NDFA Interval Review: July 2014-March 2021

Ulcer episode: The NDFA collects information on diabetic foot ulcers (DFUs). An ulcer episode refers to the period during which a person has 1 or more DFUs. A person may have more than 1 ulcer episode if separated by a period of being ulcer-free, no matter how short.

First expert assessment: The first expert assessment (FEA) of the ulcer is that undertaken by a member of the team registering the ulcer episode. Time to FEA is the interval between first presentation to any health professional (e.g. a GP or in A&E) and first assessment by the clinician with a specialist interest. People with foot ulcers may also self-refer to a specialist foot care service (self-referral).

Ulcer severity is documented by the specialist foot care service at the FEA. It is defined using the SINBAD classification (Ince et al. 2008) which scores an ulcer between 0 and 6 depending on how many of the 6 SINBAD adverse elements are present: Site (on hindfoot), Ischaemia, Neuropathy, Bacterial infection, Area (≥ 1cm²), Depth (to tendon or bone). Ulcers with a score of 0 to 2 are defined as less severe; scores of 3 to 6 are defined as severe. If a person has more than 1 ulcer at FEA, 1 (usually the most severe or clinically significant) is selected as the index ulcer for the purpose of classification.

Healing is documented at 12 weeks following the FEA¹ and is said to have occurred if the person is alive and ulcer-free (i.e. all ulcers present during the ulcer episode have fully healed). Being ulcer-free also includes those who have had surgery – including minor amputation (below the ankle) and major amputation (above the ankle) – provided all wounds have healed. The ulcer episode is still active if any ulcers persist unhealed. Active ulcers are ulcers that have not healed. The ulcer episode is still regarded as active if the original index ulcer has healed but if other foot ulcers remain active.

Healthcare providers are the parent organisations of the specialist foot care services. This is typically an NHS trust in England or a local health board (LHB) in Wales. It may also be an independent healthcare provider (IHP).

The National Institute for Health and Care Excellence (NICE) produces guidelines for the treatment of diabetic foot problems². Getting It Right First Time (GIRFT) is a national programme designed to improve the treatment and care of patients, including those with diabetes³.

Results in this report are split by audit year, which run from April to March (e.g. 2019-20 is from 1 April 2019 to 31 March 2020). The 1st NDFA audit year 2014-15 is shorter than subsequent audit years because data collection started on 14 July 2014.

Notes: 1. Defined as between 10 weeks (70 days) and 14 weeks (98 days) but as close as possible to 12 weeks (84 days). 2. NICE NG19. 3. GIRFT Programme National Specialty Report: Diabetes (2020).