Foot care education in patients with diabetes at low risk of complications: a consensus statement

A McInnes, W Jeffcoate, L Vileikyte, F Game, K Lucas, N Higson, L Stuart, A Church, J Scanlan, J Anders, A McInnes, W Jeffcoate, L Vileikyte, F Game, K Lucas, N Higson, L Stuart, A Church, J Scanlan, J Anders

Abstract

Aims: To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications.

Methods: A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts' clinical experience and judgement.

Results: Four main health behaviours were identified for those at low risk of developing foot complications, namely: control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine.

Conclusion: There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications.

© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

References

    1. De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Are Type 2 diabetic patients offered adequate foot care? The role of physician and patient characteristics. J Diabetes Complications. 2005;19:319–327.
    1. Ortegon MM, Redekop WK, Niessen LW. Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care. 2004;27:901–907.
    1. Ragnarson Tennvall G, Apelqvist J. Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations. Diabetologia. 2001;44:2077–2087.
    1. Connor H. Diabetic foot disease—where is the evidence? Diabet Med. 1999;16:799–800.
    1. Kneepkens T, Lincoln T, Radford K, Jeffcoate W, von Fragstein M, Game F. Influence of differing professional opinion on foot care education. Diabetic Foot. 2006;9:14–17.
    1. McInnes A. No consensus between HCPs on diabetic foot care education. Diabetic Foot. 2010;13:29–38.
    1. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32:S13–61.
    1. International Working Group on the Diabetic Foot. Practical Guidelines on the Management and Prevention of the Diabetic Foot. Available at Last accessed 18 November 2009.
    1. NICE. Clinical Guideline 10: Type 2 Diabetes: Management of Foot Problems. 2004. Available at Last accessed 18 November 2009.
    1. De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Physician attitudes toward foot care education and foot examination and their correlation with patient practice. Diabetes Care. 2004;27:286–287.
    1. Del Aguila MA, Reiber GE, Koepsell TD. How does provider and patient awareness of high-risk status for lower-extremity amputation influence foot-care practice? Diabetes Care. 1994;17:1050–1054.
    1. Bell RA, Arcury TA, Snively BM, Smith SL, Stafford JM, Dohanish R, et al. Diabetes foot self-care practices in a rural triethnic population. Diabetes Educ. 2005;31:75–83.
    1. Litzelman DK, Slemenda CW, Langefeld CD, Hays LM, Welch MA, Bild DE, et al. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1993;119:36–41.
    1. Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care. 2006;29:823–829.
    1. Johnson M, Newton P, Goyder E. Patient and professional perspectives on prescribed therapeutic footwear for people with diabetes: a vignette study. Patient Educ Couns. 2006;64:167–172.
    1. Johnson M, Newton P, Jiwa M, Goyder E. Meeting the educational needs of people at risk of diabetes-related amputation: a vignette study with patients and professionals. Health Expectations. 2005;8:324–333.
    1. Vileikyte L. Psychological aspects of diabetic peripheral neuropathy. Diabetes Rev. 1999;7:387–394.
    1. Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathy and its late sequelae. Diabetes Metab Res Rev. 2004;20:S13–S8.
    1. Calle-Pascual AL, Duran A, Benedi A, Calvo MI, Charro A, Diaz JA, et al. A preventative foot care programme for people with diabetes with different stages of neuropathy. Diabetes Res Clin Pract. 2002;57:111–117.
    1. Pollock RD, Unwin NC, Connolly V. Knowledge and practice of foot care in people with diabetes. Diabetes Res Clin Pract. 2004;64:117–122.
    1. Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Pub Health. 1984;74:979–983.
    1. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM. Preventive foot care in diabetes. Diabetes Care. 2004;27:S63–64.
    1. Johnston MV, Pogach L, Rajan M, Mitchinson A, Krein SL, Bonacker K, et al. Personal and treatment factors associated with foot self-care among veterans with diabetes. J Rehabil Res Dev. 2006;43:227–238.
    1. Lincoln NB, Jeffcoate WJ, Ince P, Smith M, Radford KA. Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF) Pract Diabetes Int. 2007;24:207–211.
    1. Perrin BM, Swerissen H, Payne C. The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study. J Foot Ankle Res. 2009;2:3.
    1. Rajan M, Pogach L, Tseng CL, Reiber G, Johnston M. Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement. Prim Care Diabetes. 2007;1:147–153.
    1. Vileikyte L, Gonzalez JS, Leventhal H, Peyrot MF, Rubin RR, Garrow A, et al. Patient Interpretation of Neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care. Diabetes Care. 2006;29:2617–2624.
    1. Vileikyte L. Psychosocial and behavioral aspects of diabetic foot lesions. Curr Diab Rep. 2008;8:119–125.
    1. Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ. Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study. Diabetes Care. 2006;29:1202–1207.
    1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–986.
    1. Gale L, Vedhara K, Searle A, Kemple T, Campbell R. Patients’ perspectives on foot complications in type 2 diabetes: a qualitative study. Br J Gen Pract. 2008;58:555–563.
    1. Barth R, Campbell LV, Allen S, Jupp JJ, Chisholm DJ. Intensive education improves knowledge, compliance and foot problems in Type 2 diabetes. Diabet Med. 1991;8:111–117.
    1. Balamurugan A, Rivera M, Jack L, Jr, Allen K, Morris S. Barriers to diabetes self-management education programs in underserved rural Arkansas: implications for program evaluation. Prev Chronic Dis. 2006;3:A15.
    1. Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care. 2005;11:253–260.
    1. Schmidt S, Mayer H, Panfil EM. Diabetes foot self-care practices in the German population. J Clin Nurs. 2008;17:2920–2926.
    1. Harvey JN, Lawson VL. The importance of health belief models in determining self-care behaviour in diabetes. Diabet Med. 2009;26:5–13.
    1. Persell SD, Keating NL, Landrum MB, Landon BE, Ayanian JZ, Borbas C, et al. Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes. Prev Med. 2004;39:746–752.
    1. Ronnemaa T, Hamalainen H, Toikka T, Liukkonen I. Evaluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. Diabetes Care. 1997;20:1833–1837.
    1. Mudge E, Price P. Risk of diabetic foot ulceration: perception and behavioural change. Diabetic Foot. 2004;7:95–101.
    1. van Houtum WH. Barriers to the delivery of diabetic foot care. Lancet. 2005;366:1678–1679.
    1. Searle A, Campbell R, Tallon D, Fitzgerald A, Vedhara K. A qualitative approach to understanding the experience of ulceration and healing in the diabetic foot: patient and podiatrist perspective. Wounds. 2005;17:16–26.

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