Sushil Kotru, Bharat Kotru and Kumud Joshi
Background: In Southern Punjab region, we see high prevalence of diabetic foot patients. The causes are peripheral neuropathy, peripheral vascular disease, foot deformities, lack of foot care awareness and use of faulty footwear. The patients approach physicians at an advanced stage of diabetic foot for which they have to undergo regular debridements and amputations. Lack of foot care, the use of desi medicines (containing heavy metals), walking bare foot practices, excess alcohol intake and local juti’s (faulty footwear) further increase the risk of diabetic foot problems. If the patient is made aware about the benefits of controlled blood sugar levels and proper foot care practices at an early stage, there will be significant decrease in diabetes related foot complications.
Method: We divided patients into two groups in our diabetes foot care clinic; intensively educated and trained group A patients (provided customized footwear also) and group B patients, given standard oral and written information on diabetes foot care. The division was done on the basis of their availability and acceptance for foot checkup, attending group education and training sessions at first visit and at every 3 months period. The preliminary check-up of the foot of all patients were done by use of various analytical techniques like –10 gm mono filament perception, vibration sensation (biothesiometer), plantar foot pressures (podiascan), ABI Index to see lower limb blood flow (foot doppler). This study was carried from 15th march 2013 to 14th march 2014 (1 year) at ASIAN Diabetes and Obesity Care Centre in Bathinda, Punjab. Diabetes foot clinic was started on 23rd june 2013 Total 550 diabetic patients with some foot problems were registered in diabetes foot clinic at the start of this study (15th march). Inclusion criteria was - Type 2DM patients, Duration of diabetes 10-12 yrs, VPT>25 on Biothesiometer (neuropathy present), AGE 40-80 yrs, either of three foot complications-: Pvd or Foot deformities or Abnormal plantar foot pressures.
Results: our preliminary data results states that out of 250 eligible patients, 131 agreed to participate. Out of 131 included patients, 74 were males 57 were females, 61 were in group A (males=34 and females=27) and rest 70 in group B (40 males and 30 females). After 12 months out of 131 patients, 23 patients were drop outs, 11 from group A (M=7 and F=4) and 12 from group B (M=7 and F=5) so 108 patients completed the study period. At the study period 34% out of 108 patients had abnormal plantar foot pressures on podiascan, 20% had foot deformities (calluses, bunions, claw toes, hammertoes etc) and 17% had peripheral vascular disease and rest had combination of these. After one year when observed in group A, new ulcer or diabetic foot was seen in only 18% patients, while in group B new ulcer or diabetic foot developed in 31% patients
Conclusion: Thus it significantly states that group A patients are better benefitted by intensive education, training and customized footwear. The main reasons for ulcer development were shoe bite, external trauma, burns, walking bare foot and no known cause in some patients. In our study, the patients in the group B were presented with a set of predefined actions/goals and they were able to choose as to whether or not they wished to adapt to these objectives while the patients in group A were ready to attend regular foot checkup clinics, diabetes foot care group sessions, workshops, and trainings at first visit and at every 3rd month regularly. They were provided with customized footwear and insoles for both indoor and outdoor purposes. However the sample size was small along with other limitations, we can still infer that this outcome is significant. Also we need long term follow up of all these patients to see favorable outcome from intensive diabetes education