Diabetic people with foot ulcers are being given “motivational interviews” under a three-year NHS trial that aims to change patients’ lifestyles and make amputations less likely.
Foot ulcers are a common issue in people with diabetes, with up to a third of patients developing the condition.
About one in eight of these can lead to amputation, data show, and the NHS performs thousands of such operations every year as the ulcers can be fatal.
Scottish scientists have received a grant of almost £300,000 to trial a new psychological approach to try and tackle foot ulcers.
Foot ulcers are caused by a variety of factors including numb feet leading to ulcers and sores, poor-fitting shoes, poor blood-sugar control, and limited blood supply preventing normal healing.
People living with diabetes in poorer areas are up to five times more likely to have foot ulcers, data show, and experts from Glasgow Caledonian University are hoping targeted, person-specific interviews could help people improve their lifestyle to reduce the threat of ulcers.
“Current treatment approaches are not effective. People with diabetes are well informed about their condition but this does not necessarily lead to behaviour change,” said Dr Ruth Barn, who has conducted studies on this issue before and will co-lead the trial.
Improved self-care
“We have developed a new treatment based on motivational interviewing – a way of having a conversation with a person that helps them understand their reasons and barriers to positive lifestyle change, and supports adoption of new behaviours, or stopping unhelpful behaviours, to prevent foot ulcers.
“This approach has previously been successful for people attending services in other areas such as addictions, long-term condition management and weight loss.
“Our aim is to undertake a small trial, comparing motivational interviewing to current care, to find out if a larger trial is possible and worth doing.
“We hope that this intervention could empower people with diabetes and foot ulceration, leading to improved self-care, and reduced ulceration and amputation rates, in the long run.”
The three-year trial is a collaboration with the Greater Glasgow and Clyde, Tayside, Ayrshire and Arran, and Lanarkshire health boards and will be run by Dr Barn, Dr Gordon Hendry and Dr Jodi Binning.
The team have expertise in podiatry, diabetes and motivational interviewing which they hope can stop diabetics suffering the dangerous and painful ulcers.
Dr Binning is podiatry services manager at NHS Ayrshire & Arran and did a PhD on motivational interviewing and found it was effective for patients from poorer areas of Glasgow.
“People involved in the study said that the approach is more individualised and feels different. Of the 17 people who took part, 15 reported positive behaviour changes,” she said.
Dr Hendry added: “While motivational interviewing intervention is focused on behaviour change, the actual outcome we are interested in reducing is the number of ulcers that people develop during that follow up period.
“As little as a 10 per cent reduction in ulceration rate could bring significant cost benefits to the NHS and would be enough to justify a much larger future trial.
“It’s possible that a little bit of behaviour change chosen and driven by patients themselves, with the support of highly trained podiatrists, will have a tangible effect on reducing ulceration and amputation rates in a group that has greater need.”
The £299,751 in funding came from the Scottish Government’s Chief Scientist Office.
A Scottish Government spokesperson said: “Diabetes is a clinical priority for the Scottish Government and by funding this innovative pilot we hope that progress can be made in tackling diabetes-related foot ulceration in some of the country’s most deprived areas.
“We know that diabetes remains a significant health challenge and a leading cause of ill health in Scotland.
“In February 2021, we updated our Diabetes Improvement Plan which sets out our priorities and commitments to improve the prevention, treatment and care for everyone living with diabetes in Scotland.
“The plan contains a specific commitment to support ongoing work to improve outcomes for people with foot disease and we look forward to the outcomes of this important project.”
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
