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CLINICAL: DIABETES Cathy Moulton Diabetes UK Clinical Advisor


Reducing the need for foot


amputation in diabetes patients Primary care nurses have a vitally important role in the fight against diabetic foot and subsequent amputation


R


ates of amputation in people with diabetes are unacceptably high. These rates are set to continue rising, despite 80% of amputations being potentially preventable.1


Diabetes UK is


launching a foot care campaign to encourage nurses to work with patients to ‘put feet first’. The aim of this campaign is to reduce foot


amputations in people with diabetes by 50% over the next three years, and nurses have an integral role in ensuring this is success- ful. Many will already be doing, or training staff to do, the annual recommended foot checks, so primary care nurses are at the heart of addressing the problem.


AMPUTATION: THE FACTS People living with diabetes are 30 times more likely to have an amputation compared to the general population.2


perform these thoroughly. Simply asking a patient how their feet are is not enough. We recommend asking patients to remove their shoes and socks, to allow ‘at risk’ feet to be identified. A good foot check involves checking for any cuts, infections or signs of ulceration that could potentially result in further infection and complications. By checking the feet of a patient with diabetes you might


This is staggering


and is only set to get worse unless concerted action is taken. The majority of these amputations are caused by a foot ulcer.1


Diabetes


UK aims to reduce the number of amputations to give people back their quality of life and increase their life expectancy. A person who has had an episode of foot disease has a 40% risk of a second episode within 12 months,3


and the average


survival rate at five years is just 50% for people who present with active disease of the foot.4


years, even in those with predominantly neuropathic disease.5


Average life expectancy is reduced by 14 The


relative likelihood of death following amputation or foot ulcers within five years is greater than colon, prostate and breast cancer.6,7 The number of people living with diabetes in the UK is 2.9


million and this number is set to continue to rise. It is estimated that by 2025 there will be 5 million people living with diabetes in the UK, so it is highly likely that you will have numerous people with the condition in your care.8


‘PUTTING FEET FIRST’ If you are involved in doing foot checks, it is important that you


uncover problems that the patient was unaware of, as some patients with diabetes may have limited or no feeling in their feet and may not even realise there is a problem. It may also be the case that they are playing down the severity of a foot problem because they don’t want to cause a fuss. Diabetes UK encourages making a fuss of your patients’ feet, and recommends that if you notice anything of concern it is vital that patients are referred to their GP for an urgent referral to a foot specialist, or if this isn’t possible, directed to A&E immediately. A foot ulcer can deteriorate in 24 hours, so it is vital if you do


spot any problems with a patient’s feet that you act promptly. Getting them the support they need and quickly (in the case of ulceration they should be seen by a specialist within 24 hours) could mean the difference between them losing or keeping a foot. It is important that people with diabetes are educated about the


risk of complications and encouraged to look after and check their feet. Primary healthcare professionals are in a great position to ask a patient if they are aware of their risks, and discuss how they can look after themselves further. After each foot check sit down with your patient and let them know how their feet are, discussing their risk status with them and documenting it.9 While the foot checks themselves are once a year, it can be a


good idea to ask people about their feet during other appoint- ments. During the consultation, have a quick chat with patients about how they can care for their feet – perhaps give tips on foot hygiene and highlight the importance of wearing comfortable fitting socks, tights and shoes. Identifying problems early, together with good management of


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