title: Delay between Onset of Symptoms and Seeking Physician Intervention Increases Risk of Diabetic Foot Complications: Results of a Cross-Sectional Population-Based Survey.
abstract: We present a post hoc analysis of 17,530 questionnaires collected as part of the 2012 screening for neuropathy using Norfolk Quality of Life tool in patients with diabetes in Romania, to assess the impact on foot complications of time between the onset of symptoms of diabetes/its complications and the physician visit. Odds ratios (ORs) for self-reporting neuropathy increased from 1.16 (95% CI: 1.07-1.25) in those who sought medical care in 1-6 months from symptoms of diabetes/its complications onset to 2.27 in those who sought medical care >2 years after symptoms onset. The ORs for having a history of foot ulcers were 1.43 (95% CI: 1.26-1.63) in those who sought medical care in 1-6 months and increased to 3.08 (95% CI: 2.59-3.66) in those who sought medical care after >2 years from symptoms of diabetes/its complications onset. The highest ORs for a history of gangrene (2.49 [95% CI: 1.90-3.26]) and amputations (2.18 [95% CI: 1.60-2.97]) were observed in those who sought medical care after >2 years following symptoms onset. In conclusion, we showed that waiting for >1 month after symptoms onset dramatically increases the risk of diabetic foot complications. These results show the need for accessible educational programs on diabetes and its chronic complications and the need to avoid delays in reporting.
authors.affiliation: Society of Diabetic Neuropathy, Worwag Pharma GmbH&Co.KG, Romanian Representative Office, 11 Fagului Street, 400483 Cluj-Napoca, Romania.
authors.forename: Norina A
authors.initials: NA
authors.lastname: Gavan
authors.affiliation: Department of Diabetes, Nutrition and Metabolic Diseases, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 4-6 Clinicilor Street, 400006 Cluj-Napoca, Romania.
authors.forename: Ioan A
authors.initials: IA
authors.lastname: Veresiu
authors.affiliation: Eastern Virginia Medical School, Strelitz Diabetes Center, 855 West Brambleton Avenue, Norfolk, VA 23510, USA.
authors.forename: Etta J
authors.initials: EJ
authors.lastname: Vinik
authors.affiliation: Research & Neuroendocrine Unit, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, USA.
authors.forename: Aaron I
authors.identifier: 0000-0002-5279-0628
authors.initials: AI
authors.lastname: Vinik
authors.affiliation: IMOGEN Research Center, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș Street, 400012 Cluj-Napoca, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Florea
authors.affiliation: Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 6 Pasteur Street, 400349 Cluj-Napoca, Romania.
authors.forename: Cosmina I
authors.identifier: 0000-0001-6245-4188
authors.initials: CI
authors.lastname: Bondor
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D017719:Diabetic Foot / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005734:Gangrene / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011788:Quality of Life; D012306:Risk; D012383:Romania; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists