Dr Satish Mishra at the first world congress on non-communicable diseases event in Chandigarh, India last month.

Between April-October 2017 842 diabetes patients that attended Dispensary 9 at the Bhabha Atomic Research Centre had their feet examined once by physicians that had received additional training from Imperial College London, comprising planning and data analysis.

Neuropathy, which can occur in diabetes patients following prolonged exposure to high blood sugar which can damage delicate nerve fibers, was found in 9% of the patients. Peripheral arterial disease, which occurs when a build-up of fatty deposits in the arteries restricts blood supply to leg muscles, was found in 0.5%.

Previously, not all diabetic patients were receiving foot examinations as part of the standard treatment pathway. The diabetic foot project aimed to use QS to achieve measurable indicators of healthcare improvement. The key process measure for the project was the cumulative sum of patients with diabetes receiving foot examination; and the key outcome measure was the percentage of patients screened for neuropathy and peripheral artery disease.

The pilot project met its objective and provides important evidence to show that diabetic foot care can improve by training healthcare providers, standardising processes, regular data review and feedback. Lessons learned on how to integrate diabetic foot care in a high-volume primary care clinic has relevance for India and other populous south Asian countries.

The findings were presented by principal investigator Dr Satish Mishra at the first world congress on non-communicable diseases event in Chandigarh, India last month.

Visit the National Health Mission’s website to read how the QS were developed from the recommendations in the standard treatment guideline on diabetic foot. Details of the planning and implementation of the project are on the poster presented at the first world congress on non-communicable diseases.

The implementation of the diabetic foot quality standards is critical as India is estimated to have 65 million people with diabetes, projected to reach over 100 million by 2035. Patients with diabetes are at risk of developing serious complications such as lower limb amputation, cardiovascular disease, kidney failure and blindness, all preventable through better detection and appropriate management. The implementation of the diabetic foot quality standards in primary care practice aims to identify diabetics at risk of foot complications to help in the timely provision of interventions like corrective footwear for prevention of foot ulcers and gangrene. Complications of the foot are responsible for more hospital admissions than any other complication of diabetes. The implementation of the quality standards can potentially decrease the huge risk to individual patients and economic burden.

The team at the BARC primary healthcare center spent six months preparing for the implementation of the QS, including re-designing the care pathway, creating new new data input processes and referral to diabetic foot services provided by the surgery department, and developing a standardized and reliable data recording system . Core training on diabetes and diabetic foot management was provided by Dr Amanda Adler and Dr Prashant Vaz, both UK diabetic experts . In the implementation phase, continuous quality improvement is being facilitated. This includes local data capture and analysis to monitor compliance with the QS and address issues as their arise. Explicit reporting & transparent sharing of data with all concerned staff is being encouraged.