8 Diabetic Foot Canada Volume 1 No 2 2013 Authors Janet Kuhnke is an Enterostomal Therapist and a Baccalaureate Nursing faculty member, St. Lawrence College, Cornwall, ON. T he Canadian Diabetes Association estimates 9 million Canadians are living with pre-diabetes or diabetes (CDA, 2012). Diabetes and its complications result in decreased quality of life, with earlier mortality and increased health system use (PHAC, 2011). It is imperative that healthcare systems prioritize interventions that slow or halt the progression of diabetes complications (Council of the Federation, 2012). Early screening can detect diabetes-related complications in four key areas: • HbA1C blood tests measure the average blood glucose over the previous 90 days, with higher levels predicting accelerated end organ diabetes complications • Urine protein tests detect early renal disease • Dilated eye examination detects early signs of diabetic retinopathy • Diabetic foot screening identifies people with a high-risk foot, allowing for preventive treatment to decrease the chances of ulceration, wounds and amputation (CIHI, 2009). Diabetic foot complications are common in Canada and may include ulcerations (wounds) and amputations. System-level strategies to combat these complications include: • Education for patients, families, caregivers and health care professionals • Prevention by early identification of persons with feet at risk for ulceration and potential amputation • Close monitoring of people with high-risk feet and assessment by multidisciplinary teams (IWGDF, 2012). People with diabetes (PWD) are at high risk of developing foot complications because of a number of factors. People living with diabetes have a high incidence of neuropathy, peripheral arterial disease (PAD) and a decreased immune response (Boulton et al, 2008). This results in: • Decreased protective sensation • Deformity related to motor neuropathy • Local ischemia • Distal gangrene from PAD • Increasing immune defects. These foot changes can, in turn, result in: • Calluses • Blisters • Skin ulcers • Gangrene • Secondary bacterial infections, such as cellulitis and osteomyelitis • Avoidable amputations (Perkins & Bril, 2003). People with consistently high and unstable blood glucose levels are at even higher risk. Some people with diabetes may have no symptoms of foot complications; however, they may have treatable, undetected foot complications. Completion of a comprehensive assessment and diabetic foot screening, as recommended by international and national diabetes clinical practice guidelines (CPGs) is critical to the prevention of foot complications in people with diabetes. Article points 1. Widespread failure to carry out diabetes foot screening can lead to risk of ulceration and amputation. 2. All healthcare organizations, programs and clinicians should implement diabetes foot screening and Clinical Practice Guideline recommendations. 3. People with diabetes must be empowered to take responsibility for their foot health and deserve access to knowledgeable healthcare professionals. Key words - Screening - Amputation - Best practise Citation: Kuhnke J, Botros M, Elliot J et al (2013) The case for diabetic foot screening. Diabetic Foot Canada 1(2): 8–14 Janet L Kuhnke, Mariam Botros, James Elliott, Elise Rodd-Nielsen, Heather Orsted, R. Gary Sibbald Diabetes foot screening is a key component of the systematic and multidisciplinary care required by people with diabetes and is strongly supported by evidence- based best practice recommendations. Failure to carry out comprehensive diabetes foot screening can have detrimental consequences for those with diabetes. This article summarizes the key evidence supporting diabetes foot screening for risk of ulceration and lower-extremity amputation. The case for diabetic foot screening Article