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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems [Internet]. Sheffield (UK): University of Sheffield; 2003. (NICE Clinical Guidelines, No. 10.)</p></div><div class="bk_msg_box bk_bttm_mrgn clearfix bk_noprnt"><div class="iconblock clearfix"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/niceng19guid/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng19guid-lrg.png" alt="Cover" height="100px" width="80px" /></a><div class="icnblk_cntnt"><ul class="messages"><li class="info icon"><span class="icon"><a href="/books/n/niceng19guid/">See 2019 update</a></span></li></ul></div></div></div><div class="messagearea bk_noprnt" style="margin-bottom:1.3846em "><ul class="messages"><li class="warn icon"><span class="icon">This publication is provided for historical reference only and the information may be out of date.</span></li></ul></div><div class="bk_prnt"><p style="color:red;"><strong>This publication is provided for historical reference only and the information may be out of date.</strong></p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg10/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg10-lrg.png" alt="Cover of Clinical Guidelines for Type 2 Diabetes" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK51707_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK51707_dtls__"><div>NICE Clinical Guidelines, No. 10.</div><div>School of Health and Related Research (ScHARR), University of Sheffield.</div><div>Sheffield (UK): <a href="https://www.sheffield.ac.uk/scharr" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">University of Sheffield</a>; 2003.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/nicecg10/">Contents</a></li></ul></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg10/appendixes.app25/" title="Previous page in this title">< Prev</a><span class="inactive page_link next">Next ></span></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK51707_"><span class="label">Appendix 26</span><span class="title" itemprop="name">Patient education framework</span></h1></div><div class="body-content whole_rhythm" itemprop="text"><p>The Guideline Development Group considered the issues of key points/topics that should be covered in patient education, particularly from the viewpoint of what people with diabetes need to know about foot care. The Group members recognised that that it was not possible to give definitive answers in this area, but they produced a framework of key points that might provide a useful starting point for healthcare professionals providing or developing education materials on foot care for people with type 2 diabetes. This was developed from a consensus of the Guideline Development Group rather than from research literature, which is not available.</p><div id="appendixes.app26.s1"><h2 id="_appendixes_app26_s1_">Patient education: key points to address</h2><p>Education is an essential element in the empowerment of people with diabetes, helping an effective partnership between healthcare professional and individual develop, which is key in achieving effective care. Foot care should be considered an important part of self-care in people with diabetes, and as much part of a self-care routine as blood glucose control or diet.</p><p>Patient education/information needs to be tailored to meet each individual’s needs. Some individuals, because of their personal circumstances or attitudes to their condition, may need increased levels of education, care and support.</p><p>A person with diabetes should expect to be offered information about the following:</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">what they can expect in terms of care</p></dd><dt>♦</dt><dd><p class="no_top_margin">self-care and self-monitoring</p></dd><dt>♦</dt><dd><p class="no_top_margin">when and where to seek advice</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">details of the healthcare professional to contact if an individual feels their condition has changed and they need advice before their next routine appointment</p></dd><dt>♦</dt><dd><p class="no_top_margin">details of an alternative (out of hours) contact if an emergency arises (such as a new ulcer) and the usual contact professional is not available</p></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">the possible consequences of neglecting the feet</p></dd><dt>♦</dt><dd><p class="no_top_margin">management of symptoms (e.g. pain, odour from ulcers)</p></dd></dl><p>Other information about foot care and other aspects of diabetes should also be offered as needed.</p><div id="appendixes.app26.s2"><h3>Key points to be included in patient education</h3><div id="appendixes.app26.s3"><h4>For all people with diabetes, and people at low current risk of foot ulcers</h4><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">self-care and self monitoring</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">daily examination of feet for problems (colour change, swelling, breaks in the skin, pain or numbness)</p></dd><dt>♦</dt><dd><p class="no_top_margin">footwear (the importance of well fitting shoes and hosiery)</p></dd><dt>♦</dt><dd><p class="no_top_margin">hygiene (daily washing and careful drying)</p></dd><dt>♦</dt><dd><p class="no_top_margin">nail care</p></dd><dt>♦</dt><dd><p class="no_top_margin">dangers associated with practices such as skin removal (including corn removal)</p></dd><dt>♦</dt><dd><p class="no_top_margin">methods to help self examination/monitoring (eg the use of mirrors if mobility is limited)</p></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">when to seek advice from a healthcare professional</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">if any colour change, swelling, breaks in the skin, pain or numbness is found</p></dd><dt>♦</dt><dd><p