Title : Adherence to guidelines and patient factors in diabetic foot disease
Abstract:
Background: Foot ulceration is a common complication of diabetes, due to loss of protective sensation related to peripheral neuropathy. The clinical course can be compounded by peripheral vascular disease and inadequate footcare.Good patient outcomes are reliant on optimising glucose control and prompt management of early ulceration. Approximately 180 diabetes related amputations are performed weekly in the UK, many are preventable.
Aim: To evaluate compliance with NICE guidelines regarding routine monitoring of diabetes and risk factors for complications, together with subsequent management of ulceration.
Methods: A two-cycle audit and retrospective data analysis was performed on patients admitted with diabetic foot complications at our Trust in 2023-2025. Patients were identified from the foot team database and data collected utilising e-notes.
Results: Final data analysis completed for 111 feet of 100 patients in the first cycle and 50 feet of 48 patient in the second cycle. 94% of patients had evidence end organ disease including 84% with documented peripheral neuropathy in cycle 1. Severe ulceration was defined as SINBAD score >2. Only 1.8% of 111 feet and 6% of 50 feet had SINBAD score documented at presentation. From descriptive terms, it was possible to retrospectively calculate SINBAD score for the remainder; 90% of 111 feet and 72% of 50 feet had a SINBAD score >2. In the second cycle, there was a noticeable improvement in how ulcers were described and documented, with 58% being well-documented.Contrary to NICE guidelines, 48% of patients had HbA1c tested at greater than three-month intervals in cycle 1 and 53% in cycle 2.
Conclusion: While adherence to HbA1c measurement guidelines remains suboptimal, there has been a marked improvement in ulcer documentation following increased awareness of SINBAD, allowing for consistency in ulcer description and management.
