NIHR: People with diabetes with a low risk of developing foot ulcers can be screened less often

NIHR | January 2021 | People with diabetes with a low risk of developing foot ulcers can be screened less often

Current NICE guidance recommends that people with diabetes have their feet screened annually to identify those most at risk of developing foot ulcers.  Now a new NIHR- funded study suggests that annual foot checks could be reduced. It found that people at low risk of developing ulcers do not need yearly reviews, as 1 in 20 patients at low risk of a foot ulcer progressed to medium risk level over a two year period.

The researchers analysed the data of over 10 000 patients in Scotland diagnosed with diabetes, who attended their first screening session in the period from 2009 to 2017. From this they identified each individual’s risk of foot ulceration according to standard risk factors of insensitivity, previous ulcers, and whether pulses in the foot could be felt. They looked at the change over time – from low to moderate risk. They cross-referenced this information with data on ulceration, amputation and death.

The results showed:

  • People with diabetes changed from low to moderate risk slowly
  • Around one in ten changed from low to moderate risk after five years (9.9 %) and eight years (11.3%)
  • Most changes in risk status (94%) were down to nerve damage in the feet (peripheral neuropathy)
  • One in 250 (0.4%) in the low-risk group developed ulcers after two-years; one in a thousand (0.1%) had an amputation (Source: NIHR).

Read the full NIHR Alert

Primary paper is available from Diabetic Medicine

GIRFT: Clinical practice guide for improving the management of adult COVID-19 patients in secondary care

Getting It Right First Time | January 2021 | Clinical practice guide for improving the management of adult COVID-19 patients in secondary care: Shared learning from high performing trusts during COVID-19 pandemic


This GIRFT programme sought to understand the factors that influenced hospital outcomes for COVID-19 patients during the first wave of the pandemic. To do this, stakeholders analysed of national hospital datasets and engaged with NHS trusts with excellent outcomes for COVID-19 patients. These stakeholders acknowledge that this is crucial to inform clinicians, but also to recognise that there will be shifts in future practice such as the continuation of elective services.

Image source: GIRFT
Image description: A figure outlining the five stages of the project; from understanding the national lanscape, collating local information, performing cross-specialty deep dives, and qualitative analysis of information received during these deep dives, to producing the report.

The authors of this publication have used statistical analysis (adjusting for patient risk factors including age, sex, ethnicity, deprivation, and co-morbidities) to enable them to identify factors influencing in-hospital COVID-19 related mortality rates. They used hospital episode statistics data covering discharges from 1 March to 31 May and extended to 31 July 2020 where data were available.

Virtual deep dive meetings were cross-specialty and multidisciplinary and aimed to draw out valuable learning.

This document summarises the challenges faced and responses utilised by the high performing trusts we visited as part of the GIRFT cross-specialty COVID-19 deep dives, as well as identifying successful innovations they implemented

Clinical specialty guidance from deep dives for diabetes

  • National clinical guidelines should be rapidly adopted and disseminated, to optimise glycaemic control in COVID-19 patients both with and without diabetes.
  • A seven-day inpatient service should be maintained and where this does not exist, it should be rapidly developed, with diabetes specialist nurses playing a vital role.
  • Inpatients with diabetes should be proactively identified and reviewed, using technology for virtual reviews where appropriate.
  • Maintaining outpatient services, especially foot and pregnancy services, is vital in preventing admissions, facilitating early supported discharge, and providing ongoing chronic disease management (Source: GIRFT).

GIRFT Clinical practice guide for improving the management of adult COVID-19 patients in secondary care