Stephanie Stanley

Citation: Stanley S (2022) A “Wight” approach to diabetic foot screening? The Diabetic Foot Journal 25(2): 53–7

Key words  - Diabetic foot ulcer  - Podiatrist-led screening service  - Screening

Article points

1. Early identification of patients at high risk of developing diabetic foot ulceration is of paramount importance.

2. The annual screening appointment is an opportunity to check not only neuropathy and vascular supply, but also other issues.

3. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Author

Stephanie Stanley Consultant Podiatrist, Clinical, Professional and Operational Lead for Podiatry Podiatry Department St. Mary’s Hospital Parkhurst Road Newport Isle of Wight

Early identification of patients at high risk of developing diabetic foot ulceration is a top priority due to the associate clinical, economic and psychosocial burdens. Routine screening is necessary for preventive care and optimal use of resources. Attendance at the screening appointment gives an opportunity to check not only neuropathy and vascular supply, but also myriad other issues. Involving patients in their own care decreases foot complications, such as ulceration and amputation. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Martin B. Whyte PhD1 | Mark Joy PhD2 | William Hinton BSc1,2 | Andrew McGovern MD1 | Uy Hoang PhD1 | Jeremy van Vlymen BSc1 | Filipa Ferreira BSc2 | Julie Mount PhD3 | Neil Munro DPhil1 | Simon de Lusignan MD1,2

1 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK

2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

3 Eli Lilly and Company, Hampshire, UK

Correspondence

Martin B. Whyte, PhD, Department of Clinical & Experimental Medicine, Leggett Building, University of Surrey, Guildford GU2 7WG, UK.

Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 Funding information Eli Lilly and Company

Abstract

Aim: To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in the risk of major adverse cardiovascular events (MACE).

      Materials and Methods: A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database—a large, English primary care network—was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycaemic bands were created: groups A (HbA1c < 58 mmol/mol [<7.5%]), B (HbA1c ≥ 58 to 75 mmol/mol [7.5%- 9.0%]) and C (HbA1c ≥ 75 mmol/mol [≥9.0%]). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycaemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (≥5.5 mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time-varying Cox proportional hazards models, which included the first-year transition and the glycaemic variability score.

      Results: From 26 180 patients, there were 2300 MACE. Compared with group A->A transition over 1 year, those with C->A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60-0.94; P = .014), whereas group C->C had HR 1.21 (0.81-1.81; P = .34). Compared with the lowest glycaemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11-2.06; P = .0096). Conclusion: Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycaemic variability had a negative effect on an individual's risk.

KEYWORDS: computerized, diabetes complications, macrovascular, medical record systems, primary care, type 2 diabetes

Charley Samler

Citation: Samler C (2022) Creating a culture of curiosity: How to promote effective safeguarding in the diabetes team and beyond. Diabetes Care for Children & Young People 11: [Early view publication]

Article points

1. There is a need for a shared definition and understanding of how to practice professional curiosity at an inter-agency level.

2. Professional curiosity and inter-agency working rely on one another to thrive.

3. The children and Young Person’s diabetes clinic presents a unique opportunity to practice professional curiosity.

4. Professional curiosity needs to be embedded within all Health and Social Care Professionals’ core training.

5. There is a need for regular safeguarding supervision and simulated workshops to promote ongoing practice of professional curiosity.

Key words

- Diabetes clinic - Inter-agency collaboration - Professional curiosity - Respectful uncertainty - Safeguarding supervision

Authors

Charley Samler is Children’s Diabetes Nurse Specialist, Musgrove Park Hospital, Taunton.

      The National Wound Care Strategy Programme (NWCSP) seeks for improvement in the care of patients with wounds (The National Wound Care Strategy Programme — Lower Limb Recommendations, 2020). The recommendations offer a clear framework for the development for local delivery in clinical care settings. The Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH) developed clinical pathways through collaboratively system leadership with the Doncaster Place Wound Care Alliance, ensuring secondary care was included and potential and historical barriers overcome, to implement the NWCSP recommendations. Here we describe the process of the translating national recommendations into clinical pathway and the issues that led to the development of a secondary care focused version.

KEY WORDS  Chronic wounds  Lower leg   National Wound Care Strategy Programme (NWCSP)  Secondary care  Wounds

KELLY MOORE Skin Integrity Lead Nurse, Doncaster and Bassetlaw teaching Hospitals NHS Foundation Trust