Impact of mandatory foot exam for a population at risk: Big difference. Short Time.

Here’s some fascinating data from our SALSAmigo Mohamad al Derwish in Riyadh presented at the ISDF 2015 in The Hague. The summary: Going from 60% to 90% of patients receiving a comprehensive diabetic foot exam appears to have reduced the number of ulcers by more than half.

Impact of mandatory foot exam in the pre-clinic of university diabetic center setting Mohammed Derwish, University Diabetes Center, Riyadh, Saudi Arabia

Introduction: The prevalence of diabetes among Saudi population is almost 24%, and mainly type 2 due to lifestyle changes and some genetic background. It is generally assumed that regular foot exam may reduce the burden of diabetic foot ulceration. So, appropriate patient foot exam in the pre-clinic setting will enhance lower limb salvage. King Saud University diabetes center is a referral center dealing with more than 15 000 diabetic patients yearly.

Aim: We sought to implement a mandatory foot exam policy referral, in our pre-clinic setting for foot screening and follow up.
Methods: In the pre-clinic diabetic setting policy assessment:, vital signs, body mass index (BMI), hip/waist ratio, mid-stream urine (MSU), gluco-markers, complete blood culture, lipid and hormonal profile, and foot exam are implemented. 42 641 diabetic patients visits in the pre-clinic rooms were examined during 3 years, among them 34 169 patients were referred, to the foot unit between 2011 and 2013 for further evaluation. In the foot unit patients were screened for, neuropathy, vasculopathy, dermatology, musculoskeletal assessment and pedorthic evaluation.

Results: In 2011, 2012, and 2013: 9596 patients with 84 ulcers, 11 616 patients with 83 ulcers, and,  12984 patients with 36 ulcers were found respectively. The number of screened patient for pedal ulceration decreased significantly (see Table) after the mandatory foot exam referral implementation while the number of examined cases increased. Most of them were pick it up earlier and manage in timely manner except 4 cases were sent for further vascular consultation.


Conclusion: The mandatory referral showed an increased number of examined patients with less foot ulceration over 3 years which underlines the role and urgent need of mandatory foot exam referral in our community diabetes center settings.

3 thoughts on “Impact of mandatory foot exam for a population at risk: Big difference. Short Time.

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  1. Hello David, the decrease in ‘found ulcers’ after 2012 in the Riyadh study suggests some type of intervention. Any data on how this was achieved; ie education, supplying off-loading etc?

    1. Charlie: We have seen this before. It actually may be the increased surveillance catching people who were very high risk (ADA Foot Risk category 3) in the first year or year and a half that led to the decreased number of wounds in year three. Either way, this is good news!!!

  2. There is an association alright , wether it’s cause and effect or not needs a different study altogether. As you said, it’s good news either way 😊

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