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“Strong suggestive evidence” indicates that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes in diabetes footcare, an article has concluded.
There is an “urgent need” to improve the variation of care in a bid to avoid poor outcomes relating to diabetic foot ulcers, researchers said in the Diabetes Care journal.
Professor William Jeffcoate, from the Nottingham University Hospitals NHS Trust, led the commentary-type article written by UK and US experts, which investigated why foot ulcers remain a major health care problem around the world, despite considerable advances in treatment over the last 25 years.
The researchers also said the five-year survival rate, following presentation with a new foot ulcer is of the order of only 50 to 60 per cent and worse than that of many common cancers.
The study said that reports stated up to one-third of diabetes expenditure was on lower-limb–related problems in the US.
The writing team commented on a series of issues, such as effectiveness of existing treatments, the incidence of major amputation, new ulceration after healing and specific strategies to reduce them.
They looked at why evidence base on diabetic foot ulcers is so poor, saying it is a “topic that has generally failed to attract the same level of interest by health care professionals as other diabetes complications”.
Several recommendations were suggested. They included major investment in the conduct of high-quality clinical trials that are “necessary to improve the evidence base for routine clinical care” and to ensure that those responsible for the “design and delivery of care for people with diabetic foot ulcers comply with such evidence-based guidance as is available”.
They also suggested that attention must be paid to the structure of the care pathway, stating “there is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes”.
The researchers added: “Available evidence suggests that very considerable improvements can accompany structural changes in the way professionals work and in the way that care is delivered.
“Available evidence suggests that such structural changes should focus on 1) the creation of clear pathways to enable early assessment of diabetic foot ulcers by a specialist multidisciplinary service and2) the provision of structured surveillance and care for those who have had a diabetic foot ulcer and are in remission after healing.
“If communities embrace these initiatives, it should be possible to trigger substantial improvement in outcomes relating to diabetic foot ulcers. Care of the foot needs to metamorphose from a subspecialty to a “superspecialty” of diabetes.”
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