DFA has published the finding from a major research project investigating priority research questions according to Australian stakeholders involved in diabetes-related foot health and disease. The article can be found here, and even though we are biased it is important to talk about the results.
In 2017, Diabetes Feet Australia (DFA) published the “Australian diabetes-related foot disease strategy 2018-2022: The first step towards ending avoidable amputations within a generation” (7). 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 DFD 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 and consumer representation. The team worked very well together with Tash Purcell superbly managing the online data collection.
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.
A limitation of the study was lack of voice from Aboriginal and/or Torres Strait Islander people, and a “Phase 2” project is being planned by DFA to determine what research questions Aboriginal and/or Torres Strait Islander people prioritise.
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.
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