Registed Nurses' Association of Ontario


Nurses have a key role to play in the prevention, treatment and management of diabetes

Did you know that one in four Canadians are living with diabetes, undiagnosed diabetes or pre-diabetes? That’s a finding of the Canadian Diabetes Association (CDA). And, according to the same organization, by 2020, one in three Canadians will be living with diabetes.

In Ontario, as of 2013, roughly 1.3 million people have been diagnosed with this complex chronic illness (the CDA thinks this number could rise to 1.9 million by 2020), which is estimated to cost the health-care system millions annually.

Nurses have a key role to play in the prevention, treatment and management of diabetes. Management of the disease is especially important because diabetes can lead to numerous complications, including kidney, eye and nerve issues.

One of the more troubling complications of this disease is the risk of developing a foot ulcer. In fact, more than 10 per cent of people living with diabetes are likely to face this fate if their condition is left unchecked.

Foot ulcers are sores below the ankle that don’t heal on their own and that increase the risk of infection. If they are left not treated, foot ulcers may lead to amputations. According to the Canadian Institute for Health Information (CIHI), diabetes was linked to more than 2,000 foot amputations from 2011-12, many of which “could have been avoided if proper wound care management and prevention had been in place.”

Complications such as amputations, in turn, lead to lost income, longer hospital stays, and the need for special therapy. Compromised wounds are also burdensome to the health-care system, CIHI says.

RNAO recognizes this as an area for action, and has developed two best practice guidelines (BPG) related to improving care for those with the chronic illness: Assessment and Management of Pressure Injuries for the Interprofessional Team (currently in its third edition) and Reducing Foot Complications for People with Diabetes, which was revised in 2011.

In 2012, Assessment and Management of Foot Ulcers for People with Diabetes was adopted by the Council of the Federation (CoF), which is comprised of Canada’s premiers and territorial leaders. The CoF, acting on advice contained in a report from its Health-Care Innovation Working Group, agreed to implement the guideline across the country. The working group agreed that ulcers and amputations can be prevented with education, monitoring and early treatment.

Consistent care is also vital. To help pave the way for standardized diabetic foot ulcer care, organizations such as St. Joseph’s Health Care Hamilton, Red Cross Care Partners, Kingston’s Hotel Dieu Hospital, London Health Sciences Centre, Richmond Hill’s Mackenzie Health, and Mississauga’s Trillium Health Partners have implemented one (or both) of the BPGs.

Other RNAO guidelines that deal directly with diabetes care include: Assessment and Management of Venous Leg Ulcers, Best Practice Guideline for the Subcutaneous Administration of Insulin in Adults with Type 2 Diabetes, Risk Assessment and Prevention of Pressure Ulcers and Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients.

RNAO believes RNs and other health-care professionals can help lower the number of Canadians living with this chronic disease by arming themselves with up-to-date, reliable information and notifying their patients on how to manage their condition with evidence-based care and know how.