Inpatient management of diabetic foot problems: summary of NICE guidance

Abstract

Foot problems that are related to diabetes (“diabetic foot” problems) affect a substantial number of people with diabetes, and 15% of people with diabetes will have a foot ulcer at some point in their lives. Diabetic foot ulcers precede more than 80% of amputations in people with diabetes and are the most common cause of non-traumatic limb amputation in the United Kingdom. Delays in diagnosis and management of diabetic foot problems increase morbidity and mortality, contribute to a higher amputation rate,1 and seriously affect patients’ quality of life—for example, by reducing mobility, leading to loss of employment, depression, and damage to or loss of limbs. Diabetic foot problems have a financial impact on the NHS through increased outpatient costs and bed occupancy and prolonged stays in hospital. This article summarises the most recent recommendations in a short clinical guideline from the National Institute for Health and Clinical Excellence (NICE) on the management of diabetic foot problems in inpatients.2 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Multidisciplinary foot care team