International Consensus on the Diabetic Foot

International Working Group on the Diabetic Foot

Available from M Wijnandts, Department of Internal Medicine, Academic Hospital Maastricht, Netherlands, fl35

ISBN 90 9012716 x

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Rating: ★★★

Why is the diabetic foot so important that we need consensus, and international consensus at that? The reason is partly statistical and partly personal. Around the world at least 120 million people have diabetes, and up to 10% will develop foot ulceration at some time. About 9% of NHS funds are spent dealing with diabetes; nearly half of this is for hospitalisation for complications, particularly of the diabetic foot. Throughout the developed world similar healthcare costs are incurred, but in the developing nations the scarcity of care means that most of the costs are social.

Such is the public health picture, but there is a more personal and equally disturbing side. Patients often live with chronic discharging ulcers, pain, and progressive deformity. Repeated outpatient attendances, dressing changes, antibiotics, and surgical procedures are often the norm. Enforced rest and time lost from work add to the misery.

This is the background to the formation of the International Working Group on the Diabetic Foot. Opinion leaders in the subject have produced this paperback publication, which purports to be a consensus on the diabetic foot, with particular emphasis on screening and prevention. Consensus is only collective opinion, but my colleagues and I had no difficulty in agreeing with the vast majority of the material, including those areas for which the evidence base is currently rather thin.

Ulceration of the diabetic foot is no accident. It starts with a mix of sensorimotor and autonomic neuropathy, usually with a degree of vascular insufficiency. Unfortunately, inadequate advice from healthcare professionals and maladaptive patient behaviour can hasten the pathological process. Reduction of new and recurrent ulceration and amputations is an important organisational challenge for us all, at whatever level in the system we work. Molecular biology may be the answer to diabetic complications in the future but not today. For now, simple screening of at risk feet and straightforward treatments are cost effective.

International Consensus on the Diabetic Foot says little that is new, but its mix of textbook and care manual is authoritative and easy to read. There is clear advice on the necessary clinical examinations and programmes, backed up by colour photographs and learning points. The forthcoming national service framework on diabetes will stimulate interest in systematic preventive care, so this book is well timed.