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
The study aimed to determine what a broad range of people think are the most important questions about diabetes-related foot health and disease that should be answered by research. The study was led by Diabetes Feet Australia (DFA), the peak body related to diabetes-related foot disease in Australia in partnership with La Trobe University.
Any person with experience in the field of diabetes-related foot health and disease was invited to participate. This included people living with diabetes, a carer of a person with diabetes, health professionals involved in the care of people with diabetes and foot problem, and researchers, industry representatives and government agencies. All participants must have resided in Australia and being part of the study was voluntary.
To participate in the study, we asked participants tp 3 surveys over 3 months.
- In Round 1 you will be asked to nominate three research questions related to diabetes-related foot health and disease that they think should be answered by research.
- In Round 2 you will be asked to select your top 10 research questions from the list of questions suggested by all the participants following Round 1. The top 10 questions for the whole group, and from each group of participants who identify themselves as living with diabetes, health professionals, researchers or from industry will be determined for Round 3.
- In Round 3 you will be asked to rank a final set of 10 questions in order from 1 (highest priority) to 10 (lowest priority) for the whole group, and also the sub-group that you identified with.
The Round One survey was open throughout the month of August for four weeks, with the Round Two and Round Three surveys to followed in December and February 2021.
If you no longer want to complete the questionnaire, simply close the web browser. If you change your mind after clicking on the ‘Submit’ button, please email to request the withdrawal of information: B.Perrin@latrobe.edu.au
If you would like to speak to us about the study, please use the contact details below:
Name: Dr Byron Perrin
Organisation: La Trobe University
Position: Head of Department, Rural Department of Community Health
Telephone: 03 9479 1443
Email: b.perrin@latrobe.edu.au
Yes! We're publicising this study though our website and social media, and have asked relevant organisations to promote the project. Word-of mouth promotion is also encouraged.
The personal information provided was handled in accordance with applicable privacy laws, any health information collected will be handled in accordance with the Health Records Act 2001 (Vic). Subject to any exceptions in relevant laws, you have the right to access and correct your personal information by contacting the research team.
More information can be found by clicking on the below Participant Information Statement. This study also has Ethics Approval from La Trobe University: HEC20282.
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.
Questions with a focus on taking the pressure off the skin of the feet.
Questions with a focus on circulation or peripheral arterial disease.
Questions with a focus on sensation in the feet or peripheral neuropathy, including painful peripheral neuropathy.
Questions with a focus on diabetes-related foot infection.
Questions with a focus on wound healing interventions, including wound dressings and other applications and interventions related specifically to the wound.
Questions with a focus on CN, a chronic, progressive condition of the bones, joints and soft tissues most commonly of the foot in people with diabetes and peripheral neuropathy.
Questions with a focus on lower limb amputation.
Questions related to psychological, sociological or behavioural aspects of diabetes-related foot health and disease, including quality of life.
Questions with a focus on the epidemiology of diabetes-related foot disease, including investigating the prevalence and predictors of foot complications.
Questions with a focus on education for people with diabetes or health professionals on diabetes-related foot health and disease.
Questions with a focus on the health service design or delivery for diabetes related foot health and disease.
Questions with a focus on mortality or life expectancy.
Questions with a focus on health economics of diabetes-related health and foot disease.
Questions with a focus on the use of technology in the field of diabetes-related foot health and disease.
Questions that generally relate to assessment, screening or diagnosis of diabetes-related foot disease that weren’t specifically covered in other categories.
Questions that generally relate to management of diabetes-related foot disease that weren’t specifically covered in other categories.
Questions that generally relate to prevention of diabetes-related foot disease that weren’t specifically covered in other categories.
Questions with a focus on the role that the blood glucose management or control has on diabetes-related foot health and disease.
Questions with a focus on the role exercise has on diabetes-related foot health and disease.
Questions with a focus on Aboriginal and Torres Strait Islander people’s diabetes-related foot health.
Questions with a focus on the role nutrition has on diabetes-related foot health and disease.
Questions with a focus on the translation of research evidence on diabetes-related foot health or disease into clinical practice.