The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study

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Authors: Perrin BM, Allen P, Gardner MJ, Chappell A, Phillips B, Massey C, Skinner I, Skinner TC.
Publication: Journal of Foot and Ankle Research
Year: 2019

Background: 

There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia.

Methods: 

Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis.

Results: 

Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86).

Conclusions: 

A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.

  • Listing ID: 9159
  • Author/s: Perrin BM, Allen P, Gardner MJ, Chappell A, Phillips B, Massey C, Skinner I, Skinner TC
  • Publication: Journal of Foot and Ankle Research
  • Year: 2019
  • Volume: 12
  • Start Page: Article Number 56
  • Article Keywords: Australia; Diabetes; Diabetic foot; Models of care; Podiatry