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The chronic complications of diabetes place an enormous burden on healthcare resources, with foot ulceration representing a major cause of hospital bed occupancy for people with diabetes. See footnote 1 below. Diabetic patients undergo up to 70% of all non-traumatic lower limp amputations. The average cost of a major lower limb amputation of £11,000. 84% of amputations are preceded by a foot ulcer. It is well established that neuropathic ulcers, the commonest type of ulceration, can be reduced by: 
- patient education
- targeted podiatry
- correct identification of high-risk status.
The Exeter Diabetic Footcare Service, aware that 75% of diabetic patients in Mid, North and East Devon localities are managed primarily in the community, undertook a randomised controlled trial in 1997 to evaluate an integrated care pathway (ICP), aimed at improving the identification and management of the high-risk diabetic foot.
Over a 6-month period, patients' and health professionals' knowledge of, and attitudes towards, foot care improved significantly in the group exposed to the model of care. Appropriate referrals from this group to the specialist foot clinic also rose significantly.
As a result of these findings, we propose that the ICP be adopted by all Trusts in the Exeter Area.
Footnote 1
Donohoe ME, Fletton JA, Hook A, Powell R, Robinson I, Stead JW, Sweeney K, Tooke JE. Improving foot care for people with diabetes mellitus - randomised controlled trial of an integrated care approach. Diabetic Medicine 17: 581-587.
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