A study exploring the unmet needs of people with DFUD (MiFoot)
Research type
Research Study
Full title
A qualitative study exploring and understanding the unmet needs of people with diabetic foot ulcer disease (DFUD)
IRAS ID
305316
Contact name
Kamlesh Khunti
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Research Summary
Type 2 diabetes (T2D) is increasingly common. It can lead to unwanted outcomes such as diabetes-related foot ulcer disease (DFUD). DFUD is a patch of broken skin on the foot that can be slow to heal. In the UK there are many people with T2D who live with DFUD. Those who have had DFUD are more likely to experience health problems such heart problems, compared to people with T2D who have never had DFUD. We know little about people with T2D and DFUD and their needs to prevent heart problems.
The study is funded by National Institute for Health Research (NIHR) and Diabetes UK (DUK) under Programme Grants for Applied Research (PGfAR). This study will form part of a wider research programme, the MiFoot programme; an intervention designed and tailored especially, to reduce heart problems in adults with T2D and current/previous DFUD. Study findings will provide guidance to help improve the care that people with T2D and DFUD receive from healthcare professionals.
People eligible to take part are:
Participants with T2D and current/previous DFUD:
The expected study duration is approximately up to 90 minutes per participant. Participant will take part in either one focus group or one, one-to-one interview.HCPs:
The expected study duration is approximately up to 30 minutes per participant. Participant will take part in one, one-to-one interview.The study will be conducted at secondary care sites. Participants can be identified through primary and secondary care organisations.
Summary of Results
The problem: Adults with type 2 diabetes and diabetes-related foot ulcers (DFUs) are more likely to have problems with their heart, which can lead to events such as a heart attack or stroke. This is also known as cardiovascular disease. They are also more likely to experience anxiety or depression, which can negatively affect their quality of life. At present, we do not know about the current needs of people with type 2 diabetes and DFUs, and this is needed to improve the care and support they receive from healthcare professionals.
What we did: We conducted interviews with 25 people living with type 2 diabetes who had a current or previous DFU. In the interviews we explored their views and experiences of living with these conditions. We also asked about the DFU care they have received from healthcare professionals, and how they felt about it. Interviews were also conducted with 20 healthcare professionals who provide care and treatment to people with type 2 diabetes and DFUs. In these interviews we explored their views and experiences of providing DFU and CVD care. We also asked what they felt helped or prevented them from providing care. All the interviews were held in person, on the telephone, or over video call.
What we found: We found that many people with type 2 diabetes did not know that DFUs were a complication of diabetes. This meant they were often surprised or shocked when they got their DFU diagnosis. People with DFUs wanted more information and education from healthcare professionals to make people more aware of DFUs. We also found that DFUs affected people’s behaviours. Some people made positive changes to their health after they were diagnosed. For example, they ate healthier foods because they wanted to improve their health and prevent further ulcers. In contrast, other people engaged with behaviours which negatively affected their health. For example, they ate more unhealthy foods. This was because they felt anxious about recovery, or bored because they couldn’t walk around with a DFU. We found that some people with DFUs were not able to follow healthcare advice to help their ulcer heal. This was often because the advice was not suited or specific to their needs. For some people, living with DFUs also affected their mental health. However, the availability of psychological support services was based on where the services were located. Overall, participants felt that there was a lack of support available in many areas. In addition, DFUs could also affect people’s physical health. For example, because some people with a DFU were advised to rest their foot for long periods of time, sometimes they would experience problems with their muscles. Our findings also suggested that we need suitable support to help people with a DFU maintain their physical health. We found that it would help to have suitable exercise programmes that are available during periods where people are advised not to put weight through their feet.
We found that people with type 2 diabetes were unaware of the link between diabetes-related foot ulcers and cardiovascular disease. Healthcare professionals identified a number of barriers and facilitators to providing cardiovascular care to people with DFUs. The barriers included a lack of time, a lack of resources, and a lack of skills. Specifically, there were no guidelines to follow to help them provide appropriate cardiovascular care to people with type 2 diabetes and DFUs. Many of the HCPs also felt they did not know enough about cardiovascular disease to confidently talk about it with patients. This was because many of the healthcare professionals we spoke to were specialists in foot care. The facilitators to providing cardiovascular care included more time, training to improve knowledge and skills, and evidence-based guidelines to follow. Healthcare professionals also wanted to improve communication with General Practice surgeries and other healthcare professionals with good cardiovascular disease skills and knowledge.
What does this mean: People with type 2 diabetes want and need improved education about DFUs and how they are linked to type 2 diabetes. They also need support with changing their behaviours to improve their health and help their ulcer heal. Healthcare professionals can help with this by designing treatment plans alongside the person with DFU. This will ensure they are suited to each person’s individual needs. People with DFUs also need improved access to psychological support and specialist physical activity support which is tailored to their needs.
The barriers and facilitators identified by healthcare professionals are a starting point for improving cardiovascular knowledge and care for people with type 2 diabetes and DFUs.
REC name
London - Brent Research Ethics Committee
REC reference
22/PR/0272
Date of REC Opinion
27 May 2022
REC opinion
Further Information Favourable Opinion