Racial Variation of Regular Foot Examination Among Diabetics in California

Shaheen, Magda

Purpose: This study aims to examine the racial variation and determinants of having foot examined among adult diabetics in California using the guidelines by American Diabetes Association (ADA).

Rationale/Conceptual Basis/Background: Diabetic foot is one of the common diabetes-associated complications. Regular annual foot examination is an inexpensive tool used for early detection and prevention of complications.

Methods: We analyzed data from the 2005-2012 California Health Interview Survey (CHIS) which is a cross-sectional survey using telephone interview of random sample of California adults (un-weighted sample of 17,671 diabetic adults). We examined the relationship between having foot examined last year and demographics, insurance, health status, diabetes duration, and had hemoglobin A1c last year. The data were analyzed using the survey module in STATA 14 taking into consideration the sample design and the sample weight.

Results: Of 17,671 diabetics, 30% did not have their foot examined within one year [30% in Hispanics, 39% in Asian, 26% in others, 20 in Blacks and 28 in White, p<0.05]. In the multivariate model, foot examination within one year was associated with race/ethnicity, age, gender, education, insurance, diabetes duration, had co-morbidity, had HbA1c checked last year, and self-perceived health status (p<0.05). Elderly males who are Asian or Hispanic with no insurance, and perceived their health as fair/poor have higher adjusted odds of not having their foot examined within one year relative to the other groups (p<0.05).

Implications: Uninsured elderly Asians or Hispanics diabetics had higher odds of not having foot examined in a year. With high percentages of diabetics diagnosed annually, there is a need for evidence based, culturally informed campaigns and interventions to increase awareness around diabetic screenings among these vulnerable populations. Nurses and healthcare providers must be vigilant in identifying and managing the diabetic foot for the vulnerable population by providing adequate and convenient awareness, education, and follow-up care.