Sixty second screening identifies persons at risk for diabetic foot ulcers

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aim: To develop and apply a low-tech screening tool for risk status of developing diabetic foot ulcers in a resource-poor setting. Methods: The 60 second screening tool identifies high risk status on the basis of history, examination of the foot for lesions or deformity, monofilament loss of protective sensation, joint stiffness and the absence of a pedal pulse. The tool was applied in a weekly medical diabetic clinic at Georgetown Public Hospital Corporation, (Guyana’s only referral and teaching hospital). The clinic has a population base of more than 2000 patients. High risk status was defined as a single positive score on the tool. Identified high risk patients were referred to the Diabetic Foot Centre for further assessment to prevent foot ulcers through patient education and the supply of appropriate footwear and orthotics. results: Audit of initial screened 1000 patients: 70% of screened population is female; 40% of total screened population is at high risk; 13% had previous ulcers; 5% previous amputation; 8.5% an absent foot pulse; 7.7% an active ulcer. The tool profiles the frequencies of risk factors in the population. Interand intra-rater reliability of the tool will be presented. High risk patients referred to DFC form a cohort to determine the effects of patient education, follow-up concerning foot care and the wearing of appropriate footwear on ulcer prevention. Discussion/conclusions: Screening of people with diabetes for high risk status is an essential component of comprehensive diabetes care. It focuses preventive practices and reduces workload for the treatment of foot ulcers and their complications. It also identifies unrecognized ulcers at an early stage. Screening and patient education to change behaviors are the keys to preventing diabetic foot ulcers. The 60 second tool has been adopted by the Ministry of Health in Guyana.