1. DIABETES CARE IN AN ORTHOPAEDIC LED FOOT CLINIC
R Maahi, AM Ahmad, A Khan, Z Bhikha, T Khokhar, PJ Weston, D Sharma, TS Purewal, R Zaidi, D Kalathil
The Royal Liverpool and
Broadgreen University Hospitals
NHS Trust
INTRODUCTION
History of hypertension and peripheral neuropathy were common (Figure C).
Foot complications in diabetes mellitus (DM) is common, disabling and frequently leads to amputation of the leg. The NHS spends several million pounds on 7000 DM related amputations a year; 80% of these are preventable 1,2.
The risk of foot disease in people with DM is increased, largely because of either diabetic neuropathy and/or peripheral arterial disease. Approximately 1 in 10 people with DM will develop a foot ulcer at some point in their lives2.
Prevention requires tight glycaemic control and optimisation of contributory risk factors. It is understood that the need to prioritise the prevention of DM foot complications is critical from both a financial and medical perspective. Due to the increase in number of ulcers and consequent amputations, it raises the question of whether the patients that are presenting with foot complications are receiving appropriate care for their DM?
Many patients had insulin as part of their regimen to combat their glucose levels (Figure D).
AIM
We aimed to evaluate the diabetes care received by patients attending an orthopaedic-led foot clinic for management of diabetic foot disease.
METHOD
A cross-sectional study was carried out including patients presenting to the orthopaedic-led podiatry clinic at Broadgreen Hospital, Liverpool, UK over a 7-week period.
Data was obtained from the patients themselves (via questionnaire) along with their medical records. Data includes: demographics, DM care parameters (i.e. HbA1c), medical/drug history and foot care.
RESULTS
All patients were confirmed to have had previous foot disease (Figure E).
Over the 7-week period, data was collected from 29/38 (76.3%) patients who had DM (Table 1).
TABLE 1: DEMOGRAPHICS
Total DM patients, n 29
Mean age, years (±SD)
60.0 (±12)
Number of male patients, n (%)
20 (69.0)
Patients with type 1 DM, n (%)
5 (17.2%)
Patients with type 2 DM, n (%)
24 (82.8%)
The mean HbA1c was found to be considerably high.. Consultant-led care was only received by 31.0% of patients (Table 2).
CONCLUSION
TABLE 2: DIABETES CARE
Mean HbA1C, mmol/mol (±SD)
77.2 (±22.2)
HbA1c of <53mmol/mol, n (%)
4 (13.8%)
HbA1c measured in the past year, n (%)
24 (82.8%)
Lipid profile checked in the past year, n (%)
13 (44.8)
eGFR/creatinine checked in the past year, n (%)
23 (79.3)
DM care managed by GP/practice nurse, n (%)
16 (55.2)
DM care managed by hospital, n (%)
9 (31.0)
Patients with diabetic foot disease have poor glycaemic control, modifiable risk factors and multiple complications, making their care needs complex. Their diabetes management does not seem to receive the attention it merits. We believe these patients should be looked after in a multidisciplinary foot clinic as recommended by NICE if we wish to succeed in preventing recurrent foot disease.
REFERENCES
Public Health England (2016). Diabetes Footcare Activity Profiles. Using the average annual number of amputations per year from
NICE Guidelines (2015). Diabetic foot problems: prevention and management (2015)