Environmental sustainability of offloading care pathways for people with a diabetes-related foot ulcer: a life-cycle assessment

Abstract Aims/hypothesis Insights into the environmental impact of diabetes care are scarce and are absent regarding treatments for diabetes-related foot disease. We aimed to compare the environmental impacts of three offloading pathways for people with a plantar foot ulcer. Methods We performed a bottom-up, process-based life-cycle assessment according to ISO standards. We defined three evidence-based offloading pathways from first visit to healing: total contact cast (TCC), non-removable walker and removable walker. Inventory data were collected for all activities within scope (materials, waste, transport, energy consumption). Life-cycle assessment was performed using ReCiPe-2016 midpoint and endpoint methods, employing SimaPro and Ecoinvent 3.10. Monte Carlo simulation with 1,000,000 individuals provided the environmental impact per offloading pathway. Results Environmental impact was lowest for the removable walker pathway and highest for the TCC for all 18 midpoints and five endpoints. For global warming, the mean impact was 141 kg CO 2 -equivalents (CO 2 -eq) (SD: 88; 95% prediction interval 67, 377) for the TCC pathway, 108 kg CO 2 -eq (SD: 62; 95% prediction interval 59, 276) for the non-removable walker and 90 kg CO 2 -eq (SD: 57; 95% prediction interval 36, 244) for the removable walker. The largest environmental impact came from patient transport (59–78% of all impact per pathway in CO 2 -eq). Conclusions/interpretation Diabetes-related plantar foot ulcer treatment pathways with a walker are likely to result in lower environmental impact compared with the TCC pathway, with the lowest impact for the removable walker pathway. This resulted from using a single device (i.e. no replacements required) and, for the removable walker, fewer visits, despite longer time to healing. Taking environmental impact into account may alter clinical decision-making in offloading treatment.