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In the context of a nationwide outcomes research program on Type 2 diabetes, we investigated physician and patient practices related to foot care. Patients filled in a questionnaire investigating whether they had received information about foot care, how often they had had their feet examined in the last year, and how often they usually checked their feet. Analyses were adjusted for patient case-mix and physician-level clustering. Overall, 3564 patients were recruited by 125 diabetes outpatient clinics (DOCs) and 103 general practitioners (GPs), of whom 6.8% suffered form lower limb complications. The presence of foot complications was correlated with insulin treatment, cigarette smoking, low levels of school education, and the presence of other diabetic complications. More than 50% of the patients reported that they had not had their feet examined by their physician and 28% referred that they had not received foot education. Patients with lower levels of school education and income, as well as overweight individuals, were less likely to receive foot education. Physicians tended to perform foot examination more often in males, low-income patients, those with foot complications, and those treated with insulin, but not in patients with the highest risk of foot complications, that is, those with diabetic neuropathy or peripheral vascular disease (PVD). GPs tended to perform foot examination less frequently than diabetologists do. Foot self-examination was not performed by 33% of the patients. Those individuals who had received foot education or had had their feet examined were more likely to check their feet regularly. A substantial proportion of Type 2 diabetic patients is not offered adequate foot care, even in the presence of major risk factors for lower limb complications. Patient knowledge and practices are strongly related to physicians' attitudes.
AIMS AND OBJECTIVES: The aim of the current study was to present the outcome of clinical nurse performed foot examinations in a group of Tanzanian diabetic patients and make comparisons with matched Swedish patients. BACKGROUND: Nurses working with diabetic patients in any country need to be familiar with foot problems in diabetic patients to educate patients about foot care.
DESIGN: A comparative study examining diabetic patients in Tanzania and Sweden with a quantitative approach. METHOD: One hundred and forty-five diabetic patients in each country were examined. They were matched in gender and age. All patients responded verbally to questions about individual foot-care and underwent clinical foot examination concerning existing foot lesions, sensitivity testing using Semmes-Weinstein monofilament (5.07) and, vibratory perception using a tuning fork (128 Hz).
RESULTS: The Tanzanians had more reported foot problems than the Swedes. The latter reported problems due to poorly fitting footwear whilst the Tanzanians reported pain issues of the feet irrespective of footwear. In the Tanzanian group 37 patients presented with peripheral neuropathy (PN), 13 with peripheral vascular disease (PVD) and six had both PN and PVD. In the Swedish group of patients four had PN, three PVD, but none had both PN and PVD. Only 20 Tanzanians reported carrying out self-inspections of their feet, while 103 Swedes reported doing so.
CONCLUSIONS: Nurse performed foot examinations showed that the Tanzanian diabetic patients in this study had poorer foot status than the Swedish study sample.
RELEVANCE TO CLINICAL PRACTICE: Knowledge about foot problems in diabetic patients worldwide will hopefully improve education about self foot-care and therefore decrease incidence of foot lesions and other foot problems in this cohort.
Re: Are Type 2 diabetic patients offered adequate foot care?
In response to are Diabetics getting adequate foot care?
I work daily with patients who have diabetes daily and we try our best to encourage the following health care providers in their care.
Endocrinologist, Podiatist and a Pedorthist.
We also keep literature about all aspect of the disease in our store which they can take with them.
When we see a patient we take off their shoes and sock and I do a thorough exam, them speak with them about any problem areas we may have discovered.
They are advised on how to wash and dry their feet, not to walk around barefooted at home.
For the most part 95% are very compliant , however there is that 5% that do not care, they will not wear socks, see a Podiatrist, go to a diabetic class, smoke, drink.
How do we reach them................
Now we are also seeing Juvinelle diabetes on the rise..................