IDF21-0015 Can weekly ‘foot alerts’ using a bespoke mobile app improve patient diabetic foot care knowledge and practices in Kuwait

Abstract

Background: Diabetic foot ulcers (DFU) are the leading cause of non-traumatic lower limb amputation, occurring every 20-secs. An important step in disrupting the pathway to amputation is improving patient awareness and foot care practices. Improvement in short-term knowledge and behaviour following education programs has been reported, but without sustained improvement. Two recent Cochrane reviews reported that not enough high-quality evidence existed to prove the effectiveness of patient education programs on the prevention of DFU, as delivery methods are not evidence-based, nor are the right patients targeted. We propose that patients who receive weekly foot alerts alongside their regular Podiatry appointments will have better foot care knowledge and behaviours at 12-months compared to a control group. Aim: This study aims to determine if targeted weekly diabetic foot alerts improve diabetic foot care behaviour and knowledge in patients with high and moderate diabetic foot risk classification, compared to participants who only receive regular podiatry interventions. Method: This randomized, investigator-blinded, two-armed, study aims to pilot an innovative approach to education delivery. Participants will be included if they have been classified as high or moderate risk of developing DFU using the NICE classification system. Ninety-eight Participants will be randomised to (1) control group, who will receive usual diabetic foot care education, including daily foot inspections, foot hygiene, and footwear advice, supplemented by an information leaflet or (2) intervention group, in addition to the diabetic foot care education and information leaflet given to the control group, participants will receive a 10-minute audio-visual pre-recorded presentation based on the foot care education and an application will be downloaded onto their smart phone. This application will deliver weekly foot alerts based on the presentation, repeating at 12-weekly intervals. Podiatry appointments will be scheduled depending on risk classification. Participants will complete an adapted Summary of Diabetes Self-Care Activities behaviour questionnaire (SDSCA) and a Foot Care Knowledge questionnaire at first Podiatry appointment and 12-months. Results: The primary outcome measure will compare means of each questionnaire between the two groups. It is anticipated that participants in the intervention group will have improved foot care knowledge and practices. Secondary outcomes will include assessing the association between participants knowledge and behaviour and the number of foot alert engagements, and the number of podiatry appointments. Lastly, the number of new DFUs and change in HbA1c will be compared between the two groups. Discussion: This novel approach to diabetic foot care education could have a significant impact on patients' foot health and quality of life. Moreover, the financial burden to healthcare facilities and governments may be lessened by improving foot care behaviour and reducing DFU frequency.