Reduction of Lower Extremity Clinical Abnormalities in Patients with Non-Insulin-Dependent Diabetes Mellitus

摘要: OBJECTIVE To evaluate the effect of a patient, health care provider, and systems intervention on prevalence risk factors for lower extremity amputation in patients with non-insulin-dependent diabetes. DESIGN Blinded, randomized, controlled trial. SETTING Academic general medicine practice. PARTICIPANTS Of 395 diabetes who underwent initial patient assessment, 352 completed study. INTERVENTION The 12-month was multifaceted. Patients received foot-care education entered into behavioral contract desired self-foot care, which reinforced through telephone postcard reminders. Health providers were given practice guidelines informational flow sheets foot-related diabetic patients. In addition, folders had special identifiers that prompted to: 1) ask remove their footwear, 2) perform foot examinations, 3) provide education. RESULTS receiving less likely than control to have serious lesions (baseline prevalence, 2.9%; odds ratio, 0.41 [95% CI, 0.16 1.00]; P = 0.05) other dermatologic abnormalities. Also, they more report appropriate self-foot-care behaviors, examinations during office visits (68% compared 28%; < 0.001), receive from (42% 18%; 0.001). Physicians assigned physicians examine patients' feet ulcers, pulses, abnormal conditions refer podiatry clinic (10.6% 5.0%; 0.04). CONCLUSIONS An designed reduce amputations positively affected behavior as well by reduced clinical disease