Patient Knowledge and Habits as Predictors of Foot Complications in Diabetes: A Cross-Sectional Study

This cross-sectional study aimed to identify patients' awareness of predictors of diabetic foot complications (DFCs) based on 1) knowledge of hemoglobin A1c (HbA1c), 2) performance of fasting blood glucose (FBG) at home, and 3) type of footwear used and relationship with DFCs.

A total of 4,652 diabetic patients were seen between 2006 and 2021 at Dr. Khalid Edrees Specialized Medical Center. A questionnaire was completed by trained nurses at the patients' initial visit, collecting patients' knowledge of the HbA1c test, monitoring of FBG at home, and type of footwear used at the time of the visit. History of foot ulcers, current foot ulceration (CU), and history of lower limb amputation (LLA) were obtained.

The majority of our cohort were male (60%), and the mean age was 60 years (SD, 17.5 years). Ninety-six percent had type 2 diabetes, and 39% were diagnosed with diabetes for at least 11 years. More than half did not know what HbA1c was, 32% were not doing home FBG, and 62% were using inappropriate footwear. Fifty-two percent had a CU, 35% had a history of foot ulcers, and 13% had an LLA. We found a significant association between CU and knowledge of HbA1c and type of footwear (P < .001). Similarly, LLA was significantly associated with all of the aforementioned variables (P < .001). A history of foot ulcers was significantly associated with knowledge of HbA1c and type of footwear (P = .001) but not with home FBG.

A high proportion of patients in our cohort had never heard of HbA1c and were using traditional footwear. This highlights the importance of patient education regarding the basics of diabetes and the use of appropriate footwear in preventing DFCs.