A mobile screening programme for the cardiovascular and microvascular complications of Type 2 diabetes in primary care

Assessment and management of diabetic foot ulcers

Diabetic foot ulcers can cause considerable disability and morbidity. The complex pathology requires expert and in-depth assessment and management to achieve the best outcomes. Assessment is underpinned by attention to four key points: vascular sufficiency, neurological/sensory status, appropriateness of footwear, and presence of foot deformity. The 'shopping list' for management is derived from the assessment and requires careful planning and a multidisciplinary approach. This article outlines key first line principles and practices in assessment and management of diabetic foot ulcers, including the importance of offloading pressure and mechanical trauma to aid healing and prevent recurrence.

Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service

AIMS

To compare diabetes bed occupancy and inpatient length of stay, before and after the introduction of a dedicated diabetes inpatient specialist nurse (DISN) service in a large UK Hospital.

METHODS

We analysed bed occupancy data for medical or surgical inpatients for 6 years (1998-2004 inclusive), with a DISN service in the final 2 years. Excess bed days per diabetes patient were derived from age band, specialty, and seasonally matched data for all inpatients without diabetes. We also analysed the number of inpatients with known diabetes who did not have diabetes recorded as a discharge diagnosis.

RESULTS

There were 14,722 patients with diabetes (9.7% of all inpatients) who accounted for 101 564 occupied bed days (12.4% of total). Of these, 18 161 days (17.8%) were excess compared with matched patients without diabetes, and were concentrated in those < 75 years old. Mean excess bed days per diabetes inpatient under 60 years of age was estimated to be 1.9 days before the DISN appointment, and this was reduced to 1.2 bed days after the appointment (P = 0.03). This is equivalent to 700 bed days saved per year per 1000 inpatients with diabetes under 60 years old, with an identical saving for those aged 61-75 years (P = 0.008), a saving of 1330 diabetes bed days per year by one DISN. Excess diabetes bed occupancy was 167 excess bed days per year per 1000 patients with diabetes in the local population after the DISN appointment. One quarter of the known Type 2 diabetes population were admitted annually, but one quarter of patients had no diagnostic code for diabetes.

CONCLUSIONS

Diabetes excess bed occupancy was concentrated in patients < 75 years old, and this was reduced notably following the introduction of a DISN service.