class="no_top_margin">if self-care and monitoring is not possible or difficult (eg because of reduced mobility)</p></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">possible consequences of neglecting the feet</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">foot problems can often be prevented by good diabetes overall management as well as specific foot care</p></dd><dt>♦</dt><dd><p class="no_top_margin">prompt detection and management of any problems is important, thus the importance of seeking help as soon as a problem is noticed</p></dd><dt>♦</dt><dd><p class="no_top_margin">complications of diabetes such as <a class="def" href="/books/n/nicecg10/appendixes.app24/def-item/glossary.gl1-d34/">neuropathy</a> and <a class="def" href="/books/n/nicecg10/appendixes.app24/def-item/glossary.gl1-d28/">ischaemia</a> can lead to foot problems such as ulcers, infections, and in extreme cases gangrene and <a class="def" href="/books/n/nicecg10/appendixes.app24/def-item/glossary.gl1-d5/">amputation</a></p></dd></dl></dd></dl></div><div id="appendixes.app26.s4"><h4>For people at increased or high risk of foot ulcers</h4><p>The key points to be addressed for all people with diabetes are still important and should be addressed in patient education for people at increased/high risk of foot ulcers.</p><p>The following should also be addressed.</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">if <a class="def" href="/books/n/nicecg10/appendixes.app24/def-item/glossary.gl1-d34/">neuropathy</a> is present, the resulting numbness means that problems may not be noticed, so extra care and vigilance is needed and additional precautions to keep feet protected is needed</p></dd><dt>♦</dt><dd><p class="no_top_margin">every break in the skin is potentially serious</p></dd><dt>♦</dt><dd><p class="no_top_margin">not walking barefooted</p></dd><dt>♦</dt><dd><p class="no_top_margin">seeking help to deal with corns and calluses</p></dd><dt>♦</dt><dd><p class="no_top_margin">dangers associated with over the counter preparations for foot problems (eg the dangers of ‘corn cures’)</p></dd><dt>♦</dt><dd><p class="no_top_margin">potential burning of numb feet</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">checking bath temperatures</p></dd><dt>♦</dt><dd><p class="no_top_margin">avoiding hot water bottles, electric blankets, foot spas and sitting too close to fires</p></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">moisturise areas of dry skin</p></dd><dt>♦</dt><dd><p class="no_top_margin">regular checking of footwear for areas that will cause friction or other problems</p></dd><dt>♦</dt><dd><p class="no_top_margin">seeking help from a healthcare professional if footwear causes difficulties or problems</p></dd><dt>♦</dt><dd><p class="no_top_margin">wearing specialist footwear if it has been prescribed/supplied</p></dd><dt>♦</dt><dd><p class="no_top_margin">additional advice about foot care on holiday</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">not wearing new shoes</p></dd><dt>♦</dt><dd><p class="no_top_margin">planning adequate rest periods to avoid additional stress on feet</p></dd><dt>♦</dt><dd><p class="no_top_margin">when travelling by air, the importance of walking up and down aisles</p></dd><dt>♦</dt><dd><p class="no_top_margin">use of sun block on feet</p></dd><dt>♦</dt><dd><p class="no_top_margin">have a first aid kit and covering any sore places with a sterile dressing</p></dd><dt>♦</dt><dd><p class="no_top_margin">seeking help if problems develop</p></dd><dt>♦</dt><dd><p class="no_top_margin">holiday insurance issues (does it cover diabetes?)</p></dd></dl></dd></dl></div><div id="appendixes.app26.s5"><h4>For people with foot ulcers</h4><p>The issues to be addressed for all people and those at increased or high risk should again be covered.</p><p>The following issues should also be covered.</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">every break in the skin is potentially serious</p></dd><dt>♦</dt><dd><p class="no_top_margin">infection can develop with alarming rapidity</p></dd><dt>♦</dt><dd><p class="no_top_margin">early detection and rapid treatment improve the chances of a good outcome</p></dd><dt>♦</dt><dd><p class="no_top_margin">appropriate resting of foot/leg</p></dd><dt>♦</dt><dd><p class="no_top_margin">signs and symptoms that healthcare professionals involved in the management of a foot ulcer should be told about</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">changes in the ulcer</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">increase in size</p></dd><dt>♦</dt><dd><p class="no_top_margin">colour</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">redness of the skin round the ulcer</p></dd><dt>♦</dt><dd><p class="no_top_margin">bluish marks like bruises</p></dd><dt>♦</dt><dd><p class="no_top_margin">skin going black</p></dd><dt>♦</dt><dd><p class="no_top_margin">ulcer itself changed colour</p></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">discharge</p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">ulcer wet where it was dry before</p></dd><dt>♦</dt><dd><p class="no_top_margin">blood or pus discharging from it</p></dd></dl></dd></dl></dd><dt>♦</dt><dd><p class="no_top_margin">new ulcers or blistering</p></dd><dt>♦</dt><dd><p class="no_top_margin">pain (ulcer becomes painful or uncomfortable or foot is throbbing)</p></dd><dt>♦</dt><dd><p class="no_top_margin">smell (ie foot smells strange/different)</p></dd><dt>♦</dt><dd><p class="no_top_margin">swelling (eg shoe becomes tight)</p></dd><dt>♦</dt><dd><p class="no_top_margin">feeling unwell (fever, ‘flu-like symptoms’ or poorly controlled diabetes)</p></dd></dl></dd></dl></div></div></div><div id="bk_toc_contnr"></div></div></div>
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