Self-awareness of foot health status in patients with Type 2 diabetes: the Fremantle Diabetes Study Phase II

• Published in: Diabetic medicine 2014-11, Vol.31 (11), p.1439-1445
• Main Authors: Baba, M., Foley, L., Davis, W. A., Davis, T. M. E.
• Format: Article
• Language: English
• Subjects: Aged; Ankle Brachial Index; Cohort Studies; Combined Modality Therapy; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - therapy; Diabetic Foot - diagnosis; Diabetic Foot - epidemiology; Diabetic Foot - physiopathology; Diagnostic Self Evaluation; Female; Humans; Longitudinal Studies; Male; Middle Aged; Neuritis - complications; Neuritis - epidemiology; Neuritis - physiopathology; Peripheral Nervous System Diseases - complications; Peripheral Nervous System Diseases - epidemiology; Peripheral Nervous System Diseases - physiopathology; Prevalence; Risk; Severity of Illness Index; Surveys and Questionnaires; Western Australia - epidemiology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12521

Aims To determine self‐awareness of diabetes‐related foot problems and its associates in a community‐based cohort of people with Type 2 diabetes. Methods A survey concerning diabetic foot problems was administered to 358 consecutive patients with Type 2 diabetes [mean ± sd age 67.4 ± 10.8 years, 56.1% males, median (interquartile range) diabetes duration 9.0 (3.9–16.8) years] attending for detailed clinical, biochemical and questionnaire assessment as part of the longitudinal observational Fremantle Diabetes Study Phase II. Results Compared with the 213 patients (59.5%) who considered their feet to be normal, the 145 (40.5%) who considered their feet to be abnormal were older, had longer diabetes duration and were more likely to have sensory neuropathic symptoms and self‐reported poor circulation (P < 0.001). In those who considered their feet to be normal, 67.9% had peripheral sensory neuropathy (score >2/8 on the Michigan Neuropathy Screening Instrument clinical portion), 9.9% had an ankle‐brachial index < 0.9, 6.1% had both peripheral sensory neuropathy and an ankle‐brachial index < 0.90, and 86.9% had one or more features on inspection, such as deformity, dry skin, callus and fissures that could facilitate more serious complications, despite the majority having had at least one foot examination by a healthcare professional in the previous year. Conclusions Self‐assessment of diabetes‐related foot problems by patients in the Fremantle Diabetes Study Phase II was unreliable. The present data suggest that self‐perceived foot health should be assessed together with foot examination findings. Intensive education and monitoring may be necessary in those who consider their feet to be normal but who have neurovascular, structural and/or other precursors of serious foot pathology. What's new? There have been no previous studies that have examined in detail self‐awareness of foot health in Type 2 diabetes. In this community‐based cross‐sectional study, a large majority of patients who considered their feet to be normal had features on inspection such as deformity, dry skin, callus and fissures that could promote more serious complications, even though most had undergone foot examination by a healthcare professional in the previous year. Most patients with self‐reported normal feet also had objective evidence of peripheral sensory neuropathy, and a smaller number of patients had peripheral arterial disease and the combination of neuropathy and arteriopathy. Self‐