Annual Foot Research Articles

Temporal trend in quality indicators of diabetes care performance among persons with type 2 diabetes in primary care practice: a serial cross-sectional analytical study, 2013/14 to 2021/22.

Although the national-based policy implemented an initiative program to offer diabetes care management in Thailand, there are limited time trends of evidence to gauge whether the quality of diabetes care in primary care practice is improving. As such, we aimed to identify temporal trends in the quality of diabetes care performance among type 2 diabetes mellitus (T2DM) patients in primary care practice. Using assembled patient-level data from a suburban community in northern Thailand, this serial retrospective cross-sectional analytical study obtained adult T2DM patients from nine consecutive fiscal years 2013/14 (n = 976) to 2021/22 (n = 1,242). Based on international and national guidelines recommended, nine quality indicators were examined, namely, smoking cessation, hemoglobin A1c monitoring, foot and eye examinations, albuminuria testing, statin prescription, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription for chronic kidney disease (CKD)/albuminuria, and blood pressure and glycemic control. Rates and time trends achieved in each quality indicator performance were estimated. Differences in the rates of patients who met each quality indicator across reimbursement schemes were explored. From 2013/14 to 2021/22, all quality indicators have increased over time (p for trend <0.05) except for smoking cessation, which remained steady. In 2021/22, only three out of nine quality indicators (i.e., smoking cessation, annual HbA1c monitoring, and annual foot examination) were successfully met at 70% or greater. Differences in quality indicators of diabetes performance were observed, particularly those under the Civil Servant Medical Benefit Scheme compared with other health insurance counterparts. For overall time trends analysis (compared with 2013/14), significant relative changes in the fiscal year 2021/22 were found in the annual foot examination (adjusted 12.1% increase; p = 0.048), annual albuminuria testing (adjusted 12.1% increase; p = 0.048), and ACEI/ARB prescription for persons with CKD or albuminuria (adjusted 22.2% increase; p = 0.025). Among adult T2DM patients from 2013/14 to 2021/22, overall quality indicators for diabetes performance have substantially improved over time. However, health inequity regarding diabetes care performance was found across different reimbursement schemes. Sustainable policy implementation and innovative strategies to narrow health inequity are warranted to optimize diabetes care in primary care practice.

Accuracy and reliability of the Ipswich touch test in identifying loss of protective sensation among diabetic patients

ObjectiveTo evaluate the accuracy of the Ipswich touch test compared to the 10-g monofilament test for identifying of loss of protective sensation in Thai patients with diabetes mellitus. MethodsA cross-sectional observational study was conducted on Thai patients with diabetes mellitus who attended routine annual foot check-ups in an outpatient diabetes clinic. The loss of protective sensation was assessed by the Ipswich touch test and compared with the Semmes-Weinstein 10-g monofilament test. Sensitivity, specificity, predictive values and likelihood ratios were calculated to measure the accuracy of the Ipswich touch test against 10-g monofilament as a reference standard. The interrater reliability of the Ipswich touch test was assessed by two raters. ResultsIn a study of 283 diabetic patients, 10-g monofilament detected a 25 % prevalence of loss protective sensation. The Ipswich touch test demonstrated a good diagnostic accuracy, with a sensitivity of 70.8 %, specificity of 98.6 %, and an area under the curve of 0.85 when compared to 10-g monofilament. Positive and negative predictive values were 94.4 % and 90.8 % respectively. The positive likelihood ratio was 49.82, and the negative likelihood ratio was 0.30. Interrater reliability, assessed with two raters in a subset of 93 participants, yielded a kappa of 0.88, indicating almost perfect agreement. ConclusionsThe Ipswich Touch Test demonstrated good accuracy and interrater reliability compared to the standard 10-g monofilament, thus establishing its effectiveness as a valuable diagnostic tool for identifying loss of protective sensation among diabetic patients. However, its relatively low sensitivity suggests it should be used with caution as a screening tool.

