1. NHS Medical Directorate Diabetic foot disease Preventing loss of life and limb Dr Rowan Hillson MBE National Clinical Director for Diabetes

2. NHS Medical Directorate Diabetes in England (diagnosed) 2.2 million people with diabetes (1.3 million in 2003) (Retinal screening programme, 2009) 4.8% adults (QOF 2008) 2.5 million UK Everyone with diabetes deserves the highest standards of personalised diabetes care, no matter where, when or by whom they are cared for.

3. NHS Medical Directorate Why do people with diabetes get foot trouble? Neuropathy - nerve damage 20 – 40% of people with diabetes Peripheral vascular disease - circulation damage 20 – 40% Ligament and joint problems – deformity High glucose – infection

4. NHS Medical Directorate Foot ulcers in diabetes Following pressure or injury Ball of foot in neuropathy. Pressure sores if immobile or in bed

5. NHS Medical Directorate Gangrene Poor circulation After injury With infection

6. NHS Medical Directorate Multiple foot problems. Infection. Recurrence

7. NHS Medical Directorate Amputation 100+ major amputations a week (Diabetes UK) Half those who have a major amputation die in the next 5 years (Robbins 2008)

8. NHS Medical Directorate Prevention Most diabetic foot problems could have been prevented

9. NHS Medical Directorate Prevention Teach people with diabetes to look after their feet Healthcare professionals must check feet Process NDA (1.4 m people) 2003 - 042007 - 08 HbA1c6891 Cholesterol6590 Smoking history noted6386 Foot exam2977

10. NHS Medical Directorate Prompt, proper treatment

11. NHS Medical Directorate Thank you rowan.hillson@dh.gsi.gov.uk