Implementation of evidence-based foot screening in people with diabetes: A scoping review

Abstract

Background: Recommendations to prevent diabetes ulceration and amputation include an annual foot check, primarily screening for sensation and circulation. Using these simple, evidence-based components is vital to identifying complications early, assessing risk, and managing care to prevent or delay amputations. However, routine implementation of these assessments is suboptimal and approaches to their integration remain poorly understood.

Aim: We aimed to identify and synthesize information on the factors affecting implementation of simple evidence-based diabetes foot screening.

Methods: We reviewed published and grey literature using a blinded two-stage process by two independent reviewers. Included studies were primary research that implemented or improved foot screening for adults with type 1 or 2 diabetes, assessing at least one of the following: 10-g monofilament sensitivity, pedal pulse palpation, or history of ulceration or amputation. A thematic synthesis approach was used.

Results: We screened 5133 titles and abstracts, reviewed 102 full-text articles, and included 26 studies in the final analysis. We identified four key themes: (1) Existing diabetes screening (i.e. retinal screening) or treatment interventions (i.e. medication collection) provide opportunities for synergistic integration; (2) Annual event-based foot screening (e.g. on World Diabetes Day) in lower resource settings provides community-focused preventative care; (3) Further opportunities to increase access to foot screening include self-administered screening and screening in complex residential settings; (4) Healthcare provider champions are essential for local foot screening implementation in primary and secondary care.

Conclusion: Further research should evaluate the issues identified in these four themes, in different contexts, and with support of implementation frameworks.

Keywords: Amputation; Diabetic foot; Diabetic neuropathy; Foot ulcer; Ischaemia; Prevention & control; Risk assessment.