Trend, disparities, and projection analysis of public data on foot fractures in Sweden: a retrospective analysis of 179 129 fractures

IntroductionOrthopedic injuries to the foot constitute a significant portion of lower extremity injuries, necessitating an understanding of trends for effective preventive strategies and resource allocation. Demographic shifts, improved traffic safety, and lifelong physical activity may alter incidence rates, trauma mechanisms, and fracture distribution. This study explores the prevalence of foot fractures in Sweden using publicly available data.MethodsUtilizing data from the Swedish National Board of Health and Welfare (SNBHW) spanning 2008–2022, retrospective study focuses on foot fractures in Sweden. Analysis includes calculating annual incidence rates per 100,000 person-years, assessing temporal trends, and exploring seasonal variations. Poisson regression analysis was used for projections into 2035.ResultsBetween 2008–2022, the average annual foot fracture incidence was 11,942, with notable fluctuations influenced by the COVID-19 pandemic. Age and sex disparities impact rates, and seasonal variance highlights increased incidence in summer. By 2035, foot fractures will decreasae amongst several demographic groups.ConclusionThis study provides insights into temporal trends, sex differences, and seasonal variations foot fracture patterns in Sweden. The identified trends suggest the utilization of targeted preventive strategies, efficient resource allocation, and informed healthcare planning. Despite limitations, this research offers valuable insights into foot fractures within the Swedish population, utilizing publicly aggregated data.

Healthcare and health situation of adults with type 2 diabetes in Germany: The study GEDA 2021/2022-Diabetes.

The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.

Longitudinal Medical Student Collaborative Care in Primary Care Patients With Type 2 Diabetes.

The Education-Centered Medical Home (ECMH) is a longitudinal clerkship that emphasizes continuity and quality improvement in primary care. We aimed to evaluate our ECMH's ability to improve type 2 diabetes mellitus (T2DM) care through a systematic chart audit and care planning process. The effect of this intervention was measured by adherence to process and outcome measures. From November 2015 to March 2017, medical students were educated on and performed monthly chart audits of guideline-based quality metrics: hemoglobin A1c systolic blood pressure; lipid and microalbuminuria evaluation; annual ophthalmic and foot examinations; flu, hepatitis, and pneumonia vaccination; and statin therapy. Patients were included if they had a diagnosis of T2DM and were seen by the ECMH clinic before and after the audits started. Students shared audit logs, using them to plan patient appointments. We assessed changes in proportion of patients meeting each guideline with Fisher's exact test. The project included 11 patients with T2DM. ECMH adherence to the annual eye exam increased significantly 1 year postintervention, compared to preintervention (73% vs 55%; P=.03) and 6 months (73% vs 46%, P=.01). The metric with significant improvement during the chart audit, annual eye exam, is a process measure requiring advance planning. This small study suggests that a formal, regular audit process can improve student adherence to evidence-based care guidelines, particularly for tasks that require advance planning or action by the care team outside the day of a patient visit.

Diabetic Foot Ulcers: A Review of Debridement Techniques.

Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus (DM) and lead to significant morbidity and mortality. Patients with DM have a lifetime risk of DFUs as high as 34%. The pathogenesis of DFUs is multifactorial, and the most common underlying causes are poor glycemic control, peripheral neuropathy, peripheral vascular disease, foot deformity, and poor foot care. Diabetic lower-extremity complications are also a significant burden in terms of healthcare costs. In the United States alone, the direct cost of diabetic foot care has been estimated to be $8,659 per patient, with total annual medical costs for managing diabetic foot disease ranging from $9 to $13 billion. Given the risk of amputation and poor wound healing, the fast, accurate diagnosis and treatment of DFUs are critical. Measures to prevent DFUs include glycemic control and annual foot inspections. For patients with DFUs, off-loading and local wound care are critical for wound healing. Debridement is the standard of care for DFU wounds, and several techniques exist. In this review, we discuss the current practices of diabetic wound care, different methods of debridement and their practical use in DFUs, and novel debridement approaches with the potential for improving wound-healing outcomes.

Access to telehealth and changes in diabetes care patterns during the pandemic: evidence from a large integrated health system in the Southeast USA

IntroductionTo examine the role of telehealth in diabetes care and management during versus pre-COVID-19 pandemic.Research design and methodsWe included adults (≥18 years) with prevalent diabetes as of January 1, 2018,...

Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study.

Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action.

Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit.

