The results are in!
In 2017, Diabetes Feet Australia published the “Australian diabetes-related foot disease strategy 2018-2022: The first step towards ending avoidable amputations within a generation”. A section of this landmark document discusses potential solutions to the lack of research into DFD and how deficiencies in research funding may be addressed. This is a big problem of course, as diabetes-related foot disease causes ~60% of the global diabetes disability burden and ~33% of all diabetes healthcare costs yet receives <0.2% of all diabetes research funding awarded.
A key recommendation of the national strategy was for the development of a widely endorsed national research agenda for DFD that focuses research priorities for achieving the common long-term national goal of ending avoidable amputations in a generation (2). While international peak bodies such as the International Working Group on the Diabetic Foot (IWGDF) have published suggested areas for future research according to uncertainties in the existing international literature (8-12), little is known about what research priorities a broad range of Australian (or anywhere else) stakeholders of diabetes-related foot disease consider important.
So, in late 2019 DFA then Chair Pete Lazzarini and Steering Committee member Byron Perrin conceived a study to determine the priority research questions according to Australian stakeholders involved in diabetes-related foot health and disease. A multi-disciplinary team comprising of DFA Steering Committee members and external experts were brought together for the project, with Aboriginal and/or Torres Strait Islander Peoples and consumer representation. In 2020 and 2021, DFA in partnership with La Trobe University conducted a study to determine what a broad range of people thought were the most important questions about diabetes-related foot health and disease that should be answered by research.
We have now published the finding from a major research project investigating priority research questions according to Australian stakeholders involved in diabetes-related foot health and disease. To access the full article click on the link below. And even though we are biased, it is important to talk about the results - so scroll down as we walk you through the key findings and results.
Citation: Perrin BM, Raspovic A, Williams CM, Twigg SM, Golledge J, Hamilton E, Crawford A, Hargreaves C, van Netten JJ, Purcell N, Lazzarini PA. Establishing the national top 10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders. BMJ Open Diabetes Research and Care 2021;9:e002570. doi: 10.1136/bmjdrc-2021-002570
Key Findings
A total 226 unique questions were proposed by 210 participants (including 121 health professionals and 72 consumers), with 69 participants completing all three rounds of the consensus-building process (39 health professionals and 30 consumers).
The key findings were:
- Patients prioritised peripheral neuropathy and prevention-related questions
- Health professionals prioritised health economic and management-related questions
- Australia’s First Peoples health was the top priority question for health professionals
To quote the article: “While it was expected that the subgroups of consumers and health professionals may show contrasting priorities, the degree of difference was somewhat surprising.” The findings demonstrate that it is important to include consumers in DFD research priority setting, as consumer research priorities cannot simply be assumed by researchers.
"While it was expected that the subgroups of consumers and health professionals may show contrasting priorities, the degree of difference was somewhat surprising."
The national Top 10 Questions
From all participants from the study
The national Top 10 Questions
From those living with diabetes, diabetes-related foot disease and their carers
The national Top 10 Questions
From health professionals, researchers and industry
Conclusions
A final conclusion of the study is that the findings from this study should guide future national research agendas that pursue answers to these important priority research questions and in turn contribute to the reduction of the disease burden caused by DFD on patients and nations. In addition, these findings should assist diabetes peak bodies in lobbying government for targeted research funding which can help to bridge the current funding gap between the high DFD burden and low DFD research funding to address this burden.
The publication of the DFA lead paper Establishing the national top-10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders in BMC Open Diabetes Research and Care is the culmination of a fruitful multi-disciplinary collaboration and is an excellent example of teamwork amongst people interested in diabetes-related foot disease.
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How did the study work?
We asked the following people to help us find and shape Australia's TOP 10 priority research questions in the field of diabetes-related foot health and disease.
- People living with diabetes, diabetes-related foot disease and their carers
- Health professionals who care for people with diabetes and diabetes-related foot disease
- Researchers involved with diabetes and diabetes-related foot disease
- Industry and organisations involved with diabetes-related foot disease
Tell us the questions you'd like to see answered by research!
About Round One
We wanted to find out what’s important to participants, based on their own experiences. This could include topics from living with, assessment, diagnosis, to treatment of diabetes-related foot disease. Participants could ask up to three questions that they would like answered by research.
Tell us the questions you'd like to see answered by research
About Round One
We wanted to find out what’s important to participants, based on their own experiences. This could include topics from living with, assessment, diagnosis, to treatment of diabetes-related foot disease. Participants could ask up to three questions that they would like answered by research.
Choose the questions that matter to you most
About Round Two
To develop Round 2, the team used inductive and deductive thematic analyses to initially independently categorize all question responses from Round 1 into DFD subcategories. The final list of unique edited questions from Round 1 was grouped according to their DFD category and presented to participants in Round 2 in random order to minimize selection bias. Participants could then select a maximum of 10 questions they considered to be most important.
Choose the questions that matter to you most
About Round Two
To develop Round 2, the team used inductive and deductive thematic analyses to initially independently categorize all question responses from Round 1 into DFD subcategories. The final list of unique edited questions from Round 1 was grouped according to their DFD category and presented to participants in Round 2 in random order to minimize selection bias. Participants could then select a maximum of 10 questions they considered to be most important.
Rank the questions to help build the national priorities
About Round Three
The Round 3 top 10 research questions were determined by identifying the 10 questions most frequently selected by all participants and by participant subgroups after Round 2. Participants were then asked to rank the top 10 questions in order from most to least important.
Rank the questions to help build the national priorities
About Round Three
The Round 3 top 10 research questions were determined by identifying the 10 questions most frequently selected by all participants and by participant subgroups after Round 2. Participants were then asked to rank the top 10 questions in order from most to least important.
Why is foot health research so important?
At the heart (or foot) of it, research aims to identify new treatments, prevention, and improve care. It can lead to new discoveries, development of new tools and procedures or highlight important trends and risks. Research can also help health care professionals to follow the most effective methods of care.
In Australia, a whopping $4 million is spent each and every day just managing diabetes-related foot disease. And when we look at the statistics below, it doesn't take much to see how quickly those costs could increase.
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What happens with the results?
Identify Research
Priorities
We can identify the agreed priority research questions on diabetes-related foot disease according to all stakeholders that need to be answered to help end avoidable amputations.
Assist
Researchers
It can assist researchers to develop important and clinically relevant future research that should have relevance and impact in Australia.
Focus on Foot funding
Provide the data to immediately recognise the priorities and give a greater focus on improving the current 0.2% allocated within the diabetes funding allocation.
FAQ's
This research is supported by Diabetes Feet Australia and Latrobe University with Ethics Approval - HEC20282
Question Categories
From the Round 1 survey we identified 22 categories. In the Round 2 survey, the questions were displayed under these categories to help participants navigate through the list. Each question that made the final Top 10 list(s) has been assigned to one of the categories listed below.