Improving clinical and quality outcomes for people with diabetes-related foot disease
Diabetes Feet Australia (DFA) and the Australian Diabetes Society (ADS) recently endorsed the 2019 IWGDF Guidelines. With 87 evidence-based practice recommendations and 44 future research priorities across 8 chapters and 194 pages, the new 2019 international guidelines contain everything known to (wo)man on prevention, offloading, peripheral artery disease, infection, wound healing and ulcer classification.
the national problem
Diabetes-related foot disease is defined as ulceration, infection, ischaemia or neuro-arthropathy of the foot in people with diabetes. People at-risk of diabetes-related foot disease are defined as those with diabetes who have developed peripheral neuropathy, peripheral arterial disease or have a history of previous foot disease.
Diabetes-related foot disease (DFD) is globally-recognised as the leading cause of diabetes-related hospitalisations and amputation, with mortality rates comparable to many cancers. It poses a major burden on an individual’s quality of life, significant risks to their morbidity and mortality, and increases their healthcare costs.
for all people with diabetes
Wear appropriate footwear that fits, protects and accommodates the shape of their feet
Wear Socks to reduce shear and friction
Educate on the importance of wearing appropriate footwear
For people at intermediate or high-risk of foot ulceration
Obtain Footwear from trained professionals
Wear appropriate footwear at all times both indoors and outdoors
Check footwear before wearing and check feet after wearing shoes
For people with a foot deformity or previous diabetes-related foot ulceration
For a foot deformity consider prescribing medical grade footwear
For a healed plantar ulcer prescribe medical grade footwear that reduces plantar pressure
Review prescribed footwear every 3 months
For people with a foot deformity or previous diabetic foot ulceration
Prescribe appropriate offloading devices - not footwear
We have established the Australia Diabetes-Related Foot Disease Strategy 2018-2022 to guide Australia’s efforts toward reducing the burden of diabetes-related foot disease in this country by prioritising:
Access to affordable and effective care
Provision of safe quality care
Research and development to improve patient outcomes
Written by Diabetes Feet Australia with input from various national and state peak bodies, interdisciplinary foot disease services and individual experts from the Australian diabetes-related foot disease (DFD) community, the aggregated feedback and DFA’s response can be found here
The following nine goals are formulated within these priorities, each with their potential areas for action and measures to keep track of their progress. We look forward to the uptake of this strategy, and monitoring the positive steps the Australian DFD community will take on the pathway towards ending avoidable amputations in a generation.
All people with diabetes should have access to annual DFD screening and understand their risk of developing diabetes-related foot disease.
All people at-risk of diabetes-related foot disease should have access to preventative evidence-based healthcare from appropriately trained health professionals.
All people with diabetes-related foot disease should have access to evidence-based
healthcare from specialised interdisciplinary foot disease services.
All health professionals and specialised interdisciplinary foot disease services caring for people with, or at-risk of, diabetes-related foot disease should demonstrate they meet minimum Australian evidence-based standards.
All health service regions should report their diabetes-related foot disease outcomes annually to monitor progress towards ending avoidable amputations.
Australian national diabetes-related foot disease guidelines should continually reflect the most up-to-date robust evidence to guide standards for healthcare provision and outcome reporting.
An “Australian Research Agenda for Diabetes-Related Foot Disease” should be developed and endorsed to guide national research priorities.
An “Australian Diabetes-Related Foot Disease Clinical Trials Network” should be established to provide national research support and leadership.
Investments in research and development for diabetes-related foot disease should be
proportionate to the national health burden caused by the disease.