Diabetic Foot Care: The Importance of Adherence

OCTOBER 03, 2014
Yvette C. Terrie, BSPharm, RPh
Maintaining tight glycemic control and performing proper foot care are critical to decreasing the incidence of foot ulcers and possible amputations among patients with diabetes.1,2

Although the number of newly diagnosed cases of diabetes in the United States continues to escalate annually, there is good news. According to the Centers for Disease Control and Prevention (CDC), there has been a significant decline in the number of lower limb amputations among adults with diabetes due to early intervention, timely management, and increased patient education efforts.1-3

Goals of Diabetic Foot Care
When counseling patients with diabetes about their medications, pharmacists should seize the opportunity to make them aware of and educate them about the importance of diabetic foot care in reducing or preventing potential complications. The main goals of diabetic foot care involve a combination of preventive strategies, including patient education, involvement, and adherence to physician recommendations, as well as maintaining tight glycemic control and performing routine skin, foot, and nail inspections.3-5

Left untreated, bacterial and fungal infections, as well as foot ulcers, can lead to amputation.1,2 Certain foot-related complications, such as skin changes (dryness, itching) and foot ulcers, are common among patients with diabetes (Table 1)6-11; many of these conditions are attributed to vascular disease, neuropathy, and relative immunosuppression. 5 Patients with diabetes, especially those whose disease is poorly controlled, are more susceptible to skin-related complications. Therefore, patients should be reminded that many dermatologic conditions can be prevented or effectively treated if identified early through daily skin inspections and proper foot care.

Foot Care Standards
Statistics from the CDC and the National Institutes of Health Diabetes Information Clearinghouse indicate that comprehensive foot care programs, such as foot care education, risk assessment, and preventive therapy, may decrease amputation rates by 45% to 85%.9 In addition, the American Diabetes Association’s Standards of Medical Care, released in 2014, include the following foot care recommendations12:
  • Patients with diabetes should obtain an annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations.
  • Patients with diabetes should receive general foot self-care education from their primary health care provider.
  • A multidisciplinary approach is recommended for patients with foot ulcers and those at high risk for foot complications, especially individuals with a history of prior ulcer or amputation.
  • Patients who smoke and/or have structural abnormalities, as well as those with a history of lower extremity complications, should be referred to foot care specialists for ongoing preventive care and lifelong surveillance.