Registered Nurses' Association of Ontario


  • Diabetes is a serious, life-long condition affecting more than 2 million Canadians. It is the leading cause of death by age, and worldwide the prevalence of diabetes is increasing annually.
  • Diabetes is a disorder manifested by high blood glucose levels that result from defective insulin secretion or insulin action or a combination of both of these problems. There are two major classifications of diabetes.
  • Type 1 diabetes, which affects 10 – 15% of all people with diabetes, is primarily a result of the inability to produce insulin due to beta cell destruction in the pancreas. While Type 1 diabetes accounts for fewer individuals with diabetes, it results in a disproportionately high frequency of diabetes related complications.
  • Type 2 diabetes, affecting over 80% of those diagnosed with diabetes, results from a combination of insufficient insulin production and/or resistance of the cells of the body to the actions of insulin.
  • Regardless of the diabetes type, over time, failure to achieve optimal glycemic control can cause damage to the body’s small and large blood vessels and nerves. This damage can affect the functioning of many body organs and interfere with wound healing. Foot complications continue to be a major cause of morbidity and disability among people with diabetes.
  • In Ontario, the adjusted rates of lower extremity amputation are approximately 20 times higher for people with diabetes than in persons without diabetes 
  • The incidence of foot ulcers in people with diabetes was 2.2% annually, and that past history of foot ulcers or history of amputation was strongly related to future ulcer risk.
  • The sequence of events leading to lower extremity ulceration and amputation in diabetes is a complex process with many factors combining to increase the likelihood that a foot injury or infection will occur and healing will be delayed.
  • The prevention of such traumatic “pivotal” events, together with the early identification and prompt treatment of foot problems can reduce the incidence of foot ulceration and amputation.
  • This can be achieved through a program of risk assessment, self-care education and regular reinforcement of self-care.
  • This guideline recommends that all nurses encourage and support clients who are identified as being at increased risk for foot complications in their efforts to access appropriate, specialized diabetes services for more in-depth assessment and intervention. Diabetes care and education is best provided by a specialized, interdisciplinary team working closely with the clients and their families to address the complex lifestyle, self-care, and multiple treatment demands of diabetes.
  • Risk-reducing foot care is one aspect of diabetes self-management that all nurses can facilitate and positively influence in the quest to reduce foot complications and associated traumatic sequelae in people with diabetes.
  • Recommendations should be considered as part of the holistic approach that is required to promote the health and well-being of the individual with diabetes. Such an approach may involve further interventions including, for example, health teaching regarding glycemic control, promoting physical activity and smoking cessation, and providing other self-management support interventions.
Chronic Disease
Reducing Foot Complications for People with Diabetes
Background Information