National Diabetes Foot Care Audit 2018 to 2023

This is documented at 12 weeks following the FEA 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. (12 weeks following FEA is defined as between 10 weeks (70 days) and 14 weeks (98 days) but as close as possible to 12 weeks (84 days)).

Runs from 1 April to 31 March each year.

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).

The number/proportion of ulcers (excluding self-referrals) that are assessed by the specialist foot care team between 0 and 13 days after referral from a health care professional.

Healing is documented at 12 weeks following the FEA and is said to have occurred if the person is alive and ulcer-free (AAUF) (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.

In this instance, 12 weeks following the FEA is defined as between 10 weeks (70 days) and 14 weeks (98 days) but as close as possible to 12 weeks (84 days).

For this analysis, person years are calculated using the following logic with the cohort being everyone who is alive on 1st January with a diagnosis of diabetes.  

Each person is assigned a 1, representing a whole year at risk of experiencing the event for the first time in the stated period e.g. major amputation during 2022.

A person is no longer at risk if they die, therefore if they die halfway through the year, the period at risk is set to 0.5.

Similarly if the event occurred a quarter of the way through the year, the person is no longer at risk of the event occurring for the first time, so the period at risk would be set to 0.25.

The numerator is set to 1 if the event occurred, else it's kept as 0. Only the first instance of the event per person is counted.

A healthcare provider is a legal entity, or sub-set of a legal entity, which may contract for the provision of healthcare; it may operate on 1 or more sites and outside hospitals. 

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).

Results in this report are split by audit year, which run from April to March (e.g. 2022-23 is from 1 April 2022 to 31 March 2023).

A direct provider of care, for example, a specialist foot care service.

The NDFA collects information on diabetes related 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.

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.