer to a referral to a multi-disciplinary team who are specialists in diabetic foot care owners.
It may be an idea to go armed that isn't relevant NICE Guidelines: 'Type 2 Diabetes: Prevention and Management of Foot Factors. NICE Clinical Guideline 10 (2004)' available from http://guidance.nice.org.uk/CG10.