Abstract
Background: Preventive care of diabetic foot and eye complications is essential. However, data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabetes are very limited in Switzerland. We aimed to fill this gap of knowledge. Methods: Cross-sectional data on recommended preventive care using RAND’s criteria in a random sample of patients aged 50-80 years in 2005-2006. Participants were recruited from 4 Swiss university primary care settings (in Lausanne, Geneva, Zurich and Basel). Scores for general preventive care in patients with and without diabetes were calculated by using generalized estimating equation binomial models. Multivariate regression models were used to identify determinants of appropriateness of angiopathic complications prevention. The main outcome measure was appropriateness of screening for angiopathic complications based on the 2005 American Diabetes Association recommendations corresponding to the period of data collection. Results: Among the 1002 patients aged 50 - 80 years, 292 (29.1%) had diabetes (101/292 [34.6%] female, mean BMI 30.7 [SD 5.7]). Fifty-nine percent had appropriate preventive foot care and 55.8% had appropriate preventive eye care. Only 34.6% had appropriate preventive care of both foot and eye. No differences in aggregate scores for general preventive care in patients with and without diabetes were found (67.5% vs. 69.1%, p value 0.39). In multivariate model, obesity was negatively (OR = 0.28, 0.15 - 0.53) and hyperlipidemia positively (OR = 2.29, 1.20 - 4.38) associated with appropriate eye preventive care and with appropriate combined foot and eye preventive care (OR = 0.35, 0.18 - 0.70 for obesity and OR = 2.82, 1.24 - 6.40 for hyperlipidemia). Conclusions: Preventive care of diabetic angiopathic complications is low among ambulatory patients despite universal health care coverage. Particular attention should be paid to obese patients with diabetes.
Highlights
Diabetes and its complications are among the most important and costly chronic diseases in developed countries
Using data from a random sample of patients with and without diabetes aged 50 - 80 years followed over 2 years (2005-2006) in 4 Swiss university primary care settings, we found that inappropriate foot and eye preventive care was frequent among patients with diabetes
While we found that patients with diabetes received as much general recommended preventive care as patients without diabetes, inappropriateness of angiopathic preventive care in patients with diabetes was frequent (57 patients, 19.5%) had neither annual eye exam, nor annual foot exam during the review period) with potential consequences on morbidity related to limb amputation and risk of impaired visual acuity or blindness
Summary
Diabetes and its complications are among the most important and costly chronic diseases in developed countries. Fifteen percent of patients with diabetes will suffer from foot ulcer during their lifetime [3] [4], one out of four foot ulcers will not heal, and up to 28% will result in amputation [5]. Factors such as previous foot ulcer or amputation, peripheral neuropathy, smoking, minor trauma, impaired visual acuity, and foot deformities have been associated with increased risk of foot ulcers [6]-[9]. Data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabetes are very limited in Switzerland. Fifty-nine percent had appropriate preventive foot care and 55.8% had appropriate
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