Diabetes global epidemic Diabetes related complications far outweigh prevalence rates in Maori No...
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Transcript of Diabetes global epidemic Diabetes related complications far outweigh prevalence rates in Maori No...
Waewae Tapu: Podiatry Assessment in NZ. Will this make
a difference?
Ihaka B, Rome K, Browne, J, Garrett N.
AUT University
The story so far
Diabetes global epidemic Diabetes related complications far
outweigh prevalence rates in Maori No standardised podiatry assessment
in New Zealand No specific podiatry diabetes course in
New Zealand
Aim
Determine key characteristics to establish a standardised and EVB assessment
Nationwide assessment for people with diabetes Primary Health care setting
Method
120 patients recruited from two Maori PHO’s
Inclusion criteria: >18years with T2DM, Maori, no ‘Get Checked’1 >12mths / or demonstrated absence of pedal pulse, sensation, previous PVD history or ulceration.
53 patients included in study1New Zealand Guidelines Group: Management of Type 2 Diabetes, Wellington: 2003.
Results
Demographic / Clinical Characteristics General Medical Characteristics Vascular, Neurological &
Musculoskeletal Foot Characteristics Foot Education Characteristics
Demographic & Clinical characteristicsMedian age - 54 years
Median BMI - 35.7 (kg/m2)
Diabetes Duration - 15 years
% of patients with HbA1c >8% continuously – 42%
Insulin (21%) OHAs (91%) diet (85%)
General Medical Characteristics% Nephropathy – 28%
% Retinopathy – 21%
% Dyslipidaemia – 55%
% Hypertension – 49%
Vascular / Neurological / Musculoskeletal Characteristics
11% complained of claudication pain
11% pedal pulses detectable with Doppler only
Ankle-brachial index median = 1.1mmHg (DP)
Neuropathy Symptom/Disability score = 2
70 % dry skin
59 % restriction in ankle joint
21 % prayer sign
58 % pre-ulcerative lesions (Wagner scale)
Foot Education Characteristics57% daily foot inspection
32% inspected footwear
34% regular moisturiser 1,2
98 % benefits of good glycaemic control
98 % the role of HT, dyslipidaemia and hyperglycaemia on foot health
86 % smoking effects on circulation
1Ronnemaa et al (1997) Diab Care 20:1833-37.
2Calle-Pascual et al (2002) Diab Res Clin Prac 57:111-117.
Foot Risk
64% of patients required more than 6 monthly visits to the podiatrist for review
Will podiatry make a difference?
Podiatrists have an integrated role in the multidisciplinary team
Aim is to upskill podiatrists on evidence-based medicine assessment
Acknowledgements
Health Research Council New Zealand (05/286)
Te Puna Hauora O Te Raki Pae Whenua PHO, Tamaki PHO, Raukura Hauora o Tainui PHO, and Waiora PHO