TOPLINE:
Overall national compliance with National Institute for Health and Care Excellence (NICE) guidelines for diabetic foot referral and screening was good. Integrated care boards (ICBs) were more compliant with acute diabetic foot care guidance than with diabetic foot screening guidelines. The main causes of non-compliance were referral timelines and screening regularity.
METHODOLOGY:
- Freedom of Information requests were submitted to all 42 ICBs in England, asking each for any available referral pathways between primary and secondary care, specifically for diabetic patients who are at moderate to high risk of developing lower limb diabetic complications.
- All ICBs responded, with 43% (18 ICBs) saying they did not possess any guidelines, whereas 57% (24 ICBs) provided information, which was divided into acute diabetic foot and diabetic foot screening referral pathways separately.
TAKEAWAY:
- For acute diabetic foot pathways, 83% fully complied with the NICE recommendations, 13% were partially compliant (pathways adhered to risk stratification and acute foot identification recommendations but did not refer within 24 hours of presentation), and one ICB was completely non-compliant.
- Regarding diabetic foot screening pathways, 62% (15 ICBs) were fully compliant regarding risk stratification and referral processes, and 34% (8 ICBs) partially compliant, in that they involved the correct secondary care teams and risk stratification but did not recommend reviews at the correct regularity. Again, one ICB was completely non-compliant.
IN PRACTICE:
"Potential reasons for incorrect screening appointment regularity may include resource limitations or a lack of clarity within primary care regarding specific NICE recommendations," the authors wrote. "As up to 20% of diabetic foot ulcers are an incidental finding during a consultation, ensuring regular screening appointments is essential in improving patient outcomes," they added.
SOURCE:
Conducted by Amy Jones, of the Department of Vascular Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK, and colleagues, the study was published online on December 14, 2024, in Diabetic Medicine.
LIMITATIONS:
Several pathways did not specify how often medium-risk patients should be seen, so some providers may be adhering to NICE guidelines but this cannot be assessed.
DISCLOSURES:
The research received no funding and the authors have no disclosures.
