Position document: Local management of diabetic foot ulcers

Incidence of diabetes among the world’s adult population has almost quadrupled in the past 30 years with 422 million adults worldwide now diagnosed with the disease, according to the 2016 World Health Organization Global Diabetes Report. Within this population, the incidence of diabetic foot ulcers (DFUs) is reported to be 4%–10%, with a 1-in-4 risk of ulceration during a lifetime.

The financial and human cost of the disease and associated complications are high: the American Diabetes Association puts the global direct costs of the disease at $825bn. The cost of the lower limb extremity accounts for a significant proportion of this spend — in the US alone the cost of care of DFUs ranges from $9bn to $13bn of which between $1.38bn and $1.9bn is spent on diabetic infection alone.

Increased incidence and escalating costs are having a devastating impact on health services and putting further pressure on resources. Central to tackling the growing problem is the implementation of robust prevention strategies that look to reduce DFU incidence. This Position Document looks at the local management of DFUs against a backdrop of increased incidence, stretched resources and patient outcomes.

Paper 1 ‘Innovations in the management of DFUs and the diabetic foot in remission’ sets the global scene, looking at classification of DFUs, prevention strategies and the growing importance of multidisciplinary teams (MDTs) in the management and treatment of them. A coordinated team is pivotal to improving outcomes and has already been shown to decrease frequency of limb loss. Yet MDTs are still in their infancy; there are currently no established parameters for these teams. Despite guidelines from the International Working Group on the Diabetes Foot, the composition of MDTs is dependent upon availability of local resources, skill mix and scope.

Paper 2 ‘Living with a DFU: the patient’s perspective’ looks at what it is like to have a DFU with a detailed look at wellbeing. It explores the importance of consultation in addressing, managing and treating not just physical effects but in developing a patient-focused, personalised care plan that tackles the psychosocial impact of DFUs. In particular it looks at the role of dressings that must meet patients’ needs (e.g. preventing leakage, reducing malodour) as well as the clinician’s need to ensure optimal healing.

The final paper ‘Managing and treating DFUs’ was developed from a meeting of leading experts in DFUs, it drills down into the principles of local management, with a detailed look at dressing use; the management of exudate levels, deep wounds, infected wounds, prevention of periwound damage and pain. It also looks at the use of second-line (advanced) topical treatments and the role of self care.

Download the PDF to access the full position document.