Preventative Foot Care for Patients with Diabetes: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

One systematic review of critically low quality and three evidence-based guidelines by Diabetes Canada, the National Institute for Health and Care Excellence (NICE) and the International Working Group on the Diabetic Foot (IWGDF) were identified. In the systematic review, a variety of foot care or education program were assessed. Health education program were different in design, setting, approach, outcome measures, and results. The implementation of the health education program was related to an improvement in foot self-care scores and foot problems. Subsequent follow-ups and evaluations were also significantly associated with better outcomes. No relevant cost-effectiveness study was identified. Three guidelines all recommend annual examination of the feet for foot problems among patients with diabetes. Both the guidelines by the NICE and the IWGDF recommend adequate education to improve self-care, risk stratification, and timely referral to specialist care. The NICE guideline further specifies the types of specialists required for foot protection services, procedures to inspect the feet, timing for patient education, and frequencies to assess the risk of developing diabetic foot problems for children or adolescents. The IWGDF guideline recommends that people with diabetes protect their feet by avoiding certain activities, such as walking barefoot and wearing unfit footwear, as well as foot temperature monitoring. There are a variety of guidelines targeting different contexts and settings, all of which recommend preventative foot care for people with diabetes.