Reframing Our Approach to Treatment and Prevention of Diabetic Foot Complications

Mrs. Smith is in her mid-40s, she is an occupational nurse and is always on her feet. About 15 years ago, Mrs. Smith was diagnosed with diabetes. In addition to her diabetes she has high cholesterol, hypertension, and a history of mild angina (chest pain).

Her family doctor prescribed her medications to control her diabetes, blood pressure, and cholesterol level. Despite her efforts in complying with her medication schedule, she started to experience pain in her feet. One morning her foot pain became so unbearable that she scheduled an appointment with a local podiatrist. Diabetic foot assessment revealed that she had a severe infection in both of her feet caused by neuropathy (damaged nerves), poor blood circulation, and poor choice of footwear. She was prescribed medication to treat her infection and a diabetic foot treatment plan was outlined to prevent the likelihood of recurrence. If she had visited the clinic any later than she did, there would have been a high chance of her developing a bone infection which may have required hospitalization.

When Mrs. Smith was asked why she didn’t visit the clinic in a timelier fashion, it was discovered that her decision to withhold pursuing a medical consultation was due to a lack of education of diabetic foot complications and additionally, she was never referred to a podiatrist or another foot specialist by her family doctor. Mrs. Smith’s experience is a typical example where a patient has fallen through a gap in the healthcare system due to the lack of patient education and a poor inter-professional primary care approach to address medical concerns.

Diabetes is a serious chronic disease and can be described as one of the most critical health issues facing Canadians today. As of 2015, diabetes in Canada affected approximately 3.4 million people. The projected number in 2025 is expected to grow to 5 million. Canada, then is facing a 44% increase in diabetes cases over the next decade, which is a significant burden on our healthcare system. Along with this rise, we also expect to see a corresponding upturn in diabetes-related foot problems. For people with diabetes, foot health is an important aspect that demands a watchful eye. Diabetes increases one’s risk of developing nerve damage and poor circulation in one’s feet. These problems often leave the feet vulnerable to complications.

Among these complications are diabetic foot ulcers – open sores that usually form as a result of skin breaking down – which impose direct health care costs of between $320-$400 million in Ontario alone. Diabetic foot ulcers are common, and can have a significant impact on disability and quality of life if they are not treated properly. It is estimated that every 4 hours in Ontario, a person has a foot or leg amputated as a result of an improperly healed diabetic foot ulcer.

There are a number of ways to reduce the occurrence of diabetic foot complications. However, the CDA Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommends a targeted prevention of diabetic foot ulcers. This includes annual exams by health-care providers and more frequent exams for people at high risk. In literature it is well established that for every dollar spent on ulcer prevention, approximately ten dollars are spent on ulcer healing. The argument has been made to spend smaller amounts of funds on prevention to avoid spending larger amounts on treatment. This approach is intuitively appealing, and highlights the importance of efficient resource allocation in healthcare. Beyond resource allocation, education too is needed to encourage patients’ life-style choices for prevention and management of diabetic foot complications. This education would be aimed at both the patients and primary care providers. Validated screening or diabetic foot-risk assessment tools exist and should be used in conjunction with prevention and education as they go hand in hand with one another. In summary, proper prevention and management of diabetic foot complications, in addition to increasing the availability of screening among patients, may put less limbs at risk and save more money for the healthcare system.

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Picture source: http://www.slideshare.net/essexunionpodiatry/diabetic-foot-care-podiatrist-springfield

This article is written by: Paul Rooprai, Kim Rooprai, and Dr. Ajai Rooprai

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