Claire O’Shea, Podiatrist(Presenting on behalf of the Waikato Regional Diabetes Service,

Multi-disciplinary

foot team, Vickie Corbett CNS Diabetes, Leigh Henry, Podiatrist,

Dr Paul Haggart, Vascular Consultant)

DIABETES MULTIDISCIPLINARY

FOOT CLINIC

Our ObjectivesLower amputation ratesIntegrate servicesImprove healing timesImprove patient quality of lifeImprove accessibility of health care

Diabetes Multidisciplinary Foot Team

MDT Five Year Statistics   2009 2010 2011

Total MDT patients

94 90 102

Average age 66 70 69

Male 66 (70%) 66 (73%) 74 (72%)

Female 28 (30%) 24 (27%) 28 (28%)

Maori/NZEuropean/Other

29(31%)/46(49%)/19(20%)

25(28%)/56(62%)/9(10%)

31(30%)/63(61%)/8(6%)

First HbA1c 8.3% (Range 14.3% - 4.7%)

7.3%(Range 15.2% - 5.2%)

8.1%(Range 14.4% - 5.3%)

Discharge HbA1c 7.3%(Range 10.9% - 5.4%)

6.9%(Range 13.0% - 5.4%)

7.8%(Range 12% - 5.3%)

Timing of ulcerpresentation

51% were 10 wks 47% are within 4wks 47% are within 4weeks53% over 4 weeks

Vascularintervention

35% 64% 69 (70%)

Deceased 17 (18%) 9 (10%) 12 (11%)

Number of Discharges

58 (64%) 71 (69%)

MDT Five Year Statistics   2012 2013 EURODIALE (2011)

Total MDT patients 93 91 1232

Average age 67 65 65

Male 66 (71%) 65 (71%) 65%

Female 27 (29%) 26 (29%)

Maori/NZEuropean/OtherEthnicity

17(19%)/65(69%)/11(12%)

20 (22%)/59 (65%) /12 (13%)

10 countries from Europe

First HbA1c 68 mmol/mol(Range 130 – 31)

65mmol/mol(Range 136-35)

>8.4% (68mmol)49% population

Discharge HbA1c 67 mmol/molRange 130 - 39)

60mmol/mol(Range 103-35)

Timing of ulcerpresentation

54% are within 4 weeks46% over 4 weeks

54% (4WKS)46% (4WKS+)

Length of time not stipulated

Vascularintervention

75 (80%) 82 (90%) 49% (PAD)22-73% range

Deceased 13 (14%) 7 (7%) 6% within 1yr

Number of Discharges

54 (60%) 72 (79%)

Renal Patients

Average eGFR

MDT patients 2013 (n92)

59ml/min

30-44ml/min 15%

<15ml/min 10%

Patient OneMrs T

Age 54

Ulcer site Right 2nd toe

Date 1st appointment 31/03/2013 - Primary care referral

Discharge Date 21/07/2013 –Community Podiatry

1st HbA1c & discharge HbA1c 108 mmol/mol % & 53mmol/mol

BP 1st & last appointment 190/90 & 152/80

Vascular investigations ADS/Angio

Insulin Start 31/03/13 Protaphane/Novorapid

Smoking status Ex-Smoker

Patient TwoMrH

Age 65

Ulcer site Left 2nd amp

Date 1st appointment 6/08/12 – Vascular team following discharge

Discharge Date 20/01/13 - Bilateral amputee

1st HbA1c & discharge HbA1c 53mmol/mol & 42 mmol/mol

BP 1st & Last appointment 160/80 & 128/68

Vascular investigations ADS/Angio failed

Insulin Start Already on Protaphane and glicazide

Smoking status Ex-Smoker

Midlands Region Amputation Rates

Month

Fiscal year

2011 2012 2013 2014

Jul 7 6 8 12

Aug 6 5 7 6

Sep 4 6 6 6

Oct 6 9 4 6

Nov 4 4 12 2

Dec 9 7 13  

Jan 7 8 5  

Feb 3 4 13  

Mar 6 4 6  

Apr 8 7 1  

May 6 8 13  

Jun 5 6 5  

Total 71 74 93 32

Waikato Diabetes Amputation Rates

Diabetic patients with amputation of lower extremities total procedures

0

2

4

6

8

10

12

14

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Tota

l pro

cedu

res

2011 2012 2013 2014

ConclusionAchieving comparable patient outcomes to

international dataStriving to continually improve our service

in the best interests of the patientWorking within an interdisciplinary

environment provides a seamless health care journey

References NZ Primary care Handbook, 2012 – www.health.govt.nz

Diabetes in Scotland - foot action group. www.diabetesinsctoland.org.uk

Type 2 Diabetes, prevention and management of foot problems. NICE guidelines, UK 2004. http://www.nice.org.uk/pdf/CG10fullguideline.pdf

International Working Group on the Diabetic Foot (IWGDF) www.iwgdf.org.

Managing the Diabetic Foot, Edmonds, M. Foster, A.(1999), Blackwell Science, Oxford.

Boulton, A, Armstrong, D, et al. Comprehensive Foot Examination and Risk Assessment, Endocrine Practice Vol14 No 5. July/August 2008. (ADA)