Diabetic Foot Disease – A Public Health Issue for Australia

Authors: Peter Sheeran¹, Prof. James Charles², Gerarda Henneken³, Brett MacCue⁴
1. JMO, Wagga Wagga Base Hospital MHLD, 2. Director, First Peoples Health Unit, Pro Vice Chancellor (Health), Griffith University, 3. Queensland Health Clinical Senate , 4. Wollongong Hospital High Risk Foot Service

Introduction:

Diabetic foot disease (DFD) is an important health issue for the Australian community. DFD encompasses ulceration with or without infection, ischaemia or neuro-arthropathy of the feet in people with diabetes. The main risk factors for DFD included peripheral neuropathy, peripheral arterial disease, previous ulceration or amputation and foot deformity. These risk factors are difficult or impossible to reverse once present and therefore DFD should be considered a separate public health issue as a subset of the overall approach to managing diabetes complications.

Objectives:

The aim of this narrative review was to identify the Public Health aspects of Diabetic Foot Disease (DFD) in Australia in addition to identifying the relevant Public Health and clinical interventions. With the aim of comparing the key differences between the two approaches and how these interventions are applied in practice.

Methods:

To identify existing literature, guidelines and recommendations for DFD in Australia we accessed the following resources: journal databases CINAHL and EBSCO in additional to various professional websites including Diabetes Australia, Diabetes Feet Australia, National Diabetes Services Scheme, Royal Australian College of General Practitioners, AIHW. We conducted content analysis to identify the main Public Health aspects and, the main interventional approach from clinical and Public Health perspectives. These approaches were analysed to identify similarities and differences in the way DFD is managed and treated in an Australian context.

Results:

The three most important three important public health aspects of DFD are awareness and education, accessibility of services, and equity. These aspects are relevant in the prevention of DFD and in preventing further progression and complications for people living with non-modifiable risk factors. Three public health interventions that address the issues identified above are early diabetes education, early screening programs and accessible multidisciplinary teams for patients with diabetes and DFD complications. The three most important clinical interventions for managing DFD are goal-oriented treatment, overall management of diabetes control including medical comorbidities and the implementation of appropriate footwear and offloading of high-pressure areas to reduce ulcer development and heal existing ulcers.

Conclusion:

In conclusion, DFD represents an increasing burden on patient morbidity and should be considered a separate public health issue as a subset of the overall approach to managing diabetes complications. In Australia Public Health and clinical interventions are implemented synergistically to address the main Public Health concerns of education, prevention of modifiable risk factors, equitable access to services. There are clear similarities and differences between how patient education, patient centred MDTs and holistic health management are implemented. Therefore, early diabetes education, increased funding for preventive care and broadening the scope of multidisciplinary teams are recommended to improve outcomes at a population and individual level.

References

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