National Institute for Health and Clinical Excellence (NICE)
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NICE consults on the management of diabetic foot problems

NICE has today opened a consultation on its draft guidelines for the care of people with diabetic foot problems in hospital.

Diabetes is one of the greatest health problems facing the UK today. In 2009, it was estimated that there were 2.6 million people in the UK with type 1 or type 2 diabetes1. With the increasing prevalence of the condition, the incidence of complications is also on the rise. These include foot problems such as ulcerations2 and gangrene3, foot deformities, and infections.

These problems may significantly affect a patient's quality of life, reducing mobility that may lead to loss of employment, depression, and damage to, or loss of, limbs. Treating diabetic foot problems also has a considerable financial impact on the NHS through outpatient costs, increased bed occupancy, and longer hospital stays.

Draft recommendations include:

  • Each hospital should have a structured care pathway for diabetic foot problems in diabetic patients who require hospital care.
  • Patients should be offered consistent, relevant information and clear explanations that support informed decision making, and be provided with opportunities to discuss issues and ask questions.
  • Within four hours of the patient being admitted to hospital, the initial examination should look for evidence of
    • Inflammation/infection
    • Ulceration
    • Deformity
    • Neuropathy.
  • When in hospital, patients with diabetic foot problems should have access to appropriate pressure reducing surfaces, to minimise the risk of pressure ulcer development on the affected limb.
  • For the management of diabetic foot infections, each hospital should have antibiotic guidelines in place, appropriate for the severity of the infection.

Sharon Summers-Ma, Associate Director, Centre for Clinical Practice Director at NICE, said: “Diabetes is a huge health problem in the UK, with growing numbers of people developing the condition. This increase brings with it more diabetic-related complications such as foot problems, which are the most common cause of non-traumatic limb amputation. It's important, therefore, that the NHS is treating diabetic foot problems in the most clinically and cost effective way. This guideline will provide recommendations to hospital staff on the standard of care to be given to patients aged 18 years and above who are at a particularly high risk of diabetic foot problems. By providing advice based on the most up-to-date evidence of best practice, the guidelines aim to reduce variations in the level of care that patients receive when they are in hospital, leading to fewer amputations, a better quality of life for those affected and lower NHS costs. We now invite interested parties to consider our draft recommendations, and give us their feedback.”

NICE has not yet issued final guidance to the NHS; these decisions may change after consultation.

Notes to Editors

About the guideline

  • The draft short clinical guideline ‘Diabetic foot problems - inpatient management of diabetic foot problems' is available for comment at
  • A previous NICE clinical guideline on prevention and management of foot problems in type 2 diabetes (NICE clinical guideline 10, 2004) concentrated on the detection, general management and treatment of diabetic foot ulcers and the care pathway ends at referral to a multidisciplinary foot care team.
  • There is currently no evidence-based clinical guideline for use in England, Wales and Northern Ireland that provides detailed recommendations on the key components of inpatient care of people with diabetic foot problems from hospital admission onwards.

About NICE

  • The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
  • NICE produces guidance in three areas of health:

1. Public health- guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

2. Health technologies- guidance on the use of new and existing medicines, treatments and procedures within the NHS

3. Clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.