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

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and/or osteomyelitis; III - fore-foot gangrene or foot gangrene. The average length ofhospitalisation was 26.9±20.9 days, 48.3±31.6 days, and 57.1±43.2 days per episode,respectively in the 3 groups (p
widely used in Australia, only the data comparing SC and WCC are considered here.The total costs for 20 weeks were $A 2446 for SC and $A 2330 for WCC. The ratesof ulcers healed were 30.9% (95% CI 26.6-35.0%) for SC and 35.6% (CI 34.8-36.4%)for WCC. Although cost were similar outcomes were better for the WCC. Howeverthis study is limited by the database used and the probably that people attendingwound care clinics had more severe lesions than people receiving standard care.Horswell et al (2003) compared a staged diabetes foot management programme withstandard care on health care cost and utilisation in a retrospective study. All subjectshad diabetes and foot ulcers, of whom 45 received staged foot care that consisted ofselfcare education, devices to offload pressure, and custom-fabricated orthoses andfootwear after healing, while 169 subjects received standard foot care which consistedof uncoordinated treatment including wound care, antibiotics and self care education.Baseline characteristics were similar in both groups. In the 1-year follow-up period,the staged foot care group had a lower foot-related hospitalisation rate than thestandard care group (0.09 v 0.50 admissions per person, p=0.002), lower foot-relatedinpatient days (0.91 v 3.97 days per person, p=0.03), and fewer amputation-relatedhospitalisation (0.04 v 0.19 per person, p=0.035). There were also fewer emergencyvisits (0.60 v 1.22 visits, p=0.004) and lower emergency department charges ($104 v$208, p=0.006) in the staged foot care group compared with the standard care group.Overall the total cost was significantly lower in the staged foot care group than in thestandard care group ($A 6,630 v $A 13,060, p=0.014).Ortegon et al (2004) performed a cost-effectiveness analysis of prevention andtreatment of diabetes foot disease in the Netherlands. A Markov model was developedto simulate the health and economic outcomes of optimal care of the diabetic foot in acohort of 10,000 people (mean age 61 years) with newly diagnosed Type 2 diabeteswho were followed through the model over their lifetime. Diabetic foot risk (DFR),based on the classification system of the International Diabetic Foot Working Group,was defined as: DFR1 - no neuropathy; DFR2 - sensory neuropathy, and DFR3 -sensory neuropathy and deformity or PVD. Costs used in the model were expressed as1999 dollars. Compared with current standard care, the mean total lifetime costs of aperson receiving guideline-based care (intensive glycaemic control (IGC) or optimalfoot care (OFC)) ranged from $A 5,680 to $A 6,090. For people receiving IGC andOFC, the costs resulted in
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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
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Summary - Ulcer as a Risk Factor fo
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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
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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
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Page 90 and 91: Section 12: Diabetes Foot ProblemsI
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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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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