title: Illiteracy and diabetic foot complications.
abstract: BACKGROUND
  Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes.
  
  
  METHODS
  Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist.
  
  
  RESULTS
  Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care.
  
  
  CONCLUSIONS
  Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications.
authors.affiliation: Department of Internal Medicine, College of Medicine and Health Sciences, UAE University , Al-Ain, United Arab Emirates. Electronic address: j.kaabi@uaeu.ac.ae.
authors.forename: Juma M
authors.initials: JM
authors.lastname: Al-Kaabi
authors.affiliation: Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
authors.forename: Fatma
authors.initials: F
authors.lastname: Al Maskari
authors.affiliation: Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates.
authors.forename: Paul
authors.initials: P
authors.lastname: Cragg
authors.affiliation: Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates.
authors.forename: Bachar
authors.initials: B
authors.lastname: Afandi
authors.affiliation: Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
authors.forename: Abdul-Kader
authors.initials: AK
authors.lastname: Souid
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs / Q000523:psychology*; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D017719:Diabetic Foot / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D057220:Health Literacy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care; D011795:Surveys and Questionnaires; D014479:United Arab Emirates / Q000453:epidemiology
keywords: Diabetes; Foot care; Foot complications; Illiteracy; UAE