Title: Amputation Prevention Initiative in South India
Authors: : R. Ambady , MD, PHD, DSC, FRCP, S. Chamukuttan, MSC, DSC, S. Madhavan, BSC, S. Rajasekar, BA, and V. Viswantathan, MD, PHD
Source: Diabetes Care Volume 28, Number 5: 1019-1021. May 2005.
PODIATRIC RELEVANCE:
Podiatrists are faced with diabetic patient care on the daily basis. Many of the podiatric emergency cases have to deal with diabetes. Diabetic foot problems are important co-factors to the high morbidity and mortality observed in diabetic patients. Not only in the United States is diabetes a prevalent disease, but also in South India. This article explores the positive impact of foot care education amongst diabetics in South India in order to prevent amputations.
METHODS:
A prospective study which included 4,872 consecutive type 2 diabetic patients. These participants were categorized into three study groups. Group 1 included subjects with diabetes and neuropathy (n=2,871); group 2 included subjects with diabetic neuropathy and deformity ( n=235); and group 3 consisted of subjects with diabetic neuropathy with deformity and foot ulceration or peripheral vascular disease(n=1,766). The patients were categorized as high-risk subjects according to the International Consensus on the Diabetic Foot. Neuropathy was diagnosed by biothesiometry. The diagnosis of peripheral vascular disease was noted as an ankle brachial index <0.8. The presence of active foot ulceration was determined by a foot examination. All subjects were educated regarding diabetic foot disease and its complications. These patients were given individual counseling in the presence of family members and educated regarding regular foot examination. Family members were requested to help support the patient in proper foot care and examination. Handouts were given as well as pictures showing foot infection, ulcers, and amputations to stress importance of proper foot care.
RESULTS:
Amongst the 4,872 patients, 3,245 (67%) were available for follow-up. There were 1,837 of 2,871 (64%) from group 1; 149 of 235 (63%) from group 2; and 1,259 of 1,766 (71%) from group 3. Among the group 3 patients who attended the follow-up visits, 718 (57%) strictly followed the given advice and 541 (43%) did not. Ulcers present during recruitment had healed in 585 of the 718 (82%) subjects who followed the advice, but in only 269 of the 541 (50%) subjects who did not. A larger proportion of subjects who did not follow the advice developed new problems (26%) and needed surgical intervention (14%) compared to those who followed the advice (5% and 3%).
COMMENTS:
The treatment of many diabetic foot problems is an important concept in our specialty . Active rapport and education with patients can help significantly with the overall healing of many foot ailments. This article demonstrates that family members can contribute greatly to the education of diabetic patients. With the advice of podiatrists, it is possible to improve foot care practices. The article also encourages podiatrists to keep a plethora of literature for patients and their family members. The more education a patient has about their problems, the easier it is for them to better understand the seriousness of following up with a podiatrist. This is one of many studies showing the beneficial effects of foot care education.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.