NICE inpatient diabetes foot disease guidance

the individual and to the NHS. With a lifetime risk of 15% of developing a foot ulcer, foot ulcers preceding 80% of amputations and diabetes being the most common cause of non-traumatic limb amputation, it is a significant problem. Prolonged length of hospital inpatient stays and increased bed occupancy (the most common diabetes reason for admission in the recent National Diabetes Inpatient Audit)1 contribute to the financial cost of this complication. The recent publication of the National Institute for Health and Clinical Excellence (NICE) clinical guideline (CG) on the ‘Inpatient Management of Diabetic Foot Problems’ (CG 119)2 comes seven years after the previous NICE guideline which concentrated on the community and outpatient prevention and management of foot disease.3 ‘Putting Feet First’,4 guidance on commissioning specialist services for the prevention and management of foot disease in hospitals, was the catalyst for this topic to be developed by NICE under the short guidelines programme. The variation in clinical management of diabetes inpatients with foot disease was, however, of particular relevance in its acceptance as a CG topic. The short guidelines review a narrower clinical area than the full guidelines (in this case, six review questions were addressed) but are developed in a shorter period of time. Therefore prevention of foot disease is not covered with regard to the general inpatient diabetes population which is a missed opportunity. The NICE review of evidence and consequent recommendations just published will nevertheless provide a distinct advantage over other guidelines, by being NICE ‘badged’, and will provide further impetus to getting much needed recognition within the NHS for the problem of diabetes foot disease, particularly in the current financial climate.