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    Prevention and Early Intervention for Diabetes Foot Problems

    8. Conclusion

    The staggering human and economic costs of diabetes foot disease may be reduced significantly with increased practice of several simple preventive care measures designed to prevent foot ulcers and lower extremity amputations. Routine annual foot screening facilitates early interventions to reduce the incidence of the most common precipitating events including injury and footwear-related trauma to the insensitive foot. The key elements of preventive care include: annual examination of the feet by health care providers to determine risk factors for ulceration; subsequent exams of high risk feet at each patient visit; patient education about daily self-care of the feet; and careful glucose management. The national health objectives for the year 2000 to decrease the rate of amputation in the population overall, as well as in specific high risk minority groups, serve as a call to action for both health care providers and people with diabetes to make routine diabetes foot care a high priority.

    References

    1. U.S. Department of Health and Human Services: Healthy People 2000. In National Health Promotion and Disease Prevention Objectives. Washington, D.C., U.S. Govt. Printing Office, 1991 (DHHS pub. No. PHS 91-50212).

    2. Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH: Survey of physician practice behaviors related to diabetes mellitus in the U.S. Physician adherence to consensus recommendations. Diabetes Care 16(11):1507-1510, 1993.

    3. Reiber GE, Boyko EJ, Smith DG: Lower extremity foot ulcers and amputations in diabetes. In Diabetes in America. 2nd ed., National Institutes of Health, NIDDK, NIH Pub. No. 95-1468, 1995.

    4. Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S: Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care 19(1):48- 52, 1996.

    5. Lavery L, et al: Lower extremity amputations in San Antonio, Texas. Abstract, 2nd International Foot Conference, Netherlands, 1995.

    6. Nelson RG, Ghodes DM, Everhart JE, Hartner JA, Zwemer FL, Pettitt DJ, Knowler WC: Lower-extremity amputations in NIDDM: 12-year follow-up study in Pima Indians. Diabetes Care 11:8-16, 1988.

    7. Mayfield JA, Rith-Najarian SJ, Acton KJ, Schraer CD, Stahn RM, Johnson MH, Gohdes DM: Assessment of diabetes care by medical record review. The Indian Health Service model. Diabetes Care 17(8):918-923, 1994.

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