The effectiveness of foot care education on people with type 2 diabetes in Tehran, Iran

Abstract

Aim

The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran.

Methods

One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20 min education session individually. The mode of the intervention was face-to-face.

Results

The applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care (P < 0.0001 and P = 0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI ≤ 25) rather than the obese ones.

Conclusions

In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs.

Introduction

Diabetes mellitus is increasing in incidence; it represents a major health problem for the 21st century. Indeed, the total number of patients with diabetes has been projected to rise from 171 million in 2000 to 366 million in 2030 [1]. Diabetic wounds and especially diabetic foot is one of the major health problems and is the source of enormous costs to healthcare services [2], [3], [4].

Foot ulceration is estimated to affect 15% of people with diabetes at some time in their life and 70% of healed foot ulcers recur within five years [3], [5].

Studies have shown that diabetic people with foot ulceration suffer from reduced quality of life in terms of pain, restricted mobility, time lost from work and reduction in social activities, leading to social isolation and loneliness [2], [6], [7], [8].

The management of the diabetic foot disease is primarily focused on avoiding lower extremity amputation. This goal is carried out through 3 main strategies: identification of the “at-risk” foot, prompt and effective treatment of the acutely diseased foot, and prevention of further problems. Education to the patients is of a vital value to succeed in any of the mentioned program. Some interventions have shown that the regular foot examinations could reduce the frequency of lower extremity amputations by 49–85% and also could prevent from the diabetes-related lower-extremity amputations [9], [10].

Since the options for specific therapy are limited [11], great emphasis is already placed on the prevention and on the foot care education in particular [12], [13], [14], [15].

While the importance of the patients’ knowledge is inevitable, the effectiveness of the education in reducing ulcer incidence has not been clearly demonstrated, as indicated by recent systematic [16] and non-systematic [17], [18] reviews. A reduced incidence of new foot ulcers has been shown in some studies when the foot care education was included as part of an integrated package for the diabetes care delivered to selected and relatively disadvantaged groups in the USA [19], [20]; however, this has not been confirmed in other studies [21], [22], [23], [24], [25], [26].

The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the at risk foot in Tehran, Iran.