Diabetic foot ulcers (DFUs) may affect up to 25% of people with diabetes at some point in their lifetime. Once a person has developed a DFU, there is a 50% chance the ulcer will become infected. DFUs are also among the leading causes of amputation.
By Kim Coy DeCoste RN, MSN, CDE
It can be quite concerning when you ask your patients attending a DSME class “How many of you have had your feet checked for blood flow and nerve function by your health care provider?”, and far less than half of them raise their hands. Probing a little further, you find that a number of patients have never even had their feet visually inspected by their health care provider (HCP) for signs of diabetic foot ulcers. This isn’t unique to my practice site. Recently when I was teaching a professional education program with diabetes educators from across the US, most in the group concurred with my findings.
It clearly states in the Clinical Practice Recommendations (Diabetes Care, 2012) that an annual comprehensive foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation. Dr. Aletha Tippet, in her blog from last August, said the testing for neuropathy using the 10gm monofilament could help to reduce amputations by 50%. Why then is it not done and what can we do as diabetes educators to encourage health care providers to provide the annual comprehensive foot exam and routine visual inspections?
In asking health care providers what would make the difference for them in following through on performing this very important, limb-saving exam I have learned that if the patient is “ready”, they are much more likely to perform the exam. This has now become a very important part of teaching foot care as part of our DSME curriculum. I teach the patients to “be ready” for the foot exam. They are instructed to take their shoes and socks off and if the provider still doesn’t check their feet, I encourage them to ask the provider to do the exam. Each patient leaves class with a 10gm monofilament and I encourage them to take this to their visit with their HCP and ask them to use it to check their feet.
It is important that patients be knowledgeable about, and practice behaviors that help to decrease their risk of developing complications from diabetic neuropathy and resulting wound conditions. The diabetes care team, including the patient, the HCP and the diabetes educator play an active role in assuring that important tests, exams and interventions are part of an action plan that can help to reduce the risks for the devastating complications of diabetes.
About The Author
Kim Coy DeCoste RN, MSN, CDE has more than 27 years of experience as a diabetes educator. She is a past member of the AADE Board of Directors, and currently on the faculty of AADE's Core Concepts Course. She has also been appointed as a member of the Kentucky Board of Diabetes Educators, taking a leadership role in the first state to require licenses for practicing Diabetes Educators.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of DiabetesProductSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.