A national foot screening indicator: an opportunity to address diabetes-related foot disease and improve equity in Aotearoa New Zealand

Michele Garrett; Rinki Murphy; Timothy Kenealy

doi:10.1071/HC25038

RESEARCH ARTICLE (Open Access)

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A national foot screening indicator: an opportunity to address diabetes-related foot disease and improve equity in Aotearoa New Zealand

Michele Garrett

¹ ² ^* , Rinki Murphy ¹ ² ³ , Timothy Kenealy

⁴

+ Author Affiliations

- Author Affiliations

¹ Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 28 Park Avenue, Grafton, Auckland 0123, New Zealand.

² Te Whatu Ora|Health New Zealand, Te Toka Tumai Auckland, 35 Park Road, Grafton Private Bag 92024, Auckland, New Zealand.

³ Te Whatu Ora|Health New Zealand, Counties Manukau, 100 Hospital Road, Otahuhu Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.

⁴ Department of General Practice & Primary Health Care, School of Population Health, University of Auckland, Building 507, 28 Park Avenue, Grafton, Auckland 0123, New Zealand.

^* Correspondence to: michele.garrett@auckland.ac.nz

Journal of Primary Health Care https://doi.org/10.1071/HC25038

Submitted: 8 March 2025 Accepted: 21 May 2025 Published: 18 June 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

References

1 Lazzarini PA, Raspovic KM, Meloni M, et al. A new declaration for feet’s sake: halving the global diabetic foot disease burden from 2% to 1% with next generation care. Diabetes Metab Res Rev 2024; 40(3): e3747.
| Crossref | Google Scholar | PubMed |

2 Chen L, Sun S, Gao Y, et al. Global mortality of diabetic foot ulcer: a systematic review and meta-analysis of observational studies. Diabetes Obes Metab 2023; 25(1): 36-45.
| Crossref | Google Scholar | PubMed |

3 Teng A, Stanley J, Krebs J, et al. Projected increases in the prevalence of diabetes mellitus in Aotearoa New Zealand, 2020–2044. N Z Med J 2025; 138(1608): 94-106.
| Crossref | Google Scholar | PubMed |

4 O’shea C, McClintock J, Lawrenson R. The prevalence of diabetic foot disease in the Waikato region. Diabetes Res Clin Pract 2017; 129: 79-85.
| Crossref | Google Scholar | PubMed |

5 Te Tāhū Hauora (Health Safety and Quality Commission). Atlas of Healthcare Variation. Diabetes; 2021. Available at https://www.hqsc.govt.nz/our-data/atlas-of-healthcare-variation/diabetes/ [updated 2 July 2024].

6 Gurney JK, Stanley J, York S, et al. Risk of lower limb amputation in a national prevalent cohort of patients with diabetes. Diabetologia 2018; 61(3): 626-35.
| Crossref | Google Scholar | PubMed |

7 Carinci F, Uccioli L, Massi Benedetti M, et al. An in-depth assessment of diabetes-related lower extremity amputation rates 2000–2013 delivered by twenty-one countries for the data collection 2015 of the Organization for Economic Cooperation and Development (OECD). Acta Diabetol 2020; 57(3): 347-57.
| Crossref | Google Scholar | PubMed |

8 McDermott K, Fang M, Boulton AJM, et al. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers. Diabetes Care 2023; 46(1): 209-21.
| Crossref | Google Scholar | PubMed |

9 Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med 2017; 49(2): 106-16.
| Crossref | Google Scholar | PubMed |

10 Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40(3): e3651.
| Crossref | Google Scholar | PubMed |

11 Sibbald RG, Ayello EA, Alavi A, et al. Screening for the high-risk diabetic foot: a 60-second tool (2012)©: diabetes. Wound Healing Southern Africa 2012; 5(2): 72-82.
| Crossref | Google Scholar |

12 Payne CB. Health services planning and the diabetic foot. The Foot 1997; 7(3): 159-65.
| Crossref | Google Scholar |

13 Pallin JA, Van Netten JJ, Kearney PM, et al. Do we screen, examine or assess to identify the “at-risk” foot in diabetes-time for agreed terms and definitions? Diabet Med 2023; 40(1): e14976.
| Crossref | Google Scholar | PubMed |

14 Pallin JA, Connell L, Mcintosh C, et al. Evaluating and mapping the evidence that screening for diabetic foot disease meets the criteria for population-wide screening: a scoping review. BMJ Public Health 2024; 2(1): e000561.
| Crossref | Google Scholar | PubMed |

15 Monteiro-Soares M, Vale-Lima J, Martiniano J, et al. A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation. J Diabetes Complications 2021; 35(4): 107837.
| Crossref | Google Scholar | PubMed |

16 Crawford F, Nicolson DJ, Amanna AE, et al. Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data. Diabetologia 2020; 63(1): 49-64.
| Crossref | Google Scholar | PubMed |

