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

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Section 13: Diabetes Foot ProblemsIssueWhat are the socioeconomic influences on diabetes foot problems?RecommendationThe influence of socioeconomic factors should be considered in the prevention andmanagement of diabetes foot problemsEvidence Statements• Socioeconomic factors influence the occurrence of diabetes foot problemsEvidence Level III-296
Background - Socioeconomic considerationsDiabetic foot problems are a major cost to the health care system. The most commonreason for hospital admission for diabetes is a diabetic foot complication (Young et al,1993a). The DiabCost Australia study (Colagiuri et al, 2003) showed thathospitalisation and complications were the major cost drivers in people with Type 2diabetes.Socioeconomic factors are important barriers to diabetes care. Factors which mayinterfere with self care include financial difficulties, priorities resulting from anindividual with diabetes having family caretaker role and responsibilities, housing andfamily problems. While these may apply to any person with diabetes, they are morelikely to apply to a person with a lower socioeconomic status. These barriers havebeen shown to result in reduced physical and social functioning, and reduced physicaland mental health in people with diabetes (Hill-Briggs et al, 2002). Also the greaterthe number of socioeconomic barriers the greater the effect (Hill-Briggs et al, 2002).While these barriers can have a direct effect on diabetes care eg not being able toafford medications or attend services, they may also operate through an indirecteffect. One study showed that when significant socioeconomic barriers were present,77% of intervention visits were used to address these non-diabetes specific issues,which reduced the focus on diabetes care as a priority (Batts et al, 2001).Evidence - Socioeconomic considerationsSocioeconomic factors influence the occurrence of diabetes foot problemsFew studies were identified which specifically addressed this issue in relation to footproblems in people with diabetes and further research is required in this area. Someindirect information is contained in the following studies.Weng et al (2000) examined environmental factors which affect diabetes outcome. Acohort of 610 people living within the Greater London boundary and having their firstdiabetes clinic visit at St Thomas hospital in 1982-85 was analysed in 1995. Out of610 people, 186 had died, 332 were re-examined in the clinic and 92 were unable tobe traced. Social deprivation was ranked according to the Jarman ‘under-privilegedarea’ (UPA) score. People were allocated according to the UPA score - >30 wasclassified as a deprived area and a score
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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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side; and 82% having the same resul
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
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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 94 and 95: Summary - Economic consequences•
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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
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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