Journal Article

The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study

Allen, Penny, Massey, Claire, Chappell, Andrew, Skinner, Isabelle, Gardner, Marcus J., Perrin, Byron M., Phillips, Bronwyn, Skinner, Timothy C.

2019

Overview

Background There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. Methods Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. Results Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82–3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22–4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35–4.86). Conclusions A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.

• Publisher: BioMed Central,BioMed Central Ltd,Wiley
• Subject: Aged / Amputation / Analysis / Australia / Australia - epidemiology / Classification / Clinical decision making / Cohort analysis / Cohort Studies / Cross-Sectional Studies / Data collection / Decision making / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetes Mellitus, Type 1 - epidemiology / Diabetic foot / Diabetic Foot - epidemiology / Diabetic Foot - etiology / Diabetic Foot - mortality / Diabetic Foot - pathology / Diabetics / Epidemiology / Feet / Female / Foot diseases / Glycated Hemoglobin - analysis / Glycosylated hemoglobin / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Models of care / Morbidity / Observational studies / Orthopedics / Pathology / Patient admissions / Peripheral Nervous System Diseases - epidemiology / Peripheral neuropathy / Podiatry / Podiatry - economics / Podiatry - standards / Prevalence / Prospective Studies / Rehabilitation / Risk Factors / Rural areas / Rural Health Services - standards / Rural Population - statistics & numerical data / Rural Population - trends / Socioeconomic Factors / Tasmania - epidemiology / Type 1 diabetes / Variables / Victoria - epidemiology