There is limited data on the standards of diabetes care in people on peritoneal dialysis (PD). Our aim was to assess the standards of diabetes care and the burden of hypoglycaemia in people with diabetes on PD. We performed a retrospective study at three university hospitals from December 2021 to January 2022. Clinical data were extracted from electronic health records. Diabetes care of people on PD was compared against recommended standards for people with diabetes on haemodialysis (as there are no agreed standards for PD). The degree of hypoglycaemia awareness was assessed by validated questionnaires. A total of 65 adults (15 type 1, 49 type 2 and 1 monogenic-diabetes) with a mean age of 63 (range 29-88) years were evaluated. Of them, 92% had diabetes retinal screening with annual review. In contrast, in this high-risk group for foot disease, only 77% had annual foot reviews. The rates of diabetes specialist reviews were variable between hospitals at 63-94% and 10 (15%) had impaired hypoglycaemia awareness. Of the cohort, 32% had HbA1c within the acceptable range of 58-80 mmol/mol (7.5-8.5%), 21% had HbA1c below 58 mmol/mol (7.5%) and 21% (n = 14) reported at least one hypoglycaemic event per month. Our results indicate variation of care within and between different centres, and the need for improved diabetes care in people on PD. Further work is required to establish agreed standards/recommendations of diabetes care in this population. Our findings highlight the necessity of an integrated multidisciplinary approach to improve the standard of diabetes care for people on PD.

Foot ulcers in older people with diabetes mellitus: prevention and management.

Foot ulcers in a person with diabetes mellitus can be life-changing and threaten the viability of their lower limb. As many as one in three people with diabetes develops a foot ulcer in their lifetime. These foot ulcers are prone to fast-spreading infection and often precede lower-limb amputation. In older people with diabetes, foot ulcers can have significant negative long-term effects in terms of quality of life, morbidity and mortality. Appropriate care is crucial to prevent the development of foot ulcers and to manage them if they develop despite adequate preventive measures. Multidisciplinary team working and robust care pathways are essential. This article outlines the role of nurses in supporting older people with diabetes to maintain optimal foot health, ensuring that they undergo an annual foot assessment, assessing them for foot ulcers and referring them promptly to specialist care when required to avoid amputation.

Examination of Feet in People with Diabetes

Diabetic foot is a common complication of diabetes and leads to considerable morbidity and mortality. Neuropathy, deformity, infection and ischemia play a key role in the pathogenesis of diabetic foot ulcer. A multidisciplinary team approach by a nurse, physician, diabetic foot surgeon and the caregiver as well as close monitoring can prevent foot complications. Proper foot care, foot hygiene, annual foot examination and correct choice of footwear are main factors in preventing foot problems, ulceration and amputations. Physicians play a lead role in early detection and prevention of foot problems. This article will focus on how to perform foot examination in routine clinical practice.

Addressing the Inertia: A Holistic Approach to Diabetic Foot Evaluation.

Diabetic foot is a well-known complication with considerable morbidity and mortality related to the diabetic population. Neuropathy, deformity, infection and ischemia are important contributors to the pathogenesis of diabetic foot ulcers. A multidisciplinary team approach by physicians, nursing staff, diabetic educators and the caregiver as well as close monitoring of feet by the patient himself can prevent foot-related complications. Proper foot care, foot hygiene, annual foot examination and the correct choice of footwear are the main elements in preventing foot problems like deformity, ulceration and amputations. Physicians play a key role in the early detection and prevention of foot problems. Foot evaluation is the most neglected part of physical examination in diabetic patients. This inertia is evident in both physicians and patients. Emphasis on visual inspection and physical foot examination at every visit may address the morbidity and mortality due to diabetic neuropathy and vasculopathy. This article will highlight extensively history taking and foot examination in the diabetic foot clinic. Optimal glycemic control, simple foot care practices, knowledge and appropriate footwear use play an important role to reduce the disease burden.

Disparities in preventative diabetic foot examination

The objective of this study was to assess the overall differences in the standard of preventive foot care for patients at risk of diabetic foot ulceration and to identify specific demographic factors affecting these health care practices, including race and ethnicity. The National Health and Nutrition Examination Survey data for 2011 to 2018 were analyzed. Participants (20 years and older) with diabetes were categorized as White, Black, Hispanic, Asian, and others (including multiracial participants) based on self-reported race and ethnicity. The primary outcome was foot examination over the past year administered by a medical professional. Logistic regression was performed to examine the effects of race and ethnicity on the annual diabetic foot examination, controlling for age (65 years and older), gender, and health insurance status. Among the 2,836 participants included in the study (weighted percentage: 61.1% were White, 13.9% were Black, 15.1% were Hispanic, 5.4% were Asian, and 4.5% were other), 2,018 (weighted percentage: 71.6%) received annual diabetic foot examination over the past year. Hispanic participants (adjusted odds ratio [aOR] = 0.685; 95% CI, 0.52-0.90) were significantly less likely than White participants to receive an annual foot examination (Black participants: aOR = 1.11; 95% CI, 0.83-1.49; Asian participants: aOR = 0.80; 95% CI, 0.60-1.07; other participants: aOR = 0.66; 95% CI, 0.40-1.10). Factors associated with receipt of foot examination were age 65 years or older (aOR = 1.42; 95% CI, 1.05-1.92) and having health insurance (aOR = 3.02; 95% CI, 2.27-4.03). Our findings suggest that Hispanic adults with diabetes are receiving disproportionately lower rates of preventive foot care compared with their White counterparts. This significant variation in the standard of care for individuals with diabetes reflects the need to further identify factors driving the disparities in preventive foot care services among racial and ethnic minority groups.

