Standards of Care for Diabetic Foot Ulcers

Standard of Care in Place for Treatment of Diabetic Foot Ulcers in Long-Term Care Patients

Known as “the silent killer” because its symptoms can go undiagnosed until the condition becomes deadly, diabetes mellitus remains a major public health care threat in the United States today. One of the more common afflictions that is suffered by people with diabetes mellitus is foot ulcers, a problem that can result in the need for amputation or even more severe clinical outcomes including death. To determine why there should be a standard of care in place for the treatment of diabetic foot ulcers in long-term care patients, this paper provides a review of the relevant peer-reviewed and scholarly literature, followed by a summary of the research and important findings concerning diabetic foot ulcers in the conclusion.

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Review and Analysis

The Significance of the Problem and How Addressing the Issue will Contribute to Society

There has been growing concern among practitioners in the health care community about the persistent prevalence of diabetes mellitus and on identifying preventive protocols for foot ulcers for patients in long-term care settings (Fidler, 2009). Addressing this problem can contribute to American society by improving the quality of life of foot ulcer sufferers and by reducing the economic toll the condition exacts on the health care system. For instance, during the 2-year period from 1995 to 1997, the number of individuals who were diagnosed with diabetes increased dramatically from 8 million to 10.3 million people (Fidler, 2009). The U.S. Centers for Disease Control & Prevention (CDC) reports that these figures have continued to increase each year since that time (Fidler, 2009). In 1998, there were approximately 15.7 million people (59%) in the United States with diabetes but the CDC also projects that at least another 5.3 million people have diabetes but remain undiagnosed (Fidler, 2009). In this regard, Fidler concludes that diabetes is a “silent killer” that is “of great concern due to the number of complications, including a variety of diabetic foot problems, that can afflict this group of patients” (2009, p. 35).

Impact that Improving this Problem Would Have on Professional Practice

There should be a standard of care in place for the treatment of diabetic foot ulcers in long-term care patients because improving this problem would improve the quality of life for diabetic foot ulcer sufferers and reduce the comorbidities that are associated with the condition (Prentice & Ritchie, 2011). In this regard, Fidler (2009) advises that effective standards of care for the treatment of diabetic foot ulcers can improve the following: (a) the patients’ quality of life, (b) infection control, (c) prevention of amputation, (d) reduction in healthcare costs, and (e) maintaining patient health status. Furthermore, treatment for foot ulcer-related complications can improve patient functionality and increase their self-sufficiency in their daily living activities, thereby reducing the workload on long-term care facility staff (Fidler, 2009).

Significance of the Improvement of Problem for Nursing and Health Care in General

The prevention of foot ulcer-related amputations is an effective way to reduce the costs of the health care staff needed to care for these patients (Fidler, 2009). In fact, reducing the direct costs of health care as well as the indirect costs that are associated with diabetic foot ulcers represents one of the overarching objectives for health care providers and patients alike (Fidler, 2009).

How Addressing this Problem Improves a Current Practice

At present, the medical management of diabetes mellitus cases remains suboptimal in many cases (Ebersole & Hess, 1999). Moreover, Ebersole and Hess (1999) emphasize that standards of care for patients with diabetes mellitus demand rigorous patient oversight. For instance, Ebersole and Hess note that, “Meticulous management of the diabetic is required to reduce the risk of long-term complications and avert acute problems” (1999, p. 278). Current interventions for patients in long-term care facilities at risk of developing diabetes-related foot ulcers include: (a) patient education regarding medications, (b) nutrition, (c) exercise, (d) foot care, (e) stress management, and (f) serum glucose monitoring (Ebersole & Hess, 1999).

The Relationship between the Clinical Problem and Stakeholders

The relationship between clinicians and diabetic foot ulcer sufferers in long-term care facilities is typically intimate, with the health status of most patients being well documented over time. By ensuring that diabetic patients understand the need for preventive care, health care providers can help reduce the prevalence of foot ulcers in this population. In this regard, Fidler concludes that, “By providing proper treatment and education to patients, healthcare professionals can maintain and improve the health status of the diabetic patient. This includes not only proper foot care but education on achieving adequate glycemic control and proper nutrition” (2009, p. 36).


The research showed that there should be a standard of care in place for the treatment of diabetic foot ulcers in long-term care patients because the problem persists and absent effective standards, the millions of diagnosed and undiagnosed patients are at increased risk of having one or more of their feet amputated. Beyond the enormous toll that such an eventuality has on the affected patients, these adverse clinical outcomes also add to the already enormous monetary costs involved in the management of diabetes mellitus in the United States today. In the final analysis, it is reasonable to conclude that the problem will continue to persist unless and until appropriate standards of care are in place in all American long-term care facilities.


Ebersole, P. & Hess, P. (1999). Toward healthy aging: Human needs and nursing response. St.

Louis, MO: Mosby.

Fidler, B.D. (2009, August 19). Diabetic foot care. Drug Topics, 146(16), 34-39.

Prentice, D. & Ritchie, L. (2011, December 1). A case management experience: Implementing best practice guidelines in the community. Care Management Journals, 12(4), 150-155.

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