The United Kingdom National Institute for Clinical Excellence (NICE) guideline development group published guidelines for inpatient management of diabetic foot problems in 2011.6 The NICE guidelines are largely similar to the 2012 IDSA guidelines. NICE guidelines call for each hospital to have a care pathway for all patients who present with a diabetic foot problem, and that these patients should be cared for by a multidisciplinary team, including appropriate wound care and debridement, assessment of vascular function, imaging with plain radiographs and MRI if osteomyelitis is suspected, and directed antibiotic therapy.
Diabetic foot infections are a common occurrence, and the guidelines for their management demonstrate how coordinated clinical care is important for improving patient care and outcomes. As health reimbursement moves toward a model of bundled payments for treatment and a greater emphasis on measureable outcomes, hospitalists are well positioned to be managers of such organized approaches with multidisciplinary teams.
Dr. Ly is a hospitalist in the division of hospital medicine at the University of California at San Francisco.
- Centers for Disease Control and Prevention. Age-Adjusted Hospital Discharge Rates for Peripheral Arterial Disease (PAD), Ulcer/Inflammation/Infection (ULCER), or Neuropathy as First-Listed Diagnosis per 1,000 Diabetic Population, United States, 1988–2007. CDC website. Available at: http://www.cdc.gov/diabetes/statistics/hosplea/diabetes_complications/fig2_pop.htm. Accessed Jan. 28, 2013.
- Centers for Disease Control and Prevention. Number (in thousands) of hospital discharges for nontraumatic lower extremity amputation with diabetes as a listed diagnosis, 1988-2006. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/diabetes/statistics/lea/fig1.htm. Accessed Jan. 28, 2013.
- Ortegon MM, Redekop WK, Niessen LW. Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care. 2004;27:901-907.Prompers L, Huijberts M, Apelqvist J, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007;50:18-25.
- Lipsky BA, Berendt AR, Comia PB, et al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis. 2012;54(12):132-173.
- Tan T, Shaw EJ, Siddiqui F, Kandaswamy P, Barry PW, Baker M. Inpatient management of diabetic foot problems: summary of NICE guidance. BMJ. 2011;342:d1280.