Screening and foot care practices among those at risk of foot ulceration: the ausdiab study
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Authors: Tapp,R. J.;Oldenburg,B. F.;Zimmet,P. Z.;Shaw,J. E.
Results: We examined foot screening and care practices among those with previously diagnosed type 2 diabetes and assessed factors associated with regular screening. The Australian Diabetes Obesity and Lifestyle study (AusDiab), is a national, longitudinal study of adults aged â‰¥25 years from 42 randomly selected areas of Australia. Participants identified as having diabetes at baseline (1999-2000) were invited to participate in the complications study at follow-up (2004-2005). Two hundred and ninety three participants completed both the complications survey and diabetes questionnaire at follow-up. Measures included the neuropathy symptom score, neuropathy disability score, monofilament test, postural BP drop, ankle brachial pressure index (ABPI), and a diabetes knowledge questionnaire. At follow-up, 61% of participants reported having their feet examined in the previous year. Of those at high risk of foot ulceration (based on the presence of neuropathy, ABPI<0.9 or history of foot ulceration) 63% reported a health professional had examined their feet in the previous year, 52% reported having seen a podiatrist in the previous 12 months and 65% reported they had examined their feet in the previous week. Logistic regression modeling was used to determine factors associated with regular foot screening. Factors entered into the logistic regression model included type of doctor treating diabetes, diabetes treatment, age, sex, visiting a diabetes nurse educator in the previous 12 months and fasting plasma glucose. The study identified visiting a diabetes nurse educator in the previous 12 months (odds ratio (OR) and 95% confident interval (CI), 3.1 [1.5-6.4]) and type of doctor treating diabetes (specialist care, OR & 95% CI, 2.8 [1.4-5.6] vs GP) as factors associated with regular foot screening. Eighty three percent of those who had seen an educator in the previous 12 months (vs 56% who had not seen an educator) reported a foot examination in the previous year. This study has shown that screening for diabetes related foot complications in Australia remains poor. Diabetes educators and specialist care play a key role in promoting screening for foot complications.