De Berardis Giorgia, Pellegrini Fabio, Franciosi Monica, Belfiglio Maurizio, Di Nardo Barbara, Greenfield Sheldon, Kaplan Sherrie H, Rossi Maria C E, Sacco Michele, Tognoni Gianni, Valentini Miriam, Nicolucci Antonio
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, CH, Italy.
J Diabetes Complications. 2005 Nov-Dec;19(6):319-27. doi: 10.1016/j.jdiacomp.2005.02.005.
In the context of a nationwide outcomes research program on Type 2 diabetes, we investigated physician and patient practices related to foot care. Patients filled in a questionnaire investigating whether they had received information about foot care, how often they had had their feet examined in the last year, and how often they usually checked their feet. Analyses were adjusted for patient case-mix and physician-level clustering. Overall, 3564 patients were recruited by 125 diabetes outpatient clinics (DOCs) and 103 general practitioners (GPs), of whom 6.8% suffered form lower limb complications. The presence of foot complications was correlated with insulin treatment, cigarette smoking, low levels of school education, and the presence of other diabetic complications. More than 50% of the patients reported that they had not had their feet examined by their physician and 28% referred that they had not received foot education. Patients with lower levels of school education and income, as well as overweight individuals, were less likely to receive foot education. Physicians tended to perform foot examination more often in males, low-income patients, those with foot complications, and those treated with insulin, but not in patients with the highest risk of foot complications, that is, those with diabetic neuropathy or peripheral vascular disease (PVD). GPs tended to perform foot examination less frequently than diabetologists do. Foot self-examination was not performed by 33% of the patients. Those individuals who had received foot education or had had their feet examined were more likely to check their feet regularly. A substantial proportion of Type 2 diabetic patients is not offered adequate foot care, even in the presence of major risk factors for lower limb complications. Patient knowledge and practices are strongly related to physicians' attitudes.
在一项关于2型糖尿病的全国性疗效研究项目中，我们调查了医生和患者与足部护理相关的行为。患者填写了一份问卷，内容涉及他们是否收到过足部护理方面的信息、过去一年中足部检查的频率以及他们通常检查足部的频率。分析对患者病例组合和医生层面的聚类进行了调整。总体而言，125家糖尿病门诊（DOCs）和103名全科医生（GPs）招募了3564名患者，其中6.8%患有下肢并发症。足部并发症的存在与胰岛素治疗、吸烟、低学历以及其他糖尿病并发症的存在相关。超过50%的患者报告称他们没有让医生检查过足部，28%的患者表示他们没有接受过足部护理教育。学历和收入较低的患者以及超重个体接受足部护理教育的可能性较小。医生倾向于对男性、低收入患者、有足部并发症的患者以及接受胰岛素治疗的患者更频繁地进行足部检查，但对于足部并发症风险最高的患者，即患有糖尿病神经病变或外周血管疾病（PVD）的患者则不然。全科医生进行足部检查的频率往往低于糖尿病专科医生。33%的患者没有进行足部自我检查。那些接受过足部护理教育或接受过足部检查的人更有可能定期检查足部。即使存在下肢并发症的主要风险因素，相当一部分2型糖尿病患者仍未得到充分的足部护理。患者的知识和行为与医生的态度密切相关。
