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Rapid access to multidisciplinary diabetes foot care teams

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m773 (Published 04 March 2020) Cite this as: BMJ 2020;368:m773

This article has a correction. Please see:

  1. Jonathan Valabhji, national clinical director for diabetes and obesity
  1. NHS England and NHS Improvement, London, UK
  1. jonathan.valabhji{at}nhs.net

Urgent referral is critical for people with new foot ulcers

Limb loss is the most feared complication of diabetes, and infected foot ulceration its most common antecedent. Management guidelines for foot ulcers in people with diabetes vary internationally, but the UK’s National Institute for Health and Care Excellence (NICE) recognises the need for rapid assessment and treatment by a multidisciplinary diabetes foot care team.1 Implementation of foot care teams has been shown to reduce rates of major amputation in adults with diabetes by 39-56%,2 and recent data suggest that early referral is associated with better outcomes.3

Although much of diabetes care has moved from secondary to primary care, management of foot ulceration has predominantly and appropriately remained within hospital settings. Almost £1bn (€1.2bn; $1.3bn) a year, 0.9% of the NHS budget for England, is spent on treating diabetic foot ulcers and amputation.4 Diabetic foot ulcers result from the microvascular complication of peripheral neuropathy leading to an insensate and sometimes deformed foot. This can be variably exacerbated by the macrovascular complication of peripheral vascular disease, whereby impaired blood flow …

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