Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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Summary - Economic consequences• Diabetic foot problems are a major cost to the health care system and are the mostcommon reason for hospital admissions for diabetes• The annual total direct cost for amputations in Australia is approximately $A 44million• Peripheral neuropathy and its complications (ulcer, osteomyelitis and amputation)account for 27% of the total direct medical costs of diabetes• The average cost of hospitalisation for treatment of a diabetic foot ulcer was $A12,474 in 1994• In a Belgium study the average cost of preventive care was $A 1,220 comparedwith $A 7,260 for treatment of an ulcer• Intensified foot care prevention and management strategies, such as staged footcare, are cost effective• The total cost for staged foot care was $A 6,630 compared with $A 13,060 forstandard care94
Evidence Table: Section 12AuthorEconomic ConsiderationsLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingBenotmane A (2001)(Adults – France)III-2 Cohort High High + HighGirod I (2003)(Adults – France)III-2 Cross-sectional High High + HighGordois (2004)(Adults – US)III-2 Cross-sectional High High HighHorswell RL (2003)(Adults – US)III-2 Cohort Medium High + HighHoskins (1994)(Adults – Australia)III-2 Cohort Medium High HighKantor J (2001)(Adults – US)III-2 Cohort Medium Medium MediumOrtegon MM (2004)(Adults – TheIII-2 Cohort Medium High + HighNetherlands)Ramsey SD (1999)(Adults – US)III-2 Cohort High High + HighVan Acker K (2000)(Adults – Belgium)III-2 Cohort High High HighFor magnitude rating:+indicates negative effect (or impact) of lower socioeconomic status on diabetic foot disease. High = clinically important &statistically significant; Medium = small clinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 9.95
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National Evidence Based Guidelinesf
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Research OfficersMs Linda SmithPodi
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2.2 Issues for Foot Problems in Typ
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• Aim to achieve the best possibl
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Background - Peripheral Neuropathy
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proportion of subjects with a durat
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and an OR 1.1-7.8. This study also
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Summary - Peripheral Neuropathy as
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Section 2: Diabetes Foot ProblemsIs
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predicting risk of amputation, 2.9
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Summary - Peripheral Vascular Disea
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Evidence - Foot Deformity and Previ
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people with both LJM and neuropathy
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Summary - Foot Deformity and Previo
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Also in the Seattle study, 67 peopl
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Summary - Ulcer as a Risk Factor fo
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The other frequently reported metho
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Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
Page 50 and 51: pulse was bilaterally absent in 1.8
Page 52 and 53: Evidence Table: Section 6AuthorClin
Page 54 and 55: Background - Frequency of Foot Exam
Page 56 and 57: Summary - Frequency of Foot Examina
Page 58 and 59: Section 8: Diabetes Foot ProblemsIs
Page 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
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Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71: In a previous Japanese randomised s
Page 72 and 73: Evidence Table: Section 9AuthorGlyc
Page 74 and 75: Background - Footwear to Reduce Ulc
Page 76 and 77: period. In addition people without
Page 78 and 79: Comparisons of in-shoe foot pressur
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Page 82 and 83: Evidence Table: Section 10AuthorFoo
Page 84 and 85: Background - Foot Clinics and Multi
Page 86 and 87: A prospective non randomised contro
Page 88 and 89: Summary - Foot Clinics and Multi-di
Page 90 and 91: Section 12: Diabetes Foot ProblemsI
Page 92 and 93: and/or osteomyelitis; III - fore-fo
Page 96 and 97: Section 13: Diabetes Foot ProblemsI
Page 98 and 99: Some ethnic groups are associated w
Page 100 and 101: Evidence Table: Section 13AuthorSoc
Page 102 and 103: Calle-Pascual AL, Duran A, Diaz A,
Page 104 and 105: Jannink MJ, van Dijk H, de Vries J,
Page 106 and 107: Moss SE, Klein R, Klein BE. The 14-
Page 108 and 109: Soulier SM, Godsey C, Asay ED, Perr
Page 110 and 111: Diabetes Foot Problems: General Ref
Page 112 and 113: McNeely MJ, Boyko EJ, Ahroni JH, St
Page 114 and 115: Diabetes Foot Problems: Other Refer
Page 116 and 117: Caputo GM, Cavanagh PR, Ulbrecht JS
Page 118 and 119: Garbalosa JC, Cavanagh PR, Wu G, Ul
Page 120 and 121: Lavery LA, Armstrong DG, Wunderlich
Page 122 and 123: Payne C. Regional variations of dia
Page 124 and 125: Tovi J, Svanborg E, Nilsson BY, Eng
Page 126 and 127: Criteria used to determine the suit
Page 128 and 129: QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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