Improving the Detection of Foot Abnormalities in Patients With Diabetes
Diabetes, the most common metabolic disorder in primary care, is the leading cause of cardiovascular disease, renal failure, retinopathy, and lower-extremity amputations (1). Diabetic foot abnormalities, including ulcers and lower-extremity amputations, are associated with substantial morbidity, loss of quality of life, and disability and are very costly for the individuals affected, their families, and society as a whole (2). Approximately 84% of nontraumatic major amputations in individuals with diabetes are preceded by foot abnormalities such as an ulceration (3). According to the Centers for Disease Control and Prevention, the total cost of diagnosed diabetes in the United States was $245 billion in 2012, with the majority of costs attributed to a high occurrence of hospital admissions, including $9 billion associated with foot ulcers alone (2).
Clinical Issue and Local Problem
Diabetes is a treatable condition, yet it is the seventh leading cause of death in South Carolina. South Carolina ranks tenth highest in the nation in the percentage of population with diabetes (4). In 2013, South Carolina had the fourth highest prevalence of diabetes in the United States, with ∼25,000 diabetes-related hospitalizations and emergency visits, costing $367 million. The cost of diabetes care in South Carolina is expected to exceed $3 billion in 2016 and to hit $4 billion by 2020 (5). Many of the costs associated with diabetes could be reduced with preventive intervention in the primary care setting, where diabetes is the most common metabolic disorder encountered. However, gaps occur in the care and management of diabetes, especially in the area of foot care. In 2012, an Institute for Preventive Foot Health/National Purchase Diary survey revealed that only 46% of patients with diabetes reported ever having foot screenings with their primary care provider (6).
Foot complications, specifically ulcers and amputations, are the number one reason for hospitalization in patients with diabetes …