INTRODUCTION If you did not seek treatment for your illness,
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
diabetes mellitus patients are susceptible to complications such as heart diseases, strokes, high blood pressure, blindness, kidney diseases, nervous system diseases, amputations,
dental diseases and complications during pregnancy. Biochemical imbalances that cause acute life-threatening events such as diabetic ketoacidosis DKA and hyperosmolar non-
ketotic coma are often caused by uncontrolled diabetes. Diabetic patients are more susceptible to other illnesses such as pneumonia or influenza and are more likely to die
of complications compared to the people who do not have diabetes.
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When circulation or nerves are impaired, diabetic patients may develop serious foot problems more quickly and they tend to develop more complications compared to
healthy people.
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Diabetic neuropathy is the most common and potentially dangerous foot problem.
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It can cause insensitivity or loss in ability to feel pain, heat or cold.
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Foot problems are a leading cause of hospitalisation and it was estimated that 15 of all people
in the United States with diabetes, will develop a serious foot condition some time in their lives. In the United States, more than 50,000 people each year with diabetes have a foot
or leg amputated due to diabetes complications.
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These amputations can be prevented with early detection and prompt treatment. Diabetic patients tend to disregard lesions,
burns, bunions and other foot maladies. Diabetic neuropathy can also affect the muscles of the feet causing deformity such as hammertoes. More than 60 percent of non-traumatic
lower-limb amputations occur among people with diabetes and 30 percent of diabetics suffer from peripheral vascular disease.
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Currently, the diabetic foot care programme in Malaysia is based on the Clinical Practice Guideline CPG on the Management of Diabetic Foot, which was issued in 2003 by the
Ministry Of Health. The CPG had been compiled by a committee comprising of orthopaedic and vascular surgeons from the public and private sectors. The CPG helps identify patients
at risk for foot complications and also serves as a guide for the management of foot disorders in Malaysian diabetic patients. This guideline consists of diagnostic methods
and evaluation, identification of risks factors, classification of diabetic foot problems with its appropriate treatment and management. According to this guideline, 30 of the total
diabetes registry should be evaluated under Quality Assurance Program to assess the effectiveness of the programme.
For the district of Larut Matang Selama LMS, 6000 diabetics have been officially recorded into the diabetes registry and this number is increasing every year. A number
of activities have been put in place to reduce the complication rate and the foot care programme is one of them.
This study aims to evaluate the effectiveness of the implementation of the foot care programme in the District of LMS.
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Figure 1: Evaluation of problems faced in the implementation of foot care program among diabetic patients
Is the current diabetic foot care programme implemented effectively?
Patient factor
Staff problems
Limited strips
Tools Staff not
interested Communication
barrier Budget to
trained staff Staff over
burden
Patient’s lifestyle
Limited awareness
Poor compliance to medication
Improper appointment
Organization of diabetic clinic
Unorganized staffing
Over-crowded patient
Time
Communication barrier Foot wear
Inadequate tools in certain places
Place for foot examination
Rate of diabetic foot
complication
Assessment
Poor education Easily
understood? Poor blood
sugar control Poor compliance with
programme Manual
procedure Process of foot
care
Inadequate training in using tools
Limited staffing Staff turnover
Limitedinadequate training of staff
Check-list Organization of the
clinic
Figure 1. Evaluation of problems faced in the implementation of foot care program among diabetic patients
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting