Practice Uncertainties Page

How can we best prevent new foot ulcers in people with diabetes?

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a1234 (Published 03 September 2008) Cite this as: BMJ 2008;337:a1234
  1. Fay Crawford, senior research fellow (hon) senior lecturer
  1. 1University of Edinburgh, Division of Community Health Sciences: GP Section, Edinburgh EH3 8DE
  1. fay.crawford{at}ed.ac.uk

    Screening people with diabetes for peripheral neuropathy and the presence of peripheral pulses every 15 months forms part of the quality and outcomes framework of the General Medical Services contract.1 Our understanding about the best ways to identify those at risk of foot disease, although not entirely definitive, has been greatly helped by epidemiological research to evaluate the prognostic value of tests.2 Unfortunately, the same progress has not been made with preventive strategies, and uncertainty exists about the best ways to prevent foot ulcers, especially new cases.3

    What is the evidence of uncertainty?

    Little evidence from randomised controlled trials (RCTs) is available to inform clinical guidelines on preventing diabetic foot ulcers.4 5 6 Naturally, good glycaemic control is highly desirable and has been shown to reduce the incidence of neuropathy.7 However, the effects of interventions that explicitly focus on foot health, specialist foot care, pressure deflection, and patient education have not been rigorously evaluated.

    Screening and specialist foot care

    A systematic review of interventions to prevent diabetic foot ulcers found no evidence …

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