Inpatient management of diabetic foot problems: summary of NICE guidance

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. Multidisciplinary foot care team Each hospital should have a care pathway for patients with diabetic foot problems who need inpatient care. [Based on very low quality observational evidence and the experience and opinion of the Guideline Development Group (GDG)] The role of the multidisciplinary foot care team is to: -Assess and treat the patient's diabetes, including interventions to minimise the patient's risk of cardiovascular events, and any interventions for pre-existing chronic kidney disease or anaemia (refer to the NICE guidance on chronic kidney disease 4 and on managing anaemia in people with chronic kidney disease 5 ) -Assess, review, and evaluate the patient's response to initial medical, surgical, and diabetes management -Assess the foot and determine the need for specialist wound care, debridement, pressure off-loading, and/or other surgical interventions -Assess the patient's pain and determine the need for treatment and access to specialist pain services -Perform a vascular assessment to determine the need for further interventions -Review the treatment of any infection -Determine the need for interventions to prevent the deterioration and development of Achilles tendon contractures and other foot deformities -Perform an orthotic assessment and treat to prevent recurrent disease of the foot -Refer patients for physiotherapy where appropriate -Arrange discharge planning, which should include...