Social Media Counterpublics and the Chief Big Foot Memorial Ride

The annual Chief Big Foot Memorial Ride represents the longest continuous example of Lakota memorial and resistance rides in contemporary Lakota activism. First held in 1986, this commemoration of the journey of Chief Big Foot’s band of Lakotas and the subsequent Wounded Knee Massacre in 1890 now reaches beyond the confines of the ride itself through the use of social media profiles that serve to both publicize and document the ride. This article seeks to understand the way that photographs from the rides influence the types and amount of engagement it receives on social media. Using a qualitative and quantitative approach, 304 images and their associated engagements from the 2018 ride were analyzed using content analysis and a grounded theory approach. This revealed that certain characteristics gave rise to the construction of a counterpublic around this ride. Findings suggest that both the content of photos and types of authors for posts influenced the number and types of engagements received by certain photographs. Given the relative isolation of many Indigenous communities in the Americas, these findings suggest that certain strategies for social media posts by Indigenous social movements can overcome these barriers to spread their message to a wider audience through strategic use of imagery associated with these movements.

Annual Foot Exams are Associated with Reduced Incident Amputation among Older Veterans with Diabetes.

We conducted a secondary data analysis to evaluate the association between annual foot exams and incident lower extremity amputations (LEA) among older veterans with diabetes during FY2007-FY2014. Older Veterans with at least one primary care provider visit each year (N = 664,162) and at least one foot exam each year (N = 72,892) and the overlap were identified from the 5years prior to the study period of interest (FY2002-FY2006 (N = 71,122)). After excluding incident LEA related to cancer and trauma, 71,018 veterans (mean age +/- SD, % male) were included in the final cohort, which was followed from FY2007-FY2014 to evaluate the influence of subsequent annual foot exams and incident LEA. Consistent annual foot exams were protective for incident LEA in older veterans with diabetes, adjusted OR was 0.85 (97% CI: 0.74-0.96). Results indicate that adherence to annual foot exam guidelines can reduce incident LEA in older veterans with diabetes.

Evaluation of quality of diabetic foot examination on YouTube.

Foot ulcers and amputations are common conditions in people with diabetes and can considerably impact quality of life, necessitate a lengthy hospital stay and increase mortality. Preventative foot care and examination can prevent or delay ulceration, and individuals may seek information from publicly available social media resources such as YouTube. Therefore, the purpose of this study is to evaluate the educational quality and reliability of publicly available YouTube videos on diabetes foot examinations. A YouTube search for "diabetic foot examination" was conducted, and the first 100 relevant English videos focused on examining the diabetic foot were included for evaluation. The Journal of the American Medical Association (JAMA) standards were used to measure video reliability. The Global Quality Score (GQS) and the Diabetes UK Annual Foot Check (DUK-C) checklist were used to assess video educational quality. Differences in JAMA, GQS, and DUK-C ratings were analysed after videos were sorted by topic and source. The mean number of views per video was 101,311.9± 348,383.6, and the mean video power index was 41.6± 170.0. The most common upload source was from physicians (28%) and, the most popular material category was diabetes foot examination (58 videos). In terms of video reliability, 36% of videos scored 0. According to the GQS standards, only 5% of the videos are of excellent quality, while 34% are of poor quality, with 24 videos scoring between 0 and 1 on the DUK-C scale. While foot care examination videos have a substantial audience, the majority are considered low in quality and reliability. Videos on comprehensive diabetic foot examination should be accessed on reputable sources that guarantee standardisations of video quality and take into account the simplification of information transmission in order to reach lay audiences.

915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas. Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test. Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p &amp;lt; 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p &amp;lt; 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) . Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes. Disclosure M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a. Funding NIDDK R01DK113295

Foot care knowledge, attitude and practices of diabetic patients: A survey in Diabetes health care facility.

