Background
There is limited epidemiological research that reports on the foot-
health of people with diabetes within Australian regional settings.
The objective of this two-year follow-up analysis was to explore inci-
dent diabetes-related foot morbidity and mortality in people residing
in Northern Tasmania.
Methods
Adults with diabetes were recruited from predominately community-
based, publicly-funded podiatric services in regional Tasmania. The
primary variable of interest was the incidence of foot ulceration,
lower limb amputation and death. Other variables of interest were
age, sex, rurality, socio-economic disadvantage, diabetes type and
duration, knowledge of diabetes and smoking status. The main out-
come was incidence of foot morbidity (foot ulceration, lower limb
amputation or death) per 100 person-years. A survival analysis was
conducted to determine median time to each morbidity outcome.
Results
There were 445 Tasmanian patients (264 males and 181 females)
who completed baseline assessments. Mean age at baseline was 65
(SD 12.9, range 19-97). Sixty-two (13.9%) participants had type I dia-
betes and 383 (86.1%) had type II. Three hundred and fifty-three
(79.3%) participants had at least one follow-up visit, with 285 (64.0%)
participants still being followed-up at 12 months, 248 (55.7%) at 18
months and 203 (45.6%) at 24 months. Median number of follow-up
visits = 10 (IQR 4, 22, range 1, 98). There were 57 deaths (12.8%).
There were 157 (35.3%) new ulcers during the study period and 24
(5.4%) new amputations. Risk factors for worsening foot morbidity
over time and the results of the survival analysis will also be
presented.
Conclusions
Public podiatric services in regional Tasmania are managing patients
at significant risk of serious diabetes-related foot morbidity. The two-
year incidence of ulceration and amputation is high, and the propor-
tion of participants who died after two years is an important finding
in the Australian context. Patients presenting to these regional public
podiatry services require multi-disciplinary health care in accordance
with national and international guidelines. There is a potential dispar-
ity between current funding models for these services and the level
of diabetes-related foot morbidity the services are managing.