Schmidt Brian M, Wrobel James S, Holmes Crystal M
Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Hospital and Health Systems, Domino's Farms (Lobby C, Suite 1300) 24 Frank Lloyd Wright Drive Ann Arbor, Michigan, USA.
Clin Diabetes Endocrinol. 2017 Feb 8;3:2. doi: 10.1186/s40842-017-0041-4. eCollection 2017.
Charcot neuroarthopathy (CN), a rare foot and ankle condition usually complicating diabetes mellitus, leads to deformity, poor quality of life, and increased mortality and morbidity. The prevalence of this condition in the diabetic patient population is not currently known but has been reportedly misdiagnosed in up to 95% of cases.
We sought to evaluate general knowledge regarding CN in non-foot specialist clinical faculty at a large academic institution and to understand their practice habits. Our survey emphasizes the necessity of better education surrounding CN to improve outcomes in a preventative fashion. This will enable us to determine how to focus educational forums surrounding this topic in the future.
Seven hundred eighty-nine faculty members were sent the survey while 400 completed the survey for a response rate of 50.7%. The respondents were representative of academic rank at the institution and were comprised of endocrinologists, internal medicine physicians and family medicine physicians. We found that 67.6% of responders had a self-described poor or complete lack of knowledge of this condition. Clinicians with self-described better knowledge of CN were more likely to provide a correct initial management of CN ( < 0.001; = 0.3639).
In this large tertiary institution, a majority of providers among internal medicine, endocrinologists, and family medicine physicians demonstrated minimal or no knowledge of this rare, but potentially devastating diabetes complication. However, those providers who are knowledgeable of CN, performed better in the initial management of this condition. Also, respondents who treated more diabetic patients demonstrated an association with correct management. Education, and the development of better understanding amongst clinicians, is crucial to limit the devastating effects of this condition in the future.
夏科氏神经关节病（CN）是一种罕见的足踝疾病，通常并发于糖尿病，会导致畸形、生活质量下降以及死亡率和发病率上升。目前尚不清楚这种疾病在糖尿病患者群体中的患病率，但据报道，高达95%的病例被误诊。
我们试图评估一家大型学术机构中非足病专科临床教员对CN的一般知识，并了解他们的执业习惯。我们的调查强调了围绕CN进行更好教育的必要性，以便以预防的方式改善治疗结果。这将使我们能够确定未来如何围绕这个主题聚焦教育论坛。
向789名教员发送了调查问卷，400人完成了调查，回复率为50.7%。受访者代表了该机构的学术级别，包括内分泌学家、内科医生和家庭医学医生。我们发现，67.6%的受访者表示对这种疾病了解甚少或完全不了解。自称对CN了解较多的临床医生更有可能对CN进行正确的初始治疗（<0.001；=0.3639）。
在这家大型三级机构中，内科、内分泌科和家庭医学科的大多数医生对这种罕见但可能具有毁灭性的糖尿病并发症了解很少或一无所知。然而，那些了解CN的医生在这种疾病的初始治疗中表现更好。此外，治疗更多糖尿病患者的受访者与正确治疗存在关联。教育以及临床医生之间更好的理解对于未来限制这种疾病的毁灭性影响至关重要。
