Exploring Diabetic Foot Exam Performance in a Specialty Clinic.

Detection of diabetic foot complications is key to amputation prevention. This study used survey and retrospective record review to examine the relationship between frequency and performance of clinician's diabetic foot examinations on performance of patient home self-foot examinations. An additional aim was to assess clinician performance of annual foot examination per American Diabetes Association (ADA) guidelines in a specialty clinic. The relationships between demographic characteristics, diabetic foot ulcer beliefs, health literacy, HbA1c level, and foot self-exam performance was also examined. No relationship was found between the performance frequency of foot examinations by providers and patient self-examination ( N = 88). The presence of specific barriers to self-management was significantly higher in those patients who did not complete daily home self-foot examinations. Only 16% of patients' charts reviewed met the ADA criteria for a complete annual foot exam. Motivational interviewing during patient visits could be a strategy to break down barriers to self-foot exam performance. Furthermore, the development of an Electronic Medical Record (EMR)-based diabetic foot exam template to improve provider documentation may improve compliance with ADA recommendations.

Prevalence and correlates of dietary supplement use in individuals with diabetes mellitus at an academic diabetes care clinic.

OBJECTIVES: This study sought to describe the prevalence of supplement use by those with diabetes mellitus receiving care at an academic outpatient diabetes care center and to identify any association of supplement use with glycemic control. METHODS: This study is based on a retrospective audit of provider-verified and patient-self-reported medication and supplement use by adults with diabetes at the University of Washington Diabetes Care Center during four 2-week periods from fall 2006 through summer 2007 (1 period per season). RESULTS: Verified medication and supplement histories for 459 adults demonstrated a per-person average use of 7 ± 4.1 prescription medicines and 0.4 ± 0.9 over-the-counter medicines daily, with 55% using some form of vitamin, mineral, or nonvitamin-nonmineral supplement on a daily basis. The rate of nonvitamin-nonmineral use was nearly twice that for type 2 diabetes mellitus as for type 1 diabetes mellitus (39.3% vs 20.3%), and A1c was lower in those using any supplement compared to those not using supplements. Vitamin use was associated with reduced A1c; however, this relationship did not hold at A1c < 7.0%. CONCLUSIONS: The findings highlight the prevalence of supplement use in diabetes mellitus and association of supplement use with improved glycemic control. Findings are limited by the retrospective design.