Unreliable HbA1c in anaemia — SCE Endocrinology MCQ

Correct answer: A — A fitted pressure-offloading device with adherence review

The best answer is “A fitted pressure-offloading device with adherence review”. Repetitive plantar pressure perpetuates a neuropathic ulcer, so offloading with a non-removable cast or other appropriate device is a core healing intervention when not contraindicated. “Prescribe antibiotics if clinical infection develops during follow-up” is less appropriate because antibiotics do not improve an uninfected ulcer and create avoidable harms “Recommend unrestricted barefoot walking to improve circulation” is less appropriate because barefoot loading increases trauma and pressure “Use bed rest alone without a fitted offloading plan” is less appropriate because bed rest is impractical and does not provide a safe, individualised ambulatory strategy “Arrange immediate amputation because dressings have failed” is less appropriate because failure of dressings alone does not justify limb loss when the mechanical driver has not been treated

Reference: NICE NG19: Diabetic foot problems — prevention and management. https://www.nice.org.uk/guidance/ng19/chapter/Recommendations