Among diabetes complications, diabetic foot disease (DFD) is the most common and the most preventable complication. This study aimed to assess the level of knowledge, attitude and practice of foot care among type two diabetes mellitus (DM) patients attending the Diabetic and Endocrine Center at King Fahad Specialist Hospital in Buraydah-Qassim region, Saudi Arabia. A descriptive cross-sectional facility-based study was conducted randomly among type two diabetic patients; respondents were 260 patients. Participants were interviewed using a pretested semi-structured questionnaire. Of the total studied patients, 54.2% were males with median age of 58 years. Majority 56.5% of patients had good knowledge and 56.9% had good practices regarding diabetic foot care. The mean knowledge score was 4.0 (±1.86) out of 6. About 39.2% of participants received advice regarding foot care from their physicians. Only 41.5% of the patients examined their feet daily, 41.9% carefully dried between the toes after washing, and 40.8% were walking barefooted at home. About 68.5% of the participants had a history of diabetic foot complications. A significant statistical association was found between the good knowledge and patients' age, educational level, family monthly income, duration of diabetic illness and having prior knowledge regarding foot care (P-value <0.05). While, good practice of the participants towards the diabetic foot care was found to be statistically associated with the family monthly income and the prior knowledge regarding diabetic foot care (P-value <0.05). Our study revealed that more than half of the participants had good knowledge and practices of diabetic foot care. However, the role of physicians and medical staff in annual foot examination and health education is crucial. An awareness program implementation for diabetic foot care is highly needed.

Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases.

Primary care physicians face the increasing burden of managing multimorbidities in an ageing population. Implementing an integrated care team (ICT) with defined roles and accountability to share consultation tasks is an emerging care model to address this issue. This study compared outcomes with ICT versus usual care for patients with multimorbidities in primary care. Data was retrospectively extracted from the electronic medical records (EMRs) of consecutive adult Asian patients empanelled to ICT and those in UC at a typical primary care clinic (polyclinic) in eastern Singapore in 2018. The study population had hypertension, and/or hyperlipidaemia and/or type 2 diabetes mellitus (T2DM). Clinical outcomes included the proportion of patients (ICT vs. UC) who attained their treatment goals after 12 months. Process outcomes included the proportion of patients who completed annual diabetic eye and foot screenings, where applicable. Data from 3,302 EMRs (ICT = 1,723, UC = 1,579) from January 2016 to September 2017 was analysed. The ICT cohort was more likely to achieve treatment goals for systolic blood pressure (SBP) (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI] = 1.38-1.68), low-density lipoprotein cholesterol (AOR = 1.72, 95% CI = 1.49-1.99), and glycated haemoglobin (AOR = 1.28, 95% CI = 1.09-1.51). The ICT group had higher uptake of diabetic retinal screening (89.1% vs. 83.0%, P < 0.001) and foot screening (85.2% vs. 77.9%, P < 0.001). The ICT model yielded better clinical and process outcomes than UC, with more patients attaining treatment goals.

Ten Years Follow-Up of a Community-Nurse Managed Intervention to Improve Diabetes Control.

Diabetes control measures were shown to improve, following multidisciplinary intervention managed by a nurse in short-term follow-ups. However, there is a lack of data regarding the long-term effects of such interventions. We assessed long-term diabetes management and control measures in a central multidisciplinary primary care clinic, following a brief intervention conducted by a community nurse. A cross-sectional study in a central, multidisciplinary, primary care clinic. A previous study cohort of randomly selected 100 people with diabetes was followed-up for over 10 years, following a brief intervention managed by a community nurse. Data of diabetes control measures (e.g., hemoglobin A1c [HbA1c], low-density lipoprotein [LDL], and blood pressure) and clinical use of medical services (e.g., nurse, physician, dietician, and hospitalizations) were extracted from the medical records and compared from before the intervention to short and long-term follow-ups (median of 25 months, 10.56 years respectively). During the follow-up period, 18 participants (median age at intervention time 73 years) died. HbA1c dropped significantly (p < .001) from before to after the intervention, and remained low. LDL and Systolic Blood pressure decreased and continued to decrease during the long-term follow-up. While the number of nurse visits per year increased, physician and dietician visits decreased. Annual foot examinations and ophthalmologist visits, which increased following the intervention, remained high. Diabetes-related hospitalizations also decreased from the point of intervention. Multidisciplinary, brief intervention managed by a community nurse, improve, and even continue to improve, most diabetes management and control measures, for more than 10 years following the intervention.