Diabetic Foot Evaluation in Family Medicine

Introduction: Diabetes mellitus is characterized by the lack of glycemic control, which may cause damage to the small and large blood vessels and nerves, which could, among the other things, lead to changes in the foot. Most of diabetic foot complications that resulted in amputation begin with the formation of skin ulcers. The most important risk factors and predictors of diabetic ulcers are the presence of diabetic neuropathy and structural foot deformities, infections and peripheral occlusive arterial disease. Smoking, hypertension and hyperlipidemia also contribute to the increased prevalence. Objective: To analyze the effectiveness of recommended interventions, conducted by family medicine team, for the prevention of diabetic foot ulcers. Patients and methods: Data from the medical records of all patients with type 2 diabetes in the family medicine team 1 of Public Health Institution - Healthcare Center Kalesija were retroactively analyzed. Interventions that were implemented in the prevention of diabetic ulcers are as follows: screening for diabetic neuropathy using Semmes- Weinstein’s monofilament, regular and systematic examination of footwear and feet, education of patients and family members about proper hygiene and foot care, daily foot inspection by the patient, and other possible effective clinical interventions such as: optimizing the values of blood pressure, blood glucose, hyperlipidemia and smoking cessation. Results: From total of 80 patients with type 2 diabetes, in 45 (56%) was established peripheral neuropathy. From these 45 patients with neuropathy, in 40 (88%) there has been no development of ulcers due to regular implementation of recommended interventions for prevention during each visit, and in 5 patients (12.5%) the disease led to the development of diabetic ulcers. Of these 5 patients with diabetes that developed diabetic ulcer, 2 (40%) underwent amputation due to poor communication and cooperation, irregular visits and the impossibility of implementing intervention and prevention measures. Conclusion: The family medicine has a central role in the prevention and early diagnosis of diabetic foot complications. Patients with diabetes may benefit from preventive interventions, including screening for neuropathy, educating patients on every visit, wearing proper footwear, intensive care and supervision, as well as early identification of high risk for amputation and evaluation for surgical intervention. A multidisciplinary team approach is vital in the management of diabetic foot. Regular, careful and systematic review of the feet of patients with diabetes is one of the easiest, cheapest and most effective preventive intervention and measure for the prevention of diabetic foot complications.