Bruun, Christine5; Guassora, Ann Dorrit6; Nielsen, Anni Brit Sternhagen5; Siersma, Volkert Dirk5; Holstein, Per Evald7; Olivarius, Niels5
1 Forskningsenheden for Almen Praksis, Eksterne centre, Københavns Universitet2 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 Department of Public Health, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet4 Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet5 Forskningsenheden for Almen Praksis, Eksterne centre, Københavns Universitet6 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet7 Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
Abstract AIM: To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. METHODS: This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively. RESULTS: Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22-30.61). The same trend was seen for 'poor' vs 'good' influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65-18.84). Of 1058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. 'Poor' vs 'good' influence of the patients' own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40-14.92). When general practitioners assessed the influence of patients' life circumstances as 'poor' vs 'good', the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22-7.24). 'Poor' vs 'very good' patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models. CONCLUSIONS: General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications.
Diabetic Medicine, 2014, Vol 31, Issue 11, p. 1468-76
The Faculty of Health and Medical Sciences; Type 2 diabetes; Amputation; Foot ulcer; Predictors; Follow-up; Lifestyle; Motivation; Journal Article; Research Support, Non-U.S. Gov't; Combined Modality Therapy; Cross-Sectional Studies; Denmark; Diabetes Mellitus, Type 2; Diabetic Foot; Female; Follow-Up Studies; Humans; Incidence; Life Change Events; Male; Middle Aged; Patient Compliance; Prevalence; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Self Care; Sex Factors