Impact of foot care program implementation in reducing diabetic foot complications among patients attending a single Diabetes Centre

Abstract

Background: Diabetic foot is a serious complication that may result in limb loss. The aim of the study
was to determine the impact of a diabetic foot care and education program on the prevention and outcome
of diabetic foot complications in our main diabetic center in Sudan.
Patients and methods: This is a prospective study performed in Jabir Abu Eliz Diabetic Centre (JADC),
Khartoum, Sudan, from Jan 2009-Dec 2012. The target population was diabetics without foot ulcer attending
the diabetic foot screening and prevention clinic. A total of 624 out of 2500 diabetic patients without foot
ulceration seen in foot care section were randomly selected if they had 4 years or more follow up. Patients
were given a standard education on diabetes control and foot care including tests for both neuropathy and
ischaemia in addition to local foot problems. Patients were followed up regularly every 6 months in the
clinic for a minimal of 4 years.
Results: A total of 624 diabetic patients were contacted. The male to female ratio was 1.2:1. The mean
age was 52 years SD 12 and the age range from 20 to 80 years. The majority of patients (94.2%) were
Type 2 diabetes (n=586). Seventy seven per cent of patients (n=480) had diabetes for more than 5 yrs. More
than half the patients (59.3%) had 4 or more foot care sessions, while the rest had 1-3 session after the
primary assessment. According to Simple Staging System (SSS) most of the patients (71.8%) (n=448) had
at least one risk factor of foot ulceration (neuropathy, ischaemia, callus, deformity and oedema) and 21.8%
were staged as high-risk group with more than one risk factor.
Seventy two per cent of patients (n=449) had one or more of the chronic complications, the major ones
being neuropathy in 56% (n=351), ischemic symptoms in 24% (n=149), nail complication in 23% (n=143),
blisters in 10% (n=62) , callus with a minor hidden foot ulcer in 10% (n=63), foot deformity in 3% (n=19).
The rate of minor toes amputation was 3.5% and major amputation 2.9% (n=18).
Seventy seven per cent of patients claimed that they will seek urgent medical advice if encountered any
foot problem, however only 45.5% did when actually had a minor foot problem. Among several factors
studied to see patient compliance; the higher the level of patient primary education was the most significant
factor (p<0.02) the more educated patients reporting earlier.
Conclusion:Patient education and regular foot care for diabetic were effective in reducing lower extremity
complications, both minor and major lower extremity amputation. There is poor compliance of patients
with follow-up and the main cause of poor compliance was unavailability of nearby service.