Diabetes Foot Management

NDFA Key Findings & Key Recommendations – Care Structures

The National Diabetes Foot Care Audit (NDFA) is a measurement system of care structures, patient management and the outcomes of care for people with active diabetic foot ulcers. Here are key highlights from the NDFA Third Annual Report (England and Wales) published 14 March 2018:

NICE recommends three Care Structures to support effective prevention and management of diabetes foot disease;

1/ Training for routine foot screening 2/ Foot Protection service pathway 3/ Foot Disease referral to expert pathway

Key findings

• Less than half of participating commissioners provide all three NICE-recommended care structures.
• Pathways for rapid expert assessment are associated with shorter time to assessment and less severe ulcers.
• Pathways for rapid expert assessment are associated with better healing outcomes.

Recommendation

Commissioners should work with local providers to ensure pathways meet NICE guidelines

NDFA Key Findings & Key Recommendations – Time to first expert assessment

Commentary, NDFA Team:

“The evidence derived from over 20,000 new diabetic foot ulcers suggests that early referral is associated with ulcers of lesser severity, and lesser severity is associated with better outcomes.”

Recommendation

All people with diabetic foot ulcers should be referred promptly for early specialist assessment, in line with NICE guidance.

NDFA Key Findings & Key Recommendations – Alive and ulcer-free

Key findings

• People are alive and ulcer-free at 24 weeks in only two thirds of cases of a diabetic foot ulcer.
• Severe ulcers take longer to heal.
• Outcomes are worse if the time to first expert assessment is ≥14 days.

Recommendations

• All people with diabetic foot ulcers should be referred promptly for early specialist assessment, according to NICE guidance.
• Providers should endeavour to record all new instances of diabetic foot ulcers, and to complete outcome data for all patients registered in the audit, in order to ensure a more complete picture of patient outcomes.
• All audit participants should engage with audit-driven quality improvement work.

‘There has been an additional £10 million transformation fund investment by NHS England to establish MDFTs where they do not exist currently, and to expand multi- disciplinary foot care service capacity where additional capacity is required.’    NHS England, NDFA March 2018 Report

Resources for further information

To read the full NDFA Report and relevant NICE Guidelines please follow these links (to external websites)

NDFA Report (2014-2017) England and Wales, Published March 2018
Link here

NICE Guidelines Diabetic foot problems: prevention and management (NG19)
Link here

NHS England Diabetes Transformation Fund 2017-2019

Link here