NHS Evidence Update on Diabetic Foot Problems

Foot examination

NHS Evidence is a service provided by NICE, the National Institute for Health and Clinical Excellence.  As part of this service, they publish regular updates of recent evidence that fits under the main sections of NICE guidance.

In March, NHS Evidence produced an Evidence Update on Diabetic Foot Problems.  This is the first Evidence Update produced by NICE in the area of diabetes.  Hopefully more will follow as they are useful tools in keeping track of new research.


The NHS Evidence team searched key bibliographic databases for new RCTs and systematic reviews published between 24th February 2010 and 1st October 2012.

24 publications were found and included in the Evidence Update.  These articles were critically appraised by an information specialist and reviewed by a team of clinical experts.


The evidence update includes new evidence on:

  • Patient information and support
  • Initial examination and assessment
  • Investigation of suspected diabetic foot infection
  • Management of diabetic foot infection
  • Management of diabetic foot ulcers
  • Assessment of suspected limb ischaemia
  • Areas not covered by NICE guidance.

The Update indicates that none of the new evidence is likely to have a substantial impact on existing NICE guidelines (2).  The Update also identified important areas of uncertainty about the effects of treatments.


  • Evidence Updates are carried out in accordance with an explicit method.
  • Although searching encompasses a broad range of important databases, the search terms as reported were very brief and may have missed important evidence.
  • It is not clear whether study selection and critical appraisal was carried out by two blind, independent reviewers.
  • The Update does not state whether there was a risk of bias in the studies.
  • Cochrane and NHS HTA systematic reviews are not critically appraised.


  1. National Institute for Health and Clinical Excellence.  Diabetic foot problems:  Evidence Update March 2013.
  2. National Institute for Health and Clinical Excellence.  Diabetic foot problems – inpatient management (CG119), March 2011
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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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