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Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Aim
We investigated the predictive value of patients’ motivation and effort in type 2 diabetes management as well as patients’ life circumstances for development of foot ulcers and amputations.

Methods
This study was based on the Diabetes Care in General Practice study and Danish population and health registers. Patient motivation, effort and life circumstances were related to foot ulcer prevalence 6 years after diabetes diagnosis and amputation incidence in the following 13 years by odds ratios (OR) from logistic regression and hazard ratios (HR) from Cox regression models, respectively.

Results
Six years after diabetes diagnosis foot ulcer prevalence was 2.93% (95% CI 1.86-4.00) among 956 patients. Doctors’ indication of Poor vs. Very Good patient motivation for diabetes management was associated with higher foot ulcer prevalence (OR 6.11, 95% CI 1.22-30.61). The same trend was seen for Poor vs. Good influence of the patient’s own effort in diabetes treatment (OR 7.06, 2.65-18.84). Of 1,058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. Poor vs. Good influence of the patients’ own effort was associated with amputation (HR 7.12, 95% CI 3.40-14.92). When doctors assessed the influence of patients’ life circumstances as Poor vs. Good, the amputation incidence increased (HR 2.97, 1.22-7.24). Poor vs. Very Good patient motivation was also associated with increased amputation incidence (HR 7.57, 2.43-23.57), although not in fully adjusted models.

Conclusions
Doctors’ existing knowledge of patients’ life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications.
OriginalsprogEngelsk
TidsskriftDiabetic Medicine
Vol/bind31
Udgave nummer11
Sider (fra-til)1468-76
Antal sider9
ISSN0742-3071
DOI
StatusUdgivet - 14 jul. 2014

ID: 111443734