Waewae Tapu: Podiatry Assessment in NZ. Will this make

a difference?

Ihaka B, Rome K, Browne, J, Garrett N.

AUT University

The story so far

Diabetes global epidemic Diabetes related complications far

outweigh prevalence rates in Maori No standardised podiatry assessment

in New Zealand No specific podiatry diabetes course in

New Zealand

Aim

Determine key characteristics to establish a standardised and EVB assessment

Nationwide assessment for people with diabetes Primary Health care setting

Method

120 patients recruited from two Maori PHO’s

Inclusion criteria: >18years with T2DM, Maori, no ‘Get Checked’1 >12mths / or demonstrated absence of pedal pulse, sensation, previous PVD history or ulceration.

53 patients included in study1New Zealand Guidelines Group: Management of Type 2 Diabetes, Wellington: 2003.

Results

Demographic / Clinical Characteristics General Medical Characteristics Vascular, Neurological &

Musculoskeletal Foot Characteristics Foot Education Characteristics

Demographic & Clinical characteristicsMedian age - 54 years

Median BMI - 35.7 (kg/m2)

Diabetes Duration - 15 years

% of patients with HbA1c >8% continuously – 42%

Insulin (21%) OHAs (91%) diet (85%)

General Medical Characteristics% Nephropathy – 28%

% Retinopathy – 21%

% Dyslipidaemia – 55%

% Hypertension – 49%

Vascular / Neurological / Musculoskeletal Characteristics

11% complained of claudication pain

11% pedal pulses detectable with Doppler only

Ankle-brachial index median = 1.1mmHg (DP)

Neuropathy Symptom/Disability score = 2

70 % dry skin

59 % restriction in ankle joint

21 % prayer sign

58 % pre-ulcerative lesions (Wagner scale)

Foot Education Characteristics57% daily foot inspection

32% inspected footwear

34% regular moisturiser 1,2

98 % benefits of good glycaemic control

98 % the role of HT, dyslipidaemia and hyperglycaemia on foot health

86 % smoking effects on circulation

1Ronnemaa et al (1997) Diab Care 20:1833-37.

2Calle-Pascual et al (2002) Diab Res Clin Prac 57:111-117.

Foot Risk

64% of patients required more than 6 monthly visits to the podiatrist for review

Will podiatry make a difference?

Podiatrists have an integrated role in the multidisciplinary team

Aim is to upskill podiatrists on evidence-based medicine assessment

Acknowledgements

Health Research Council New Zealand (05/286)

Te Puna Hauora O Te Raki Pae Whenua PHO, Tamaki PHO, Raukura Hauora o Tainui PHO, and Waiora PHO