Reducing Diabetic Foot Incidence and Its Related Complications

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Problem Identification in the Professional Work Setting

The problem is diabetes mellitus: Many clients suffer from diabetes mellitus and the incidence of this disease has been on the increase in the past ten years.

A Description of the Importance of the Problem

Diabetes mellitus is a problem that needs urgent attention because of the complications it brings to the sufferers. Specifically, patients with diabetes mellitus have a high chance of developing diabetic foot which in turn causes additional and severe complications. Complications arising from diabetic foot are caused by deep infections and gangrene, which increase the risk of the amputation of the lower limb. It is argued that people with diabetes mellitus have a risk of lower limb amputation which is twenty times higher than that of the general population. In addition, patients with diabetes mellitus have a higher morbidity rate, disability rate, emotional and physical losses than the general population because of complications arising from the diabetic foot (Poljicanin, Pavlic-Renar, Metelko & Coce, 2005).

Reputable Sources that Support the Importance of the Problem

The importance of the complications brought about by diabetes mellitus has been highlighted by various research studies. These studies are discussed in this section. Poljicanin et al., 2005 argue that out of the total number of all lower limb amputations, 40%-60% are carried out in persons with diabetes mellitus, and more than 85% of them are the consequence of a diabetic foot (p. 43). Other studies argue that the early diagnosis and management of independent risk factors may hinder or delay the development of diabetic foot. The risk of ulcers and amputations is higher among persons who have had diabetes for more than 10 years. The risk is also higher in men, and in those with poor control of glycaemia and/or cardiovascular, retinal or renal problems (Rangnarson & Apelquist, 2001).

An increased risk of amputation is related to a number of conditions which include: peripheral neuropathy with loss of protective sensation, altered biomechanics (in the presence of neuropathy); evidence of increased pressure; bone deformity; peripheral vascular disease; a history of ulcers or amputation; and severe nail pathology (Rangnarson & Apelquist, 2001, p. 2079). Armstrong, Holtz-Neiderer, Wendel, Mohler, Kimbriel et al. (2007) argue that diabetic foot wounds are common among diabetic patients and are very costly. They assert that diabetic foot wounds are brought about by frequent strain to the feet that is caused by inflammation and skin breakdown. They argue that self-care is therefore important among the diabetic patients in the prevention of diabetic foot and its related complications.

Project Objective: Specific, Realistic and Measurable Objective

To reduce the incidence of diabetic foot by 50 percent among patients with diabetic mellitus within a period of two years

Proposed Solution that will Solve the Problem

Education of patients

Patient education is an important preventive strategy for diabetic foot. The program will be conducted in two different kinds. The first type of education will involve patients who attend the general clinics for the first time and who have not been identified as having a high risk of diabetic foot after screening. This group of patients will receive general education according to the practice executed. The second type of education will involve all other patients who have been identified through screening as having a high risk of developing diabetic foot. This group of patients will receive educational materials that have all the information that pertain to the care, prevention and treatment of diabetic foot. Extended education will be conducted on different occasions such as during the patients first visit, during screening and during subsequent visits. The education will be done using different techniques such as through chart demonstrations, through practical demonstrations and through normal dialogues between the patients and the healthcare professionals. After every education session, the healthcare professionals will assess the patients understanding, motivation and level competence in foot care.

Every education session will incorporate the following areas: daily foot inspection, including areas between the toes; if the patient cannot inspect the feet, someone else should do it; regular washing of the feet with careful drying, especially between the toes; temperature of the water should always be less than 37 °C; avoidance of walking barefoot in- or outdoors, and of wearing shoes without socks, avoidance of using chemical agents or plasters to remove corns and calluses; daily inspection and palpation of the inside of the shoes; in case of impaired vision, the patients should not try to treat the feet by themselves; the use of lubricating oils or creams for dry skin but not between the toes; daily change of stockings; wearing stockings with seams inside-out or preferably without any seams at all; cutting nails straight across; avoidance of cutting corns and calluses by patients but by a health care professional; ensuring that the feet are examined habitually by a health care professional; and the patient should notify the health care provider immediately if a blister, cut, scratch or sore develops (Ortegon, Redekop & Nissen, 2004).

Reference List

Armstrong, D., Holtz-Neiderer, K., Wendel, C., Mohler, M. J., Kimbriel, H. R., et al. (2007). Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. The American Journal of Medicine, 120, 1042-1046.

Ortegon, M., Redekop, W., & Nissen, L. (2004). Cost-effectiveness of prevention and treatment of diabetic foot: A Markov analysis. Diabetes Care, 27, 901-907.

Poljicanin, T., Pavlic-Renar, I., Metelko, Z., & Coce, F. (2005). Draft program of prevention of diabetic foot development and lower extremity amputation in persons with diabetes mellitus. Diabetologia Croatica, 34(2), 43-49.

Rangnarson, T., & Apelquist, J. (2001). Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations. Diabetologia Croatica, 44, 2077-2087.

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