1. Claire OShea, Podiatrist (Presenting on behalf of the Waikato Regional Diabetes Service, Multi-disciplinary foot team, Vickie Corbett CNS Diabetes, Leigh Henry, Podiatrist, Dr Paul Haggart, Vascular Consultant) DIABETES MULTIDISCIPLINARY FOOT CLINIC

2. Our Objectives Lower amputation rates Integrate services Improve healing times Improve patient quality of life Improve accessibility of health care

3. Diabetes Multidisciplinary Foot Team

4. MDT Five Year Statistics 200920102011 Total MDT patients 9490102 Average age667069 Male66 (70%)66 (73%)74 (72%) Female28 (30%)24 (27%)28 (28%) Maori/NZ European/Other 29(31%)/46(49%)/ 19(20%) 25(28%)/56(62%)/ 9(10%) 31(30%)/63(61%)/ 8(6%) First HbA1c8.3% (Range 14.3% - 4.7%) 7.3% (Range 15.2% - 5.2%) 8.1% (Range 14.4% - 5.3%) Discharge HbA1c7.3% (Range 10.9% - 5.4%) 6.9% (Range 13.0% - 5.4%) 7.8% (Range 12% - 5.3%) Timing of ulcer presentation 51% were 10 wks47% are within 4wks47% are within 4weeks 53% over 4 weeks Vascular intervention 35%64%69 (70%) Deceased17 (18%)9 (10%)12 (11%) Number of Discharges 58 (64%)71 (69%)

5. MDT Five Year Statistics 20122013EURODIALE (2011) Total MDT patients93911232 Average age6765 Male66 (71%)65 (71%)65% Female27 (29%)26 (29%) Maori/NZ European/Other Ethnicity 17(19%)/65(69%)/ 11(12%) 20 (22%)/59 (65%) /12 (13%) 10 countries from Europe First HbA1c68 mmol/mol (Range 130 – 31) 65mmol/mol (Range 136-35) >8.4% (68mmol) 49% population Discharge HbA1c67 mmol/mol Range 130 - 39) 60mmol/mol (Range 103-35) Timing of ulcer presentation 54% are within 4 weeks 46% over 4 weeks 54% (4WKS) 46% (4WKS+) Length of time not stipulated Vascular intervention 75 (80%)82 (90%)49% (PAD) 22-73% range Deceased13 (14%)7 (7%)6% within 1yr Number of Discharges 54 (60%)72 (79%)

6. Renal Patients Average eGFR MDT patients 2013 (n92) 59ml/min 30-44ml/min15% <15ml/min10%

7. Patient One Mrs T Age54 Ulcer siteRight 2 nd toe Date 1 st appointment31/03/2013 - Primary care referral Discharge Date21/07/2013 –Community Podiatry 1 st HbA1c & discharge HbA1c108 mmol/mol % & 53mmol/mol BP 1 st & last appointment190/90 & 152/80 Vascular investigationsADS/Angio Insulin Start31/03/13 Protaphane/Novorapid Smoking statusEx-Smoker

8. Patient Two MrH Age65 Ulcer siteLeft 2nd amp Date 1 st appointment6/08/12 – Vascular team following discharge Discharge Date20/01/13 - Bilateral amputee 1 st HbA1c & discharge HbA1c53mmol/mol & 42 mmol/mol BP 1 st & Last appointment160/80 & 128/68 Vascular investigationsADS/Angio failed Insulin StartAlready on Protaphane and glicazide Smoking statusEx-Smoker

9. Midlands Region Amputation Rates Month Fiscal year 2011201220132014 Jul76812 Aug6576 Sep4666 Oct6946 Nov44122 Dec9713 Jan785 Feb3413 Mar646 Apr871 May6813 Jun565 Total71749332

10. Waikato Diabetes Amputation Rates

11. Conclusion Achieving comparable patient outcomes to international data Striving to continually improve our service in the best interests of the patient Working within an interdisciplinary environment provides a seamless health care journey

12. References NZ Primary care Handbook, 2012 – www.health.govt.nzwww.health.govt.nz Diabetes in Scotland - foot action group. www.diabetesinsctoland.org.ukwww.diabetesinsctoland.org.uk Type 2 Diabetes, prevention and management of foot problems. NICE guidelines, UK 2004. http://www.nice.org.uk/pdf/CG10fullguideline.pdf International Working Group on the Diabetic Foot (IWGDF) www.iwgdf.org. www.iwgdf.org Managing the Diabetic Foot, Edmonds, M. Foster, A.(1999), Blackwell Science, Oxford. Boulton, A, Armstrong, D, et al. Comprehensive Foot Examination and Risk Assessment, Endocrine Practice Vol14 No 5. July/August 2008. (ADA)