Service Implications for Diabetic Foot Disease

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Prevalence of Diabetic Foot Disease in the Waikato

This is the first prevalence study carried out in New Zealand on early diabetic foot disease. Up until now there has been no expansive data on diabetic foot disease to help in the future planning of primary or secondary care diabetes foot care services. This research project represents the diabetes population within the Waikato Region and we believe is reflective of the New Zealand diabetes population in age, ethnicity and type of diabetes. The results from this prevalence study of diabetic foot disease has shown that 65% of people are categorised as low risk, 22% as moderate risk, 13% as high risk and 1% of this high risk group are in the active risk category. In 2011 the Scottish foot action group published the Scottish data, which screened 61% of its diabetes population. They identified low risk 69%, moderate risk 20%, high risk 11% and active 4% of the high risk population (Leese et al., 2011), which is similar to the data gathered from this research project.

Clinical Presentation of Diabetic Foot Disease

Peripheral Diabetes Neuropathy. The 10g monofilament and the tuning fork 128Hz were both used to identify peripheral neuropathy. There was no difference in the results between the research assistant and lead researcher when using the monofilament or tuning fork. Ten percent of the total screened population could not detect the 10g monofilament, however within the moderatehigh risk group, 30% of the group were unable to detect the 10g monofilament. The 10g monofilament is a tool commonly used to identify peripheral neuropathy, however the results of non-detection varied across different prevalence studies Abbott et al. (2002) 19.7%, Malgrange et al. (2003) 27.1% and Kärvestedt et al. (2011) 15%. The possible reasons for the discrepancies across all the studies are the populations from the earlier studies are over ten years old. Diabetes care and education has improved in this time. The Malgrange et al. (2003) study which had the highest result for the 10g monofilament, did not discuss any training for the multiple health professionals using this tool nor did it discuss inter-rater reliability

Service Implications for Diabetic Foot Disease

The uptake of screening was an identified issue. Some eligible participants chose not to participate because they had their feet screened in general practice, as part of their diabetes annual review. Although eighty-five percent of people reported having had a diabetes annual review in general practice, 45% of them did not receive a foot screen at the same time. This is similar to Daly et al. (2014) who identified that nurses in primary care were not routinely carrying out a foot screen for people with diabetes. This finding raises the question of how do you make the foot screen a compulsory component of the diabetes annual review? It is important to engage the person with diabetes to empower them firstly to ask about their feet being checked and secondly to help them understand why they need to have it done. A diabetes annual review is an important factor in ensuring people stay in the low foot risk category. Another imperative factor is that their diabetes management is reviewed not only at the annual review, but whenever a visit is made to their general practice. This would be a good opportunity for general practice to provide health promotion focused education to the individual.

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Recommendations for Future Research in Diabetic Foot Disease

This study highlights many opportunities for future research in the area of diabetic foot disease. The current thesis is the first of its kind in New Zealand looking at prevalence of diabetic foot disease. Therefore, it would be worth attempting to replicate the findings of this study within other regions of New Zealand to see if similar results are found. An extension of this study would be to replicate this prevalence study in a diabetes population with eye disease (e.g. those who attend the specialist eye clinic). It is hypothesised that a majority would have a high risk foot with an active foot ulceration. It would be of interest to compare the results of age, type of diabetes, duration, gender and ethnicity to the current study. This would identify if there are any significant differences between the general diabetes population in primary care and those with diabetic eye disease that are more likely to be reviewed in secondary care.

This research project has demonstrated that screening for foot complications is important.

With the increasing number of people with diabetes, the presence of foot complications is likely to continue. There needs to be more podiatry services made available, as what currently exists is likely insufficient for the now identified need. More resources also need to be put in place to empower the person with diabetes to understand the concern of diabetic foot disease. Future planning needs to include effective foot screening which has been shown through this project to be easy to perform. “In the past, the foot was the Cinderella in diabetes care and diabetes research, but this relative neglect, by both doctor and patient, has clearly changed in the last decades”, (Schaper, 2012).

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