Registered Nurses' Association of Ontario


  • Diabetes mellitus is a serious and complex life-long condition affecting 8.3% of the world’s population and 2.7 million Canadians. 
  • 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.
  • Diabetic foot ulceration and amputation are a result of complications of diabetes such as peripheral arterial disease (PAD) and neuropathy (see Figure 1).
  •  While the majority of ulcers eventually heal, approximately one third may result in some form of amputation. Moreover, there is a possibility of infection occurring in any foot ulcer in a person with diabetes.
  • Diabetic foot infections require medical attention ranging from minor (e.g., debridement, antibiotics) to major (resection, amputation) intervention.
  • 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).
  • The Canadian Association of Wound Care Wound Bed Preparation framework is helpful in outlining the key clinical symptoms and issues related to diabetic foot ulcers and approaches to management utilizing the above principles of VIPs (Botros et al., 2010). This framework is presented in Figure 2 (click here to see Figure 2).
Chronic Disease
Assessment and Management of Foot Ulcers for People with Diabetes - Second Edition
Background Information