Patient Knowledge and Self-Care Can Improve Diabetic Foot Ulcer Healing

Patient behavior and lifestyle is driven not by the abstract designation of being “at risk”, but by the patients' own knowledge and perceptions of their risks. Thus, if patients are not aware of and do not believe that Diabetic Foot Ulcer (DFUs) will lead to amputation they are less likely to comply with treatment protocols and change behaviors to reduce ulcer risk. Improving patient knowledge of foot care and diabetes self-care activities is especially important as ulceration of the foot and its recurrence affect 15% to 25% of individuals with diabetes at some time in their lives, and the risk of a lower extremity amputation is much higher in this group than those without diabetes. Patient knowledge is antecedent to effective wound care and healing outcomes. Although there is a large amount of literature on the diabetic foot and the importance of foot care, there is a lack of research on patients' knowledge of the disease, self-care activities, and foot care practices. This study examined diabetes knowledge and foot care behaviors from a sample of 116 DFU patients (66 White, 36 Black, 12 Hispanics, 3 American Indian) treated at the four Wound Centers in Texas and Ohio. Survey questionnaire and consent forms (in English and Spanish) were administered by the research nurse. Foot care was assessed by 5 questions on foot care from the Summary of Diabetes Self-Care Activities (SDSCA) and one additional question “How many times in the last seven days did you check your feet for red areas, blisters, dryness or cracking”. The patient's knowledge was assessed by 13 questions testing their knowledge about diabetes and its complications (n=7) and foot care (n=6). Mean age was 60.6±11.9 years, with low levels of education (48% had a High School education or less), and socioeconomic status (59% on Medicare/Medicaid). Results indicated White DFU patients had significantly higher foot care score (P=0.04) and marginally higher diabetes knowledge than Black and Hispanic DFU patients. As most DFU patients are managed in an outpatient setting, a patient's knowledge of diabetes, foot care, and self-care (medications, blood glucose monitoring, diet, and physical activity) can reduce the existence of disparities in DFUs and resultant amputation in the United States. Efforts should also be made to provide health education to include lifestyle behaviors such as smoking, poor diet/malnutrition, physical inactivity, and obesity that compromise the vascular system and impedes wound healing.