Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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Summary - Foot Clinics and Multi-disciplinary Teams• A multi-disciplinary footcare team can improve the rate of ulcer healing andreduce ulcer recurrence rate and the rate of amputation in people with diabetes andhigh risk feet• The common components of the specialist multi-disciplinary team have been aphysician and podiatrist. Most have also included a specialist nurse and orthotistand have involved or had ready access to a surgeon• Further research is required to define the core services in multi-disciplinary carewhich are essential in improving outcomes by reducing the incidence of88
Evidence Table: Section 11AuthorFoot clinics and multi-disciplinary teamsLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingDargis V (1999)(Adults – Lithuania)III-2 Cohort High High EPSHF+ HighEdmonds ME (1986)(Adults – UK)III-2 Cohort Low Medium EPSNF+ HighGhirlanda G (1997)(Adults – US)III-2 Cohort Low Medium EPSNOR+ HighLarsson J (1995)(Adults – Sweden)III-2 Cohort Medium High EPSNO+ HighPinzur MS (1996)(Adults – US)III-2 Cohort Medium Medium PS+ MediumPlank J (2003)(Adults – Austria)II RCT High High P+ HighRith-Najarian S (1998)(Adults – US: Chippewa III-2 Cohort Medium High PNED+ LowIndians)Thomson FJ (1991)(Adults – UK)III-2 Cohort Low High EPSNO+ HighVan Gils CC (1999)(Adults – US)III-2 Cohort Medium High SNED+ Highvan Houtum WH(2004)(Adults – TheIII-2 Cohort Medium High + HighNetherlands)Willoughby D (2001)(Adults – US)III-2 Case-control Medium High FNH+ HighFor magnitude rating:+indicates positive effect of glycaemic control on diabetic foot disease . High = clinically important & statistically significant;Medium = small clinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 9.E = endocrinologist, P = podiatrist, S = vascular or orthopaedic surgeon, N = specialist nurse, O = orthotist, H = rehabilitationphysician, R = radiologist, F = shoe-fitter, D = Dietitian89
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National Evidence Based Guidelinesf
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Research OfficersMs Linda SmithPodi
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2.2 Issues for Foot Problems in Typ
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• Aim to achieve the best possibl
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Background - Peripheral Neuropathy
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proportion of subjects with a durat
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and an OR 1.1-7.8. This study also
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Summary - Peripheral Neuropathy as
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Section 2: Diabetes Foot ProblemsIs
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predicting risk of amputation, 2.9
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Summary - Peripheral Vascular Disea
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Evidence - Foot Deformity and Previ
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people with both LJM and neuropathy
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Summary - Foot Deformity and Previo
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Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
Page 40 and 41: Section 5: Diabetes Foot ProblemsIs
Page 42 and 43: The other frequently reported metho
Page 44 and 45: side; and 82% having the same resul
Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
Page 50 and 51: pulse was bilaterally absent in 1.8
Page 52 and 53: Evidence Table: Section 6AuthorClin
Page 54 and 55: Background - Frequency of Foot Exam
Page 56 and 57: Summary - Frequency of Foot Examina
Page 58 and 59: Section 8: Diabetes Foot ProblemsIs
Page 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
Page 64 and 65: with before the programme, after 1-
Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71: In a previous Japanese randomised s
Page 72 and 73: Evidence Table: Section 9AuthorGlyc
Page 74 and 75: Background - Footwear to Reduce Ulc
Page 76 and 77: period. In addition people without
Page 78 and 79: Comparisons of in-shoe foot pressur
Page 80 and 81: The rate of plantar callus formatio
Page 82 and 83: Evidence Table: Section 10AuthorFoo
Page 84 and 85: Background - Foot Clinics and Multi
Page 86 and 87: A prospective non randomised contro
Page 90 and 91: Section 12: Diabetes Foot ProblemsI
Page 92 and 93: and/or osteomyelitis; III - fore-fo
Page 94 and 95: Summary - Economic consequences•
Page 96 and 97: Section 13: Diabetes Foot ProblemsI
Page 98 and 99: Some ethnic groups are associated w
Page 100 and 101: Evidence Table: Section 13AuthorSoc
Page 102 and 103: Calle-Pascual AL, Duran A, Diaz A,
Page 104 and 105: Jannink MJ, van Dijk H, de Vries J,
Page 106 and 107: Moss SE, Klein R, Klein BE. The 14-
Page 108 and 109: Soulier SM, Godsey C, Asay ED, Perr
Page 110 and 111: Diabetes Foot Problems: General Ref
Page 112 and 113: McNeely MJ, Boyko EJ, Ahroni JH, St
Page 114 and 115: Diabetes Foot Problems: Other Refer
Page 116 and 117: Caputo GM, Cavanagh PR, Ulbrecht JS
Page 118 and 119: Garbalosa JC, Cavanagh PR, Wu G, Ul
Page 120 and 121: Lavery LA, Armstrong DG, Wunderlich
Page 122 and 123: Payne C. Regional variations of dia
Page 124 and 125: Tovi J, Svanborg E, Nilsson BY, Eng
Page 126 and 127: Criteria used to determine the suit
Page 128 and 129: QUESTIONS KEY WORDS NO.ARTICLESIDEN
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QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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