Two-Year Foot Care Program for Minority Patients with Type 2 Diabetes Mellitus of Zhuang Tribe in Guangxi, China

Abstract

ObjectiveThe aim of this study is to design and implement a foot care program for minority patients with type 2 diabetes mellitus of Zhuang tribe in Guangxi, China, which will achieve the following: 1) improve patients’ foot care behaviour, 2) improve their glycated hemoglobin (A1C) and 3) decrease the incidence of foot ulcers and amputation. BackgroundIn Guangxi, China, foot care resources are limited, and diabetes self-management and foot care is poor for patients with diabetes. Thus developing a program with the limited resources for diabetes foot care is very important. MethodsA multidisciplinary team led by a diabetes nurse was established. A foot care kit and set of teaching materials focusing on foot care and diabetes self-management was developed. Sixty-two inpatients with type 2 diabetes mellitus, under the same attending physician’s service, were screened to be at high risk for foot ulcers and randomized into 2 groups. The subjects in the study group received didactic diabetes education, tailored foot care and focused teaching for 2 hours. Every patient was given a foot care kit during hospitalization and then followed up in the clinic monthly with a systematic foot exam. Subsequently, diabetes education classes were given every 3 to 6 months. The subjects in the control group were just given usual care according to 2007 Americans with Disabilities Act standards. ResultsFor patients in the study group, the average score of knowledge and self foot care behaviours were higher than those of the patients in the control group both after 1 year (88.31 ± 8.15, 86.35 ± 5.17 vs. 70.27 ± 7.92, 75.86 ± 6.19) and 2 years (87.24 ± 6.20, 89.56 ± 7.00 vs. 71.43 ± 5.17, 67.87 ± 5.26). The mean A1C (6.5% ± 2.3% vs. 7.9% ± 4.2%), the incidence of foot ulcer (0% vs. 24.14%), and amputation (0% vs. 6.90%) were much lower than that of the patients in the control group after 2 years. ConclusionThe foot care program delivered by a multidisciplinary team can markedly improve foot care behaviours and reduce complications of the minority diabetes patients who are at risk of developing foot ulcer, thereby reducing the incidence of foot ulcer and amputation. In areas where resources are limited, the foot care program will be a cost-effective approach to reduce the incidence of diabetes foot ulcer.