Background

A person with type 1 diabetes presented to the diabetes clinic with foot ulcers. He had a history of diabetes-related complications such as retinopathy, peripheral neuropathy, peripheral arterial disease, chronic kidney disease and hypertension, as well as elevated blood glucose levels. In such a case worsening of complications appears to be inevitable.

Case Presentation

A 55 year old male had two non-healing, neuro-ischaemic diabetic foot ulcers - on the right heel he had an ulcer for seven months caused by cracked skin and on the left first metatarsal plantar he had an ulcer for two months due to increased pressure with underlying foot deformity. His diabetes knowledge was limited, and he had lower health literacy skills. In the past, he declined specialist diabetes support.

Management and Outcome

He required a below knee amputation on the right due to severe infection with sepsis. The wound on the left foot healed with offloading through orthotic footwear, vascular intervention, and wound care. During his hospital admission, he had ongoing diabetes nursing support. Step-by-step trust was established, and he felt empowered to set his goals. A written, personalised insulin self-management plan contributed to improving his blood glucose levels. The multidisciplinary care led to improved self-care and glycaemic control, as well as it saved one leg. Following this, he had minimal ongoing support. At four years follow-up, no further progression of his diabetes-related complications were noted. 

Discussion 

This case study demonstrates the positive value of multidisciplinary support for people with advanced disease, particularly if it focuses on patient self-care. It can significantly delay progression of complications and improve quality of life. On the other hand, it raises the question if people at risk of complications are identified early enough, self-care information given and are offered the required support?