Search

Aims: Podiatrists constitute a key member of a multidisciplinary foot care team, but their services remain underutilized. We sought to gain insights into the daily practice of podiatrists focusing on screening for and monitoring of diabetic sensorimotor polyneuropathy (DSPN) as well as foot management., Methods: This cross-sectional survey included 125 podiatrists from 12 federal states across Germany who responded to an online questionnaire., Results: The majority of patients treated in podiatry practices were referred by general practitioners and diabetologists. Screening for or follow-up of DSPN was performed by 36% of the respondents at least once a year, by 28% only at initial examination, by 21% only at suspicion, and by 10% basically at each treatment visit. Instruments to assess vibration, touch/pressure, and temperature sensation were used by 81% to 94% of the podiatrists. Previously undiagnosed DSPN and foot ulcers were detected frequently/very frequently (≥6 cases/mo) by 24.0 and 18.4% of the podiatrists, respectively. Almost all podiatrists advised daily self-monitoring of feet and appropriate foot care and >50% gave advice on medical treatment., Conclusions: Podiatrists play an important role in the detection, monitoring, and management of both DSPN and diabetic foot ulcers, suggesting that the utilization of their services should be fostered., Competing Interests: Disclosure D.Z., R.L., Kh.R, K.R., and O.S. are advisory board members of the National Education Initiative (NAI) and received honoraria for speaking activities from Wörwag Pharma. D.Z. received research grants from Wörwag Pharma. R.La. is also an advisory board member of the NAI and received a grant for prevention activities for the German Diabetes Foundation., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs' hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434) = 41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292) = 4.4, p = .013) and knowledge on HCPs' hand hygiene (F(2, 294) = 3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs' hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge. [ABSTRACT FROM AUTHOR]

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care. [ABSTRACT FROM AUTHOR]

Aims: Since neuropathy screening may be underutilized in primary care practice, we conducted a nationwide educational initiative to determine the prevalence of diagnosed and previously undiagnosed polyneuropathy., Methods: Among 1017 individuals participating in the initiative, 983 with complete data were analyzed, 359 of whom had no diabetes by history (ND), 80 had type 1 diabetes, and 544 had type 2 diabetes. Polyneuropathy was assessed by history and foot examination including pressure, temperature, and vibration perception and was classified as possible, probable, and severe. Foot pulses and HbA1c were determined in subsets of participants., Results: Polyneuropathy was detected in 53.8% of ND, 43.8% of type 1, and 55.6% of type 2 diabetes subjects and was associated with higher age. In a subset of participants with polyneuropathy, the latter was declared as previously undiagnosed by 79.1% of ND, 35.7% of type 1, and 61.5% of type 2 diabetes participants. After adjustment for age and sex, prevalent polyneuropathy was associated with peripheral arterial disease., Conclusions: More than half of subjects with and without diabetes participating in an educational initiative had polyneuropathy which was reported as previously undiagnosed by two thirds. Effective strategies to avoid underdiagnosis of neuropathy and to improve preventive foot care should be implemented., (Copyright © 2015 Elsevier Inc. All rights reserved.)