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Chronic hyperglycemia has been associated with tissue damage and systemic inflammation, both of which can worsen osteoarthritis symptoms over time

doi: 10.1038/s41467-023-37849-3 173 WuY.JhaR.LiA.LiuH.ZhangZ.ZhangC.et al

Patients should be advised to: Inspect feet daily for injuries, blisters, or colour changes Wear well-fitting footwear and avoid walking barefoot Maintain good foot hygiene and moisturise dry skin (avoiding between toes) Seek same-day assessment by the multidisciplinary foot care service for any new foot wounds, signs of infection, or sudden changes in foot shape Attend annual diabetes reviews incorporating the Nine Care Processes, including foot screening Referral to specialist services is appropriate when: Neuropathic pain remains inadequately controlled despite optimised primary care management Diagnostic uncertainty exists regarding neuropathy aetiology, or features are atypical or rapidly progressive Foot ulceration, infection, or suspected Charcot arthropathy develops (same-day referral to multidisciplinary foot care service per NICE NG19) Severe infection or critical limb ischaemia (emergency hospital admission) Severe autonomic symptoms significantly impair quality of life Patient engagement through diabetes self-management education empowers individuals to optimise lifestyle factors including diet, physical activity, and smoking cessationall contributing to improved metabolic control and reduced complication risk

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