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

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