When and how to audit a diabetic foot service

Graham P. Leese (Lead / Corresponding author), Duncan Stang

    Research output: Contribution to journalArticlepeer-review

    6 Citations (Scopus)


    Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards. A diabetes foot service should have risk stratification system in place that should compare to the population-based figures of 76% having low-risk feet, 17% moderate risk and 7% being at high risk of ulceration. Resources can then be directed towards those with high-risk feet. Prevalence of foot ulceration needs to be audited. Community-based studies give an audit standard of around 2%, with 2 to 9% having had an ulcer at some stage in the past. Amputation rates should be easier to measure, and the best results are reported to be around 1.5-3 per 1000 people with diabetes. This is a useful benchmark figure, and the rate has been shown to decrease by approximately a third over the last 15 years in some centres. Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals, an amputation can be a good outcome. In addition to clinical outcomes, processes of care can be audited such as provision of clinical services, time from new ulcer to be seen by health care professional, inpatient foot care or use of antibiotics. Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved.

    Original languageEnglish
    Pages (from-to)311-317
    Number of pages7
    JournalDiabetes/Metabolism Research and Reviews
    Issue numberSuppl. 1
    Early online date9 Oct 2015
    Publication statusPublished - Jan 2016
    Event7th International Symposium on the Diabetic Foot - The Hague, Netherlands
    Duration: 20 May 201523 May 2015


    • Combined Modality Therapy
    • Congresses as topic
    • Diabetic foot
    • Early diagnosis
    • Global Health
    • Humans
    • Limb salvage
    • Medical audit
    • Precision medicine
    • Protective devices
    • Quality of health care
    • Recurrence
    • Referral and consultation
    • Shoes
    • Journal article


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