Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

• Diabetes mellitus is a serious and complex life-long condition affecting 8.3% of the world’s population and 2.7 million Canadians (Canadian Diabetes Association (CDA), 2010; International Working Group on the Diabetic Foot (IWGDF), 2011; Lipscomb & Hux, 2007).

• There are two major classifications of diabetes, type 1 and type 2:

Type 1 diabetes, also known as insulin-dependent diabetes mellitus (IDDM), affects 10 to 15% of all people with diabetes and is primarily the result of an inability to produce insulin due to beta cell destruction in the pancreas.

Type 2 diabetes, also known as noninsulin-dependent diabetes mellitus (NIDDM), accounts
for 90% of those diagnosed with diabetes and results from a combination of insufficient
insulin production and resistance of the body’s cells to the actions of insulin (CDA, 2010).

• Diabetic foot ulceration and amputation are a result of complications of diabetes such as peripheral arterial disease (PAD) and neuropathy.

• While the majority of ulcers eventually heal, approximately one third may result in some form of amputation (IWGDF, 2011). Moreover, there is a possibility of infection occurring in any foot ulcer in a person with diabetes.

• According to Weir (2010), diabetic foot ulcers should be regarded a medical emergency.

• Principles of clinical management of the person with diabetic foot ulcers involve assessing for: vascular supply (V); infection (I); structural or bony deformities, foot wear and sensation to determine pressure related issues (P); and, sharp debridement of non-viable tissue (s).

Canadian Diabetes Association (2010). Diabetes: Canada at the Tipping Point. Retrieved from http://www.

International Working Group on the Diabetic Foot [IWGDF] (2011). International consensus on the diabetic foot
and practical and specific guidelines on the management and prevention of the diabetic foot 2011. International
Working Group on the Diabetic Foot. Retrieved from

Lipscomb, L.L., & Hux, J.E., (2007). Trends in diabetes prevalence, incidence, and mortality in Ontario Canada
1995–2005: A population-based study. Lancet, 369(9563), 750 – 756.

Weir, G. (2010). Diabetic foot ulcers – evidence-based wound management. CME, 28(40), 76-80.