Patients with diabetes require continuous comprehensive medical care and self-management education to prevent acute complications. Of all the complications of diabetes, damage to the extremities that necessitates successive amputations emerged as a high predictor of morbidity and mortality. Studies have shown that when patients are passive about appropriate foot self-check, the incidence of foot ulcers and amputations is likely to rise. Gaps in the delivery and coordination of health care still exist among people with different socioeconomic status, such as those with low incomes and less education; however, differences in sex also exist across racial and ethnic groups in diabetes care.

Our results showed significant differences in the likelihood of patients performing a proper foot self-check. Patients who had better general awareness tended to check their feet more often. This specific finding, however, may provide an opportunity for diabetes-management programs to fully engage patients in their own care, perhaps through intensive education programs or close coordination with nurses or allied health care workers.

Also, regardless of how well aware African-American and male diabetic patients were of their condition, they tended to perform foot self-check less frequently. Again, this particular finding may give direction to disease-management programs or clinical interventions, perhaps with a targeted approach to these subgroups. erectalis 20 mg

Patients who were older, who were African-American, and who smoked were generally less aware of their diabetes condition. This information is valuable in guiding education programs to address specific at-risk populations.


Some limitations to this study should be noted. It is possible that using a single variable as a measure of diabetes foot self-check might result in bias. However, given that the goal was to obtain a general indication of the presence of foot self-check, we believe that the measure we used was an appropriate approximation.

The nature of self-reported data calls for potential concerns about overreporting as a consequence of the “Hawthorne effect.” Patients may overreport twice as frequently as they underreport; thus, the information collected on foot self-check is likely to be an overestimate of the true behavior.

Patients were included in this study on the basis of their having uncontrolled diabetes; therefore, they were not representative of the overall population of at-risk patients. It is possible that selection bias resulted in excluding all those who performed more regular foot self-checks and who were more likely to keep their diabetes under control.


Our ultimate aim in publishing this article is to draw the attention of the medical and health care community to the frequency and importance of foot check self-management among diabetic patients and the risk factors associated with poor self-management. The results of our study might be helpful if they are used to inform education programs and foot self-check follow-up interventions targeted to high-risk patients.
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