40% of people with a foot ulcer are referred too late

The second report from the National Diabetes Foot Care Audit England and Wales has recently been published, presenting results of 2014 to 2016. This second report includes data from an impressive total of 11,073 patients who underwent expert assessment of their 13,034 ulcer episodes. The most important finding was that 40% had an interval of two or more weeks before their first expert assessment, with patients who presented after two months having more severe ulcers. On the other hand, 30% of the patients self-referred, and these ulcers were less severe.

Other findings confirmed the well-known demographics of people with diabetic foot ulcers (mean age of 67 years, mean diabetes duration 15 years, 70% male and 87% type 2 diabetes), as well as the poor outcomes (30% of the ulcers did not heal within 20 weeks, and 5% of patients died within 24 weeks).

What this audit also shows is the power of relentlessly pursuing national data. Professor Jeffcoate and Dr Young have worked for years to get this audit going, with the help of many. Now in its third year, it already shows a powerful signal to policy-makers and the national health services of areas in need for improvement. The Australian Diabetic Foot Ulcer Minimum Dataset has been endorsed and presented in 2016, and is a first step for Australia to obtain similar results. The road is still long, but this report from England and Wales shows we should aim high.

And even without having our own national data, we should listen carefully to the conclusions from this report and start implementing them today: “The longer it takes for someone with a new diabetic foot ulcer to reach expert assessment the more likely it is that the ulcer will be severe. It seems likely that pathways designed to shorten time to expert assessment would reduce the frequency of severe ulcers.”

These pathways may consist of improving the visibility of specialised diabetic foot clinics, improving the relation between specialised clinics and primary care, and educating patients to contact their GP as soon as they detect a problem. While the first two pathways are political undertakings with which Diabetes Feet Australia and its partners are already busy, the last one is something every clinician can do tomorrow. Make sure to educate your patients to contact their GP are soon as possible when they have (a pre-sign of) a foot ulcer.