Diabetic foot prevention: a neglected opportunity in high-risk patients.
OBJECTIVE
To evaluate the frequency of foot prevention strategies among high-risk patients with diabetes.


METHODS
Electronic medical records were used to identify 150 patients on dialysis and 150 patients with previous foot ulceration or amputation with 30 months follow-up to determine the frequency with which patients received education, podiatry care, and therapeutic shoes and insoles as prevention services.


RESULTS
Few patients had formal education (1.3%), therapeutic shoes/insoles (7%), or preventative podiatric care (30%). The ulcer incidence density was the same in both groups (210 per 1,000 person-years). In contrast, the amputation incidence density was higher in the dialysis group compared with the ulcer group (58.7 vs. 13.1 per 1,000 person-years, P < 0.001). Patients on dialysis were younger and more likely to be of non-Hispanic white descent (P = 0.006) than patients with a previous history of ulcer or amputation.


CONCLUSIONS
Prevention services are infrequently provided to high-risk patients.
Lavery
Lawrence A
LA
Department of Surgery, Scott and White Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA.
Hunt
Nathan A
NA
Lafontaine
Javier
J
Baxter
Cory L
CL
Ndip
Agbor
A
Boulton
Andrew J M
AJ
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000453:epidemiology* / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D011032:Podiatry / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012775:Shoes / Q000706:statistics & numerical data*