Diabetic Foot Disease, Self-Care and Clinical Monitoring in Adults with Type 2 Diabetes: The Alberta’s Caring for Diabetes (ABCD) Cohort Study

Published:August 01, 2015DOI:https://doi.org/10.1016/j.jcjd.2015.05.006

      Abstract

      Objective

      To examine the prevalence and predictors of foot disease, self-care and clinical monitoring in adults with type 2 diabetes in Alberta, Canada.

      Method

      Baseline data from a prospective cohort of adults with type 2 diabetes were used. Assessment of foot disease included self-reported peripheral neuropathy, peripheral vasculopathy, foot or leg ulcer/infection or gangrene/amputation. Foot self-care was assessed using the Summary of Diabetes Self-Care Activities, and clinical monitoring using patients’ reports of having feet checked for lesions or sensory loss.

      Results

      The mean age of respondents (N=2040) was 64 (SD 10.7) years; 45% were female, and 91% were Caucasian. Peripheral neuropathy was reported by 18% of the respondents, peripheral vasculopathy by 28%, ulcer/infection by 6% and gangrene/amputation by 1.4%. Only 14% of respondents performed foot self-care behaviours ≥6 days per week, and only 41% and 34% had their feet clinically checked for lesions or sensory loss, respectively. Predictors of foot disease included longer duration of diabetes, smoking, depressive symptoms, low self-efficacy and a history of cardiovascular diseases. Predictors of good self-care included older age, female sex, longer duration of diabetes and no report of hyperlipidemia. Predictors of clinical monitoring included female sex, current smoking, residing in urban areas, longer duration of diabetes, and histories of heart disease or hyperlipidemia.

      Conclusions

      Peripheral neuropathy and vasculopathy were the most common reported foot problems in this population. Foot self-care is generally infrequent, and clinical monitoring is performed for less than half of these patients, with significant variations by patient demographics and clinical presentation.

      Résumé

      Objectif

      Examiner la prévalence et les facteurs prédictifs du pied diabétique, l'auto-prise en charge et la surveillance clinique chez les adultes atteints de diabète de type 2 en Alberta, Canada.

      Méthode

      Les données basales provenant d'une cohorte prospective d’adultes atteints de diabète de type 2 ont été utilisées. L’examen du pied diabétique inclus une neuropathie périphérique auto-déclarée, une vasculopathie périphérique, un(e) ulcère/infection du pied ou de la jambe ou une gangrène/amputation. L’auto-prise en charge du pied a été évaluée en utilisant le Sommaire des Activités d’Autogestion du Diabète et une surveillance clinique utilisant les dossiers de patients ayant eu leur pied examiné pour une lésion ou une perte sensorielle.

      Résultats

      L'âge moyen des répondants (n = 2040) était de 64 ans (SD 10,7); 45% étaient des femmes, et 91% étaient de type caucasien. Une neuropathie périphérique était rapportée pour 18% des répondants, une vasculopathie périphérique pour 28%, un(e) ulcère/infection pour 6%, et une gangrène/amputation pour 1,4%. Seuls 14% des répondants ont entrepris une démarche d’auto-prise en charge de leur pied ≥6 jours par semaine, et seulement 41% et 34% voyaient leurs pieds subir un examen clinique pour, respectivement, des lésions ou une perte sensorielle. Les facteurs prédictifs du pied diabétique inclurent une plus longue durée du diabète, des antécédents de tabagisme, des symptômes de la dépression, une faible auto-prise en charge, et des antécédents de maladies cardiovasculaires. Les facteurs prédictifs d'une bonne auto-prise en charge inclurent un âge avancé, le sexe féminin, une plus longue durée du diabète, et aucune l'hyperlipidémie rapportée. Les facteurs prédictifs issus de la surveillance clinique inclurent le sexe féminin, un tabagisme existant, une résidence en zone urbaine, une plus longue durée du diabète, et des antécédents de maladie cardiaque ou d'hyperlipidémie.

      Conclusions

      La neuropathie périphérique et la vasculopathie sont les problèmes de pied diabétique les plus fréquemment rapportés dans cette population. L’auto-prise en charge du pied diabétique est généralement rare, et une surveillance clinique est effectuée pour moins de la moitié de ces patients, avec des variations importantes concernant la démographie des patients et la présentation clinique.

      Keywords

      Mots Clés

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