The prevalence of diabetes mellitus in Norway has risen from 2.5 % in 2005 to 3.2 % in 2011 (1). Foot ulcers are not uncommon in persons with diabetes; two Norwegian studies show that 7 – 10 % of these have had diabetic foot ulcers (2, 3). Diabetic foot ulcers are defined as ulcers below the ankle due to reduced capillary and/or arterial circulation, neuropathy and foot deformities (4). A number of studies show that persons with diabetic foot ulcers report reduced quality of life, that the ulcers contribute to increased morbidity, and are a marker for excess mortality (5, 6). In Norway, 400 – 500 below-the-knee amputations are performed each year as a result of diabetic foot ulcers (7).
According to national and international recommendations, diabetic foot ulcers should be treated by specialised interdisciplinary diabetic foot ulcer teams (8–11). However, these teams are not statutory. Interdisciplinary foot ulcer teams consist of persons with different clinical competencies who collaborate to treat these foot ulcers (12, 13).
The main responsibility of the foot ulcer team is to undertake ulcer treatment through ulcer revision, pressure relief, initiation of antibiotic treatment, measures associated with re-establishment of arterial circulation, and optimisation of blood glucose (8). This is deemed to enable a more systematic treatment of diabetic foot ulcers, a shorter period of healing, and fewer amputations resulting from foot ulcers (14–16).
The teams are assumed to be effective in terms of cost-benefit (17). It is recommended that the foot ulcer teams have both medical and surgical competence, and that clear routines for referral to the teams are in place (8–11). Use of the Noklus diabetes patient records and a structured ulcer classification system, for example the Site, Ischaemia, Neuropathy, Bacterial Infection, Area and Depth (SINBAD) system, are recommended to ensure prevention, follow-up and treatment of diabetic foot ulcers (8). Information stored in the Noklus diabetes patient records is also important for reporting to the national quality register, the Norwegian diabetes register for adults, in order to provide an overview of the quality of diabetes treatment in Norway.
No overview exists of diabetic foot ulcer teams in Norway, the clinical competence that they possess, or the treatment options they provide to patients with diabetic foot ulcers. This renders it difficult to ensure that this patient group receives optimal health care. The purpose of this study was therefore to identify diabetic foot ulcer teams in the specialist health service in Norway, and survey the clinical competence, organisation and work routines of these teams.