Volume 219 Issue 9

New Australian-based guidelines for diabetes-related foot disease have been summarised in an article recently published online at the Medical Journal of Australia (MJA), coinciding with World Diabetes Day on 14 November 2023. The guidelines, developed and published by Diabetes Feet Australia, are the first new Australian guidelines since 2011 and have been endorsed by ten national peak bodies. “We’ve observed over the years that well-directed implemented guidelines are critical to underpinning quality care and there are a number of areas of the guidelines that have been improved and updated compared with the ones from 2011,” guideline summary co-author Professor Stephen Twigg. “Practically developed clinical care guidelines that are up to date can really make a positive difference to health care outcomes and, in this case, for people with foot disease,” he said. The theme of this year’s World Diabetes Dayis “Know your risk, know your response”, encouraging people to know their risk level and what to do to support prevention, early diagnosis and timely treatment. Diabetes-related foot disease is a leading cause of hospitalisation, amputation, disability and health care costs in Australia. It is estimated that 300 000 Australians are at risk of developing diabetes-related foot disease annually. The guidelines at a glance The 98 recommendations made across six new guidelines for the general medical audience have been summarised in the MJA: prevention — screening, education, self-care, footwear, and treatments to prevent diabetic foot disease;classification — classifications systems for ulcers, infection, ischaemia and auditing;peripheral artery disease — examinations and imaging for diagnosis, severity classification, and treatments;infection — examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments;offloading — pressure offloading treatments for different ulcer types and locations; andwound healing — debridement, wound dressing selectionThe changes include a new risk stratification system for screening of people without diabetes-related foot disease, with more specific self-monitoring, footwear prescription, surgical treatments and activity management practices for those at increased risk. For people with diabetes-related foot disease, there are new ulcer, infection and peripheral artery disease classification systems, with more specific recommendations to resolve diabetes-related foot disease. Diabetes Feet Australia has created an interactive platform for the guidelines, which health care practitioners can use with their patients. “GPs or podiatrists or nurses with a patient with diabetes-related foot disease in front of them can click on these pathways to identify the recommendations that apply for that particular patient in terms of assessment, education and management,” guideline summary co-author Associate Professor Pete Lazzarini said.

Annika Howells

Research looking at the life expectancy of Indigenous and non-Indigenous people in the Northern Territory has won the 2022 Medical Journal of Australia (MJA) Award for Excellence in Medical Research. The research, conducted by Dr Yuejen Zhao, Shu Qin Li, Dr Tom Wilson, and Professor Paul Burgess, found that life expectancy for Indigenous people in the NT improved markedly from 1999 to 2018, with fewer lives lost to cancer, injuries and chronic disease. The MJA Editor-in-Chief, Professor Virginia Barbour, congratulated the team, saying they were worthy recipients of the award. “I congratulate Dr Zhao, Shu Qin Li, Dr Wilson, and Professor Burgess for winning the MJA Award for Excellence in Medical Research,” Professor Barbour said. “Their important research has helped contribute to the growing Australian academic literature about Indigenous health and wellbeing. “We know that more needs to be done to improve the health outcomes for Aboriginal and Torres Strait Islander people, so the MJA really encourages more research into this area. “It is also vital that the research community recognises the importance of research into the health and wellbeing of Aboriginal and Torres Strait Islander people, and here at MJA, we are proud to do that through this award.” Co-author Professor Paul Burgess, the Senior Director of Health Statistics and Informatics at NT Health, said the team were honoured to receive the award. “We are delighted and humbled to accept the MJA award for Excellence in Medical Research,” Professor Burgess said on behalf of the team. “As public health officials, we generally eschew the limelight — outside the occasional pandemic! “However, we think the true recognition for this work belongs to the many Aboriginal and non-Aboriginal people who have volunteered or worked tirelessly over the past 20 years to improve health outcomes across the NT.” Their research is part of a burden of disease study conducted every five years, Professor Burgess said. “Every five years we undertake the NT burden of disease study to understand the changing demands on the NT health system and also capture health outcomes through analysis of causes of mortality. “We use our burden of disease work as evidence to guide policy and program development in NT Health. “For our research, we were interested to see if there were changes in life expectancy in the NT population and in what disease areas these changes were occurring.” The research found that the life expectancy gap between Aboriginal and non-Aboriginal Territorians has closed significantly over the past 20 years — by 26% for men and by 21% for women. “In our research, we estimated, at the current pace of improvement, it would take another 60 years to close the gap in life expectancy between Aboriginal and non-Aboriginal Territorians,” Professor Burgess said. “Clearly, we can and should do better than this. “We have shown that life expectancy gains are achievable and that with further investment across health and the social determinants, we could expect to fast-track further improvements. “Critically, we need to listen to and partner with Aboriginal communities to address their priorities for action.” Professor Burgess hoped the research could help accelerate efforts to improve health and social outcomes for Aboriginal and Torres Strait islander people. “While our epidemiological research has not contributed directly to health gains, we have validated the efforts of the many Aboriginal and non-Aboriginal people that are working to improve outcomes every day across health, education, justice, housing and a myriad of non-government organisations,” Professor Burgess said. “It would be wonderful if our work could instil hope and perseverance for frontline workers and stimulate further investment to accelerate closing the gap in health and social outcomes. “Real change is absolutely possible.”

Sam Hunt