Excerpt

Despite the publication of strategies on commissioning specialist services for preventing and managing diabetic foot problems, there is variation in practice across different NHS settings, and amputation rates still vary up to fourfold in the UK.

This variation in practice results from a range of factors including differing levels of organisation of care for people with diabetes and diabetic foot problems. This variability depends on geography, individual trusts, individual specialties (such as the organisation and access of the diabetic foot care services) and availability of healthcare professionals with expertise in the management of diabetic foot problems.

The implementation of foot care screening programmes is still varied across the UK, and there is currently a lack of guidance on foot screening strategies aimed at children and young people with diabetes. There is a need for comprehensive guidance on foot care for people with diabetes that addresses all NHS settings.

Contents

• 1. Overview
  • 1.1. Introduction
  • 1.2. Health and resource burden
  • 1.3. Reasons for the guideline
  • 1.4. Scope
  • 1.5. The Remit
  • 1.6. Population
  • 1.7. Healthcare setting
  • 1.8. Safeguarding children
  • 1.9. Medicines
  • 1.10. Patient-centred care
• 2. Summary Section
  • Strength of recommendations
  • Interventions that must (or must not) be used
  • Interventions that should (or should not) be used – a ‘strong’ recommendation
  • Interventions that could be used
  • Recommendation wording in guideline updates
  • Update information
  • 2.1. GDG membership, Peer reviewers, ICG technical team
  • 2.2. Key Priorities for implementation
  • 2.3. Recommendations
  • 2.4. Research recommendations
  • 2.5. Related NICE guidance
• 3. Methods
  • 3.1.1. Outcomes
  • 3.1.2. Process
  • 3.1.3. Evidence synthesis and meta-analyses
  • 3.1.4. Quality assessment
• 4. Evidence reviews and recommendations
  • 4.1. Key components and organisations of hospital care
  • 4.2. Composition of foot protection services and multidisciplinary foot care services
  • 4.3. Criteria for referral to the foot protection service or multidisciplinary foot care service
  • 4.4. Classifying and stratifying risk of foot problems
  • 4.5. Monitoring those at risk of foot problems
  • 4.6. Prevention strategies for those at risk of diabetic foot problems
  • 4.7. Tools for assessing and diagnosing foot problems
  • 4.8. Monitoring of people with diabetic foot problems
  • 4.9. Management strategies for people with diabetic foot problems
  • 4.10. Debridement, wound dressings and offloading
  • 4.11. Antibiotic regimens and antimicrobial therapies
  • 4.12. Adjunctive treatments for diabetic foot problems
  • 4.13. Signs and symptoms of suspected Charcot arthropathy
  • 4.14. Indicators for referral to specialist services
  • 4.15. Tools for assessing and diagnosis Charcot arthropathy
  • 4.16. Management strategies for Charcot arthropathy
• 5. References
• 6. Glossary and Abbreviations
• Appendix A. Guideline development group membership and declarations of interest
• Appendix B. SCOPE
• Appendix C. Diabetic foot problems – review protocols
• Appendix D. Search strategies
• Appendix E. Excluded studies
• Appendix F. Full evidence tables – review questions 1 - 10
• Appendix G. Full evidence tables – review questions 11 – 16
• Appendix H. Data analysis
• Appendix I. GRADE profiles
• Appendix J. Health economics
• Appendix K. Deleted text from NICE guideline CG119

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.