Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus

• Published in: Diabetic medicine 2014-11, Vol.31 (11), p.1468-1476
• Main Authors: Bruun, C., Guassora, A. D., Nielsen, A. B. S., Siersma, V., Holstein, P. E., de Fine Olivarius, N.
• Format: Article
• Language: English
• Subjects: Amputation; Combined Modality Therapy; Cross-Sectional Studies; Denmark - epidemiology; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - therapy; Diabetic Foot - epidemiology; Diabetic Foot - prevention & control; Diabetic Foot - surgery; Female; Follow-Up Studies; Humans; Incidence; Influence; Life Change Events; Male; Middle Aged; Motivation; Patient Compliance; Prevalence; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Self Care; Sex Factors; Ulcers
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12551

Aim To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. Methods This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively. Results Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86–4.00) among 956 patients. General practitioners' indication of ‘poor’ vs ‘very good’ patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22–30.61). The same trend was seen for ‘poor’ vs ‘good’ influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65–18.84). Of 1058 patients examined at 6‐year follow‐up, 45 experienced amputation during the following 13 years. ‘Poor’ vs ‘good’ influence of the patients’ own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40–14.92). When general practitioners assessed the influence of patients’ life circumstances as ‘poor’ vs ‘good’, the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22–7.24). ‘Poor’ vs ‘very good’ patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43–23.57), although not in fully adjusted models. Conclusions General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications. What's new? Despite improved treatment, amputation incidence among people with Type 2 diabetes remains high. Little is known about how patient self‐management in diabetes influences development of foot ulcers and amputations. General practitioners' assessments of poor patient motivation and effort in diabetes management, together with patient life circumstances, are related to higher foot ulcer prevalence and increased amputation risk. General practitioners' existing knowledge of their patients' motivation, effort and life circumstances may be used to identify patients at high risk of amputation.