Personalised treatment could ease diabetic foot disease burden

A “paradigm shift” from stratified healthcare to personalised medicine must be adopted to overcome barriers to diabetic foot disease, researchers have said.

A Dutch study has looked at the best way to reduce the burden of diabetic foot disease and why people with diabetes do not take better care of their feet.

The team from the Department of Rehabilitation Medicine at theUniversity of Amsterdam found that ulcer prevention is “underexposed in research and clinical practice”.

They also identified five barriers which they believe are stopping ulcer prevention from being prioritised.

The barriers were:

1. Barriers with persons at risk of diabetic foot ulceration: The focus in ulcer prevention is on NOT getting a foot ulcer, thereby being a performance‐avoidance goal.
2. Barriers with clinicians: Clinicians who can commit the majority of their time to patients with diabetic foot disease, and thereby maximise both their expertise and outcomes, are those working in dedicated and specialised teams, mostly in university‐based or tertiary hospitals.
3. Barriers with research(ers): Support for research is limited in community settings where most foot care towards ulcer prevention takes place.
4. Barriers in industrial engagement: Similarly as 4 years ago, we found in our RCT search update that ulcer healing trials are mostly industry‐driven, whereas ulcer prevention trials are investigator‐driven.
5. Barriers in understanding ulcer development: From an epidemiological perspective, our understanding of ulcer development is limited at best.

Having looked at all the issues, the team said that rather than separately solving the barriers, adopting a “paradigm shift from stratified healthcare towards personalised medicine” is needed to help solve the identified issues.

Personalised medicine aims to deliver the right treatment to the right person at the right time, based on individual diagnostics. Different treatment strategies should be available for different people, delivered in an integrated, objective, quantitative and evidence‐based approach.

The research team said for this to be possible large-scale collaborations between stakeholders are needed, which would pay off in the long-run because treatment for foot ulcers cost more than £8,000. Research and clinical practice must also be on board with adopting the new approach too.

The researchers concluded: “We hope to see more discussion around this paradigm shift, and increasing investments of energy and money in diabetic foot ulcer prevention in research and clinical practice.”

The findings have been published in the Diabetes Metabolism journal.

To read the study in full, click here.