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NICE guidance update: Diabetic foot problems: prevention and management

For Diabetes, Type 1 and Type 2 diabetes

The National Institute for Health and Care Excellence (NICE) have published updated guidance on the prevention and management of diabetic foot problems.

The guideline covers preventing and managing foot problems in children, young people and adults with diabetes. It aims to reduce variation in practice, including antibiotic prescribing for diabetic foot infections.

In October 2019, NICE reviewed the evidence for antimicrobial prescribing for diabetic foot infections and updated the recommendations.

Diabetic foot problems
People with diabetes have too much sugar (glucose) in their blood. There are 2 main types of diabetes: type 1 and type 2. In type 1 diabetes, the body can't make insulin – insulin is the hormone that controls how much glucose is in the blood. In type 2 diabetes, the body doesn't produce enough insulin, so blood glucose levels become too high.

Diabetes has lots of effects on the body. It can affect blood flow, particularly in the feet and legs. It can also damage nerves, causing pain or uncomfortable tingling and numbness or complete loss of feeling in the feet and legs.

Blood flow problems and nerve problems can mean that:
  • you might not notice if you hurt your feet or get any sores or ulcers on them (an ulcer is a patch of broken skin)
  • any wounds on your feet won't heal as quickly or as well as they used to or, in some cases, won't heal at all
  • the bones in your feet may become weak and change the shape of the foot or ankle (Charcot arthropathy)
  • you may find it difficult to stand or walk, which may affect your lifestyle, employment, social life and even routine tasks such as cutting your toenails.
In very extreme cases the tissues in the feet may die (gangrene). If this happens, it may be necessary to remove (amputate) toes, part of the foot or even the lower leg.

Prevention is the best approach when it comes to foot care for people with diabetes. But if problems do happen, they are less likely to become severe if dealt with quickly.

© NICE [2019]

Diabetic foot problems: prevention and management. NICE guideline [NG19]. Published date: August 2015 Last updated: October 2019
Available from: See Link below. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

The information provided by NICE was accurate at the time this article was issued.

NICE guidance on diabetic foot problems

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