רקע מדעי ומטרה:

Annual foot examination is a core screening tool for preventing diabetic foot amputations; however, real-world data regarding its efficacy are scarce. This study investigated whether regular nurse-led foot examinations and patient education on self-foot assessment are associated with reduced foot amputation rates among diabetic patients.

שיטות:

This retrospective cohort study analyzed electronic medical records of diabetic patients registered with Maccabi Healthcare Services (MHS), Israel’s second-largest health maintenance organization, from 2003 to 2023. Inclusion criteria were diabetic patients aged 18-120 years with Type 1, LADA, or Type 2 diabetes. Patients with gestational diabetes and pre-diabetes were excluded.

תוצאות:

A total of 141,757 diabetic patients were included. Amputees were predominantly male (78.9% vs. 54.6%, p<0.001) and more often belonged to lower socioeconomic groups. The time from diabetes diagnosis to initial nurse-led foot examination was significantly longer among amputees (4.0±3.0 years) compared to non-amputees (3.3±2.9 years, p<0.001). However, amputees had a higher annual foot examination rate (median 74%, IQR 43.6-100.3) than non-amputees (median 59.8%, IQR 26.3-85.9). Education on self-foot examination was also significantly more frequent among amputees (median 68.5%, IQR 33.6-98.7) than non-amputees (median 50.8%, IQR 17.7-78.0).

מסקנות:

The delayed initial foot exam in amputees suggests lower health awareness or predictive difficulties in diabetes management. Contrary to expectations, higher foot examination and education rates among amputees likely reflect poorer baseline foot health identified at advanced stages.

חשיבות לרפואת המשפחה:

Findings indicate a need to reassess current nurse-led foot exam practices and emphasize early, targeted intervention strategies, particularly in disadvantaged populations through primary care physicians, from initial diagnosis.