What to Know
Head to Toe


ADA's steps to promote preventive foot care

PODIATRY TODAY NOVEMBER 1996

Wash and dry your feet thoroughly, especially between your toes. Cut your nails straight across the edges. Shake the pebbles from your shoes before putting them on. And never walk barefoot.

These personal care tips, are no big deal for most people. But for diabetics, they could spell the difference/' between healthy feet and a lower-extremity amputation.

The American Diabetes Association is trying to impress that sobering message upon the nation's 16 million diabetics.

As the centerpiece of its annual National Diabetes Month observances, the association is distributing 1.5 Million poster-style brochures listing basic ways to prevent diabetic foot and eye complications.

The brochures are available at hospitals and diabetic foot care centers across the country. Podiatrists may call the association at 1-800-DIABETES to receive a batch of copies for their patients. .

The foldout flier, titled "Diabetes: What to Know Head to Toe," urges diabetics to:

  • Control blood sugar levels;
  • Ask a physician to examine the feet during checkups;
  • Check daily for cuts, blisters, redness and swelling and call a podiatrist at once upon detecting such a wound, no matter how small.
  • Wear well-fitting shoes. Patients with neuropathy should have a DPM or other physician prescribe footwear;
  • Don't smoke.

"This is probably as comprehensive and catchy a promotion as we've ever done," says Belinda Childs, MN, RN, CDE, the American Diabetes Association's president of health care and education.

Association officials hope to help curb the approximately 54,000 amputations that occur each year- many of which, they say, can be prevented through patient education.

"If you can get people to look at their feet every day, amputations will be reduced," Childs asserts. She calls podiatrists "an important part of the diabetes management team" and urges them to continue their patient awareness efforts. "The key to compliance is educating individuals (on) the importance of diabetes management," she says.

Meanwhile, the association's New Jersey affiliate is increasing patient awareness.

The affiliate last year instituted a Foot Care Awareness screening program in conjunction with 14 other health care agencies in New Jersey, where about 1,800 amputations occur annually. Affiliates in other states have adopted the program.

In November 1995, more than 1200 patients underwent Foot Care Awareness screenings led by a hospital based podiatrist and a nurse or certified diabetes educator at 50 New Jersey hospitals and 639 of them were rreferred for follow-up care.

Also, at three stages along the way, patients filled out questionnaires that addressed lifestyles, types of doctors seen and degree of foot hygiene.

The answers 443 from a one month follow-up and about 200 from another six-month survey- showed that patients who never thought to check their feet were now doing so regularly, Patients' logs of their daily foot care also showed that behavior was being changed.

Memos publicizing the program were sent to diabetes educators throughout the Garden State, says Dana Aronson, an affiliate vice president. Interested respondents received a kit containing a nuts-and-bolts guide on organizing a public screening, a patient education video and four monofilament (wire-like devices used to test for neuropathy).

Parke-Davis, the New Jersey-based pharmaceutical company, provided funding for the program. ed pharmaceutical company, provided funding for the program.

The Cost of Diabetes in Dollars

From a purely financial perspective, complications from diabetes drive up medical costs and eat away at employers' budgets. So says the American Diabetes Association, which offers the following statistics on the disease's impact. Figures are for 1992, the last year for which such statistics are available:

  • Diabetes costs were estimated at $91.8 billion, a more than 400 percent increase across five years. The total cost in 1987 was estimated at $20.4 billion.
  • Direct medical costs totaled $45.2 billion. About $39.1 billion was spent on institutional care (in hospitals and nursing homes). A total of $371,969 diabetes-related hospitalizations were reported.
  • Lost productivity due to disability or death carried a $46.6 billion price tag. A total of one million work-loss days were attributed to diabetes, and the disease reportedly disabled some 47,800 workers.
  • Diabetes was the underlying cause of death for 48,259 people and a contributing cause for 118,678.
  • Diabetics are at a 1.5 times greater risk of hospitalization than non-diabetics, and are 11.7 times more likely to be hospitalized because of amputations.