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Diabetic foot: barriers to care and prevention

Apr 07, 2015

In the last two decades interest has grown in a forgotten complication of diabetes: diabetic foot syndrome. The evidence base for clinical practice is improving, as shown by the publication of the new edition of the International Guidelines of the International Working Group on the Diabetic Foot (IWGDF) to be presented next month at the 7th International Symposium on the Diabetic Foot. Additionally, the IDF Task Force on Diabetic Foot and the IWGDF work together on implementation of the ‘Train the Foot Trainer’ course on how to set up diabetic foot care.

As it is a right to receive insulin and other essential medications, it can be said that a person with diabetes has the right to receive appropriate foot care without extensive delay. But what diabetic foot care is essential for each person with diabetes? Should every person with diabetes have access to a yearly foot screening and adjusted shoes? Furthermore, numerous barriers still exist in implementation of foot care in both low- and high-resource settings. The barriers can be divided in three categories:

  1. Availability of health care resources;
  2. Patient-related factors;
  3. Factors related to health care systems.

As written by William Van Houtem in 2012: “The opening for improvement in diabetic foot care should be aimed for and any barriers made visible, allowing for change and perfection to occur.”

Let us discuss the barriers and improve our knowledge, skills and daily care.

Is diabetic foot care available in your country and what are the barriers for implementation of this care?

Information about the moderator

The discussion will be moderated by Dr Kristien Van Acker (diabetologist, Chair of IDF Task Force on Diabetic Foot and Chair of the International Working Group on the Diabetic Foot) and Dr Stephan Morbach.


1) Van Acker K, et al. Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review. Diabetes Metab Res Rev. 2014 Nov;30(8):635–45.

2) Doggen K, et al. Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results: Quality Improvement in Diabetic Foot Clinics. Diabetes Metab Res Rev. 2014 Jul;30(5):435–43.

3) Pickwell K, et al. Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer. Diabetes Care. 2015 Feb 9