Effect of a physician-directed educational campaign on performance of proper diabetic foot exams in an outpatient setting

Abstract

BACKGROUND:The established guidelines for a diabetes foot examination include assessing circulatory, skin, and neurological status to detect problems early and reduce the likelihood of amputation. Physician adherence to the guidelines for proper examination is less than optimal.

Factors Contributing to Diabetes Patients Not Receiving Annual Dilated Eye Examinations

“…These ulcers are a common complication of diabetes and a significant cause of morbidity and mortality in the US. 37 Foot ulcers are also the leading cause of non-traumatic amputation. 37 This is consistent with information from the American Diabetes Association: foot ulcerations are most common among men, those with diabetes for more than 10 years, those with poor glycemic control, and those with cardiovascular, retinal or renal comorbidities.…”

“…37 Foot ulcers are also the leading cause of non-traumatic amputation. 37 This is consistent with information from the American Diabetes Association: foot ulcerations are most common among men, those with diabetes for more than 10 years, those with poor glycemic control, and those with cardiovascular, retinal or renal comorbidities. Because of this positive relationship between the presence of foot ulcers and the presence of diabetic retinal manifestations, a link between the timeliness of diabetic foot examinations and diabetic eye examinations was evaluated.…”

Treatment of musculoskeletal infections of the foot in patients with diabetes

“…Regrettably, on routine visits of diabetic patients to the primary care physician, foot examinations are performed in only 14% of cases [66], and even patients admitted for diabetic foot complications are almost never adequately evaluated [23,67]. A simple, low-cost educational intervention for physicians and medical staff significantly improved the adherence to foot examination guidelines for patients with diabetes [66]. Annual, detailed foot examination, including the assessment of protective sensation, foot structure, biomechanics, vascular status, and skin integrity, is necessary to identify high -isk conditions [68].…”

Underdiagnosis of Peripheral Neuropathy in Type 2 Diabetes

“…An annual foot exam, which may include monofilament testing, is recommended by the American Diabetes Association (5). Unfortunately, neuropathy screening is underutilized in primary care practice (6,7). The GOAL A1C (Glycemic Optimization with Algorithms and Labs At Po1nt of Care) study assessed methods of A1C testing and insulin titration monitoring strategies in a large nationwide sample of predominantly primary care patients with type 2 diabetes.…”