17 Jeffcoate WJ, Vileikyte L, Boyko EJ, et al. Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care 2018; 41(4): 645-52.
| Crossref | Google Scholar | PubMed |

18 Kuhnke J, Botros M, Elliot J, et al. The case for diabetic foot screening. Diabetic Foot Canada 2013; 1(2): 8-14.
| Google Scholar |

19 Formosa C, Gatt A, Chockalingam N. A critical evaluation of existing diabetic foot screening guidelines. Rev Diabet Stud 2016; 13(2, 3): 158-86.
| Crossref | Google Scholar | PubMed |

20 Albright RH, Manohar NB, Murillo JF, et al. Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: a systematic review & meta-analysis. Diabetes Res Clin Pract 2020; 161: 107996.
| Crossref | Google Scholar | PubMed |

21 Paisey RB, Abbott A, Paisey CF, et al. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med 2019; 36(11): 1424-30.
| Crossref | Google Scholar | PubMed |

22 NHS Digital. National Diabetes Foot Care Audit - 2014-2017; 2018. Available at https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/national-diabetes-foot-care-audit-2014-2017 [cited 14 February 2019].

23 Ministry of Health. Quality standards for Diabetes Care 2020 Wellington; 2020. Available at https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/diseases-and-conditions/long-term-conditions/diabetes/quality-standards-for-diabetes-care-2020 [updated 10 January 2024, cited 15 January 2025].

24 New Zealand Society for the Study of Diabetes (NZSSD). Type 2 Diabetes Management Guidelines NZSSD; 2025. Available at https://t2dm.nzssd.org.nz/Home.html

25 Daly B, Arroll B, Nirantharakumar K, et al. Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand. N Z Med J 2020; 133(1527): 39-50.
| Google Scholar | PubMed |

26 Simmons D, Fleming CE, Cutfield R, et al. The Diabetes Care Support Service for general practitioners in Auckland. N Z Med J 1997; 110(1038): 48-50.
| Google Scholar | PubMed |

27 Garrett M, Cutfield R. The relationship between podiatry services and lower limb amputation rates within the Waitemata DHB 2004-2006. Christchurch: NZSSD Annual Scientific Meeting; 2007.

28 Tomlin A, Tilyard M, Dawson A, et al. Health status of New Zealand European, Maori, and Pacific patients with diabetes at 242 New Zealand general practices. N Z Med J 2006; 119(1235): U2004.
| Google Scholar | PubMed |

29 Chepulis L, Morison B, Keenan R, et al. The epidemiology of diabetes in the Waikato region: an analysis of primary care data. J Prim Health Care 2021; 13(1): 44-54.
| Crossref | Google Scholar | PubMed |

30 Clendon J, Carryer J, Walker L, et al. Nurse perceptions of the Diabetes Get Checked Programme. Nurs Prax N Z 2013; 29(3): 18-30.
| Google Scholar | PubMed |

31 Te Whatu Ora Health New Zealand. Virtual Diabetes Register and Web Tool; 2024. Available at https://www.tewhatuora.govt.nz/for-health-professionals/data-and-statistics/virtual-diabetes-tool/

32 Ministry of Health. Diabetes and cardiovascular disease quality improvement plan. In: Ministry of Health, editor. Wellington: Ministry of Health NZ; 2008

33 Garrett M. From random acts of treatment to integrated diabetes podiatry care; Unpubl. report prepared for NZ Ministry of Health; 2010.

34 Patients First. Diabetes foot screening guidelines decision support tool stocktake. Unpubl. report prepared for NZ Ministry of Health; 2016.

35 Garrett M, York S, O’Shea C, et al. Diabetes foot screening and risk stratification tool - 2017 Update. New Zealand: New Zealand Society for the Study of Diabetes; 2017

36 Garrett M, Gamble E, Gray S, et al. Improving foot care services Auckland and Waitemata District Health Boards Long Term Conditions. Wellington, New Zealand: Healthify; 2019.

37 Vlacho B, Bundó M, Llussà J, et al. Diabetic foot disease carries an intrinsic high risk of mortality and other severe outcomes in type 2 diabetes: a propensity score-matched retrospective population-based study. Cardiovasc Diabetol 2024; 23(1): 209.
| Crossref | Google Scholar | PubMed |

38 Gallagher KA, Mills JL, Armstrong DG, et al. Current status and principles for the treatment and prevention of diabetic foot ulcers in the cardiovascular patient population: a scientific statement from the American Heart Association. Circulation 2024; 149(4): e232-53.
| Crossref | Google Scholar | PubMed |

39 Heggie R, Chappell F, Crawford F, et al. Complication rate among people with diabetes at low risk of foot ulceration in Fife, UK: an analysis of routinely collected data. Diabet Med 2020; 37(12): 2116-23.
| Crossref | Google Scholar | PubMed |

40 Chappell FM, Crawford F, Horne M, et al. Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies. BMJ Open Diabetes Res Care 2021; 9(1): e002150.
| Crossref | Google Scholar | PubMed |