The iDEAL (Insights for Diabetes Excellence, Access and Learning) group has put forward a series of recommendations to improve foot care and education, and to reduce the number of major amputations in people with diabetes. The acronym ACTNOW has been devised to help recognise the warning signs that might lead to amputation which, if identified, should activate urgent referral to specialist care provided by multidisciplinary diabetic foot teams (MDFTs). There should be clarity of referral pathways in primary care to promote rapid access to MDFTs and to facilitate referral of feet at high risk of ulceration to foot protection teams. The iDEAL group has also recommended improved education and blood glucose control and the maintenance of an adequate workforce. If its recommendations are followed, the group believes that a 50% reduction in major amputations among people with diabetes can be achieved within 5 years.
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