Excerpt

Despite the publication of strategies on commissioning specialist services for the management and prevention of diabetic foot problems in hospital (‘Putting feet first’, Diabetes UK 2009; ‘Improving emergency and inpatient care for people with diabetes’, Department of Health 2008), there is variation in practice in the inpatient management of diabetic foot problems. This variation is due to a range of factors, including differences in the organisation of care between patients' admission to an acute care setting and discharge. This variability depends on geography, individual trusts, individual specialties (such as whether the service is managed by vascular surgery, general surgery, orthopaedics, diabetologists or general physicians) and the availability of podiatrists with expertise in diabetic foot disease.

This short clinical guideline aims to provide guidance on the key components of inpatient care of people with diabetic foot problems from hospital admission onwards.

Contents

• Introduction
• Patient-centred care
• 1. Recommendations
  • 1.1. Key priorities for implementation
  • 1.2. List of all recommendations
• 2. Care pathway
• 3. Evidence review and recommendations
  • Introduction
  • Health economic modelling
  • 3.1. Key components and organisations of hospital care
  • 3.2. Assessment, investigation and diagnosis of diabetic foot problems
  • 3.3. Debridement, wound dressings and off-loading
  • 3.4. Antibiotics for diabetic foot infections
  • 3.5. Adjunctive treatments for diabetic foot problems
  • 3.6. Timing for surgical management to prevent amputation
• 4. Notes on the scope of the guideline
• 5. Implementation
• 6. Other versions of this guideline
  • 6.1. Quick reference guide
  • 6.2. ‘Understanding NICE guidance’
• 7. Related NICE guidance
  • Published
  • Under development
• 8. Updating the guideline
• 9. Contributors
  • The Guideline Development Group
  • The Short Clinical Guidelines Technical Team
  • The Guideline Review Panel
  • NICE Centre for Clinical Practice
  • Declarations of interests
• Appendix A. Scope
• Appendix B. List of all research recommendations
• Appendix C. Guideline development methods
• Appendix D. References of all included studies
• Appendix E. Full GRADE evidence profiles
• Appendix F. Results of individual studies (Review question 2)
• Appendix G. Summary of ROC and forest plots (Review question 2)
• Appendix H. Van der Bruel plots (Review question 2)
• Appendix I. Meta-analysis and forest plots (Review question 3 and 5)
• Appendix J. Full health economic models
• Appendix K. Evidence tables
• Appendix L. List of excluded studies
• Appendix M. Glossary and abbreviations
• Appendix N. Declaration of interests
• Appendix O. Authorship and citation

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.

This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.