Abstract
Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician’s recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p < 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p < 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0–73.3% and specificity 70.6–64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level > 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician’s recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.
Highlights
Diabetic foot complication and management are a global public health problem, which affects 422 million people worldwide, is associated with high levels of morbidity and mortality, and occurs in around 10% of diabetic patients through their life
We evaluated the most common diabetic foot complication using the Michigan Neuropathy Screening Instrument (MNSII) that includes two assessments: a 15-item questionnaire, and a physical assessment and examination of the lower extremity that combines an evaluation of the appearance of feet ulceration and symmetrical peripheral neuropathy
A total of 35 individuals were aged 65 or over (72.9% of the study sample), with different times elapsed since the diabetes diagnosis (91.7% of the sample suffered from type II diabetes)
Summary
Diabetic foot complication and management are a global public health problem, which affects 422 million people worldwide, is associated with high levels of morbidity and mortality, and occurs in around 10% of diabetic patients through their life. The major adverse outcome of foot ulceration is amputation, with a prevalence of 1.6% in the age range 18–44 years, 3.4% among those aged 45–64 years, and 3.6% in patients older than 65 years. Various interventions for the prevention of foot ulcers have been studied, but adherence to treatment has been confirmed as playing an important role in the clinical outcome [6,7]. The problem of nonadherence should guide practitioners when identifying patients who are nonadherent or anticipated to be nonadherent to clinical recommendations. This evidence attests to the fact that analysis of the factors affecting adherence to treatment among patients with diabetic foot complications are necessary to implement a proper educational intervention
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
