Questions About Diabetic Feet: How to Respond
More than 80% of amputations in adults with diabetes are preceded by diabetic foot ulcers, making diabetes the leading cause of non-traumatic limb amputation in the United Kingdom. It is predicted that half of all patients with diabetes will get a diabetic foot ulcer at some point throughout their lifetimes. Naturally, the prevalence of diabetic foot ulcers is also projected to rise along with the majority of diabetes itself.
Diabetics often experience issues with their feet due to neuropathy and peripheral vascular disease, both of which are common side effects of the disease.
When a person has neuropathy, they may lose sensation in their feet, making it difficult, if not impossible, to notice any injuries or irritations. Reduced blood flow to the feet makes it difficult for even minor cuts to heal without infection.
Damage to or loss of limbs, inability to work, depression, and other mental health issues are all potential outcomes of untreated diabetic foot problems. Outpatient expenses, higher hospital occupancy rates, and longer patient stays all add to a hefty bill for the National Health Service.
There is a wide range of practice in the prevention and management of diabetic foot problems, both in the outpatient and inpatient settings, despite numerous publications on strategies to avoid and manage foot problems and the procurement of specialist services in this respect. Different medical specialists (such as orthopedic surgeons, general surgeons, vascular surgeons, and primary care physicians) may have varying degrees of familiarity with the topic.
Guidelines for preventing and treating foot issues in people with Type 2 diabetes were released in 2004 by the National Institute for Clinical Excellence (NICE Clinical Guideline 10, 2004). Diabetic foot ulcers were the primary focus, and the care pathway culminated in referral to a multi-disciplinary team.
A yearly diabetic check is a gold standard in general practice, and it is universally acknowledged that individuals with diabetes should also have one. Retinal screening for diabetic retinopathy and testing for diabetic neuropathy are two tests that should be part of a comprehensive check for diabetes.
There was a time when most diabetics were not required to get annual checkups, and some of the GP experts we hired back then agreed that it was not a breach of duty of care for a GP to have failed to arrange annual checkups for their patients in the absence of knowledge of any diabetic foot or other complications. With an increased understanding of diabetes and its consequences, things are beginning to alter. In our opinion, the duty of care is increased if the patient has a history of diabetes or foot complications. In such cases, the patient should be educated on taking care of their feet and undergo regular foot inspections, footwear evaluations, and vascular assessments as part of an agreed-upon management plan.
Suppose a foot care emergency (such as new ulceration, swelling, or discoloration) is identified during a one-time visit or an annual or routine review. In that case, it is generally accepted that the patient should be referred to a multi-disciplinary foot care team within 24 hours. Experts in vascular surgery, podiatry, orthotics, nurses educated in diabetic foot wounds, and diabetologists with lower limb issues would make up this team, typically housed in a hospital’s specialized unit.
Team members would evaluate the severity of the foot care emergency and make the call to refer the patient to a vascular surgeon or a physician who specializes in diabetes. They would also assist with routine dressing changes, remove dead tissue from foot ulcers, and recommend intensive systemic antibiotic therapy.
Unfortunately, in everyday practice, diabetic foot problems are often mismanaged. In most cases, primary care physicians do not appreciate the severity of diabetic foot complications upon initial referral, and they frequently prescribe antibiotics directly to patients without consulting specialists. This can have severe effects, including amputations that are performed when they aren’t necessary.
An emergency referral to a diabetic expert or vascular surgeon, rather than a hospital’s emergency room, may be necessary if the condition worsens.
It is not uncommon for emergency room doctors to misdiagnose an athlete’s foot as a complication of diabetes, prescribe antibiotics that should not be used in this case, and fail to refer the patient for inpatient care to the correct specialist because of this.
The National Institute for Health and Care Excellence (NICE) has released evidence-based clinical guidelines for treating diabetic foot complications in hospitalized patients in England and Wales.
Several variables contribute to the wide range of amputation rates in the UK, including divergent views among experts and uneven therapy due to differing anti-microbial methods for diabetic foot ulcers throughout the country’s hospitals.
If you have diabetes or if you experience a diabetic foot care emergency, you should call your doctor right once. Any diabetic who experiences foot pain, swelling, redness, or an open wound should immediately contact their primary care physician and demand to be sent to a multi-disciplinary team of experts in managing diabetic foot care.
It’s a good idea to include a copy of the “Type 2 Diabetes: Prevention and Management of Foot Problems” NICE Guidelines. Available at http://guidance.nice.org.uk/CG10 is the “NICE Clinical Guideline 10 (2004).”
This piece was written by Robert Rose Frische and published in Pardoes. Diabetics who are concerned about their care or believe they are victims of medical malpractice should contact their Somerset attorneys right once.
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