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CLINICAL: DIABETES


diabetes and keeping blood glucose and blood pressure levels under control, could prevent a large proportion of amputations. But while we are currently campaigning on foot care in particular, this is only one of the complications that, as primary care professionals you can play a vital role in helping to prevent. Diabetes UK’s 15 Healthcare Essentials10


outline the level of


care essential for the wellbeing of all people with diabetes. It is vital that people with diabetes not only have their feet checked at least every year, but that their blood glucose (HbA1c), blood lipid levels, kidney function and eyes are also checked annually and that they are given emotional and psychological support if required. By ensuring that people living with diabetes have their foot and


other vital checks, and by giving them an opportunity to discuss their diabetes with you, we can lower the number of people with problems that result in amputation. In doing so we can give people living with diabetes their quality of life and independence back.


REFERENCES 1.


International Diabetes Federation. Position statement - The diabetic foot. 2005. Available at: www.idf.org/position-statement- diabetic-foot


2. NHS National Diabetes Support Team. Diabetic foot guide. 2006. Available at: http://bit.ly/ndst2006


3. NHS Diabetes. Putting feet first – and fast. Factsheet 29. 2010. Available at: www.diabetes.nhs.uk/document.php?o=202


4. Boyko EJ, Ahroni JH, Smith DR, Davignon D: Increased mortality associated with diabetic foot ulcer. Diabet Med 1996;13:967–72.


5. Van Baal J, Hubbard R, Game F, Jeffcoate W. Mortality associated with acute Charcot foot and neuropathic foot ulceration. Diabetes Care 2010;33:1086–9.


6. Cancer Research UK. Cancer survival in England: one year and five year survival for 21 common cancers, by sex and age. CRUK: 2011. Available at: http://info.cancerresearchuk.org/cancerstats/incidence/ age


7. Moulik K., et al. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 26:491-494;2003.


8. Diabetes UK. Diabetes in the UK 2011-12: Key statistics on diabetes. 2011. Available at: www.diabetes.org.uk/Professionals/Publications- reports-and-resources/Reports-statistics-and-case-studies/Reports/ Diabetes-in-the-UK-2011/


9. National Institute for Health and Clinical Excellence. Type 2 diabetes - footcare (CG10). London: NICE; 2004. Available at: www.nice.org.uk/ CG10


10. Diabetes UK. 15 Healthcare Essentials. Diabetes UK: 2012. Available at: www.diabetes.org.uk/upload/About%20us/15%20measures%20 checklist.pdf


RESOURCES Diabetes UK – Putting Feet First campaign To find out more about Diabetes UK and the Putting Feet First campaign, visit www.diabetes.org.uk/putting-feet-first


BOX 1. FOOT CHECK HELPFUL HINTS


Every patient with diabetes should have an annual foot check. During this foot check, you should: Ask the patient to remove their shoes and socks/stockings. Check the skin for cuts, infections and signs of ulceration. Inspect the patient’s feet for any deformity or significant callus. Check the circulation to a patient’s feet by palpating the dorsal and posterior tibial pulses. Check for neuropathy causing loss of sensation using 10g monofilament or vibration. Ask about any pain or previous ulceration. Discuss the risks that diabetes has on the feet with the patient and inspect their footwear. Educate the patient to make thorough checks of their own feet and encourage them to see a member of their diabetes healthcare team – any time they are concerned. If you notice anything of concern refer the patient to their GP.


44 Nursing in Practice March/April 2012


www.nursinginpractice.com


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