Equitable Diabetic Foot Care
Stakeholder Perspectives on Improving Prevention of Ulcers and Research Participation
Diabetic foot ulcers (DFUs) and resulting amputations are a major health issue, with high human and financial costs. Despite recognition of problems like inadequate funding and referrals, poor care coordination, and lacking patient education, barriers persist in providing effective prevention and treatment. Healthcare professionals cite issues around engaging disadvantaged groups disproportionately affected by diabetic foot complications. Shifting focus earlier to prevent first-ever DFUs before recurrence starts could significantly reduce morbidity. However, scarce data guides research on the largely unstudied first ulcers specifically. Healthcare professional insights on study feasibility and overcoming participation barriers are key to optimally designing regional programs targeting those at high first ulceration risk for integrated education, screening, and offloading. Addressing DFU prevention this way can ultimately help curb amputations and mortality burden among vulnerable diabetes populations.
The purpose of this program of work is to understand the perspectives of frontline healthcare professionals treating diabetic foot complications, centering the experiences of underserved patient groups. The research will specifically capture provider insights on key barriers like inefficient referrals and communication between disciplines or services, inadequate resources and patient education, and difficulties engaging certain diabetes populations that hinder quality care delivery. Additionally, by eliciting details around preventing initial diabetic foot ulcers in particular from those interacting directly with patients, the findings can inform optimal design of inclusive programs and studies focused on evidence-based integrated screening, education, and offloading interventions targeting first ulcer risk. This patient-centered approach, grounded in the knowledge of healthcare teams driving treatment, can ultimately help overcome obstacles to equitable care access, efficiency, capacity and self-management facing vulnerable people with diabetes.
Simplifying the Identification of Diabetes Patients at Highest First Ulcer Risk in a low resource setting
Diabetic peripheral neuropathy can lead to loss of protective foot sensation and repetitive injury, ultimately causing diabetic foot ulcers (DFUs) which can become infected and require amputation. Preventing first-ever DFUs before this recurrence pattern starts is critical for reducing amputation and mortality risk. However, widespread prevention across all people with diabetes is impractical. Thus, simple, low-cost methods to screen for loss of protective sensation can help target interventions to those at imminent first ulceration risk. Our program of work validated two sensory tests—the Ipswich Touch Test (IpTT) and VibratipTM—for detecting loss of sensation in an Indian diabetic population without previous DFUs. Our investigations found the IpTT has high sensitivity and ability to rule out loss of sensation. The IpTT’s simplicity, free cost, and capacity for non-professional administration make it an ideal community screening tool to identify high-risk subsets most needing and likely to benefit from targeted first ulcer prevention education, foot examination, and offloading. We are continuing this work as a prospective study to inform policy and practice.
Our Key Paper
Screening for the loss of protective sensation in people without a history of diabetic foot ulceration: Validation of two simple tests in India.
Chatzistergos, P.E., Kumar, S., Sumathi, C.S., Mahadevan, S., Vas, P. and Chockalingam, N., 2023. Diabetes Research and Clinical Practice, 202, p.110810