Educating Patients With Diabetes on Their Podiatric Medical Care

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Hello, my name is Rebecca Cohen and I'm a current fourth-year podiatric medical school student at New York College of Podiatric Medicine. I completed the dual degree program and graduated from Icahn School of Medicine at Mount Sinai with my Master's in Public Health in June 2024. Today I'm going to be discussing my poster presentation for the SAWC Fall 2024, titled “Diabetic Education and Initiation of Podiatric Medical Care,” a survey of podiatrists, endocrinologists, and internal medicine and primary care professionals.
 
Why is referral to a podiatrist so important for patients with diabetes?
 
Diabetes is a chronic disease that continues to increase in prevalence globally. Diabetics can develop foot-related issues, including infections, ulcerations, and gangrene, which can result in amputation and even death. Despite the well-known impact that early intervention in podiatric medical care can have on the outcome for diabetic patients, it remains unclear why there is not more of a clinical emphasis on the importance of early podiatric referral for not only diabetic but also prediabetic patients. The importance of podiatric medical care for the prevention of adverse outcomes and on proper diabetic foot care is a public health issue that can truly improve health outcomes for patients.
 
What did the survey respondents indicate about the timing of patient referral?
 
Though more than half of the respondents, 54.9%, answered that pre-diabetic patients should be referred to podiatry for a diabetic foot check. However, the timeline for referral after initial diagnosis of pre-diabetes greatly varied. 35.3% of respondents said that after initial diagnosis of prediabetes, patients should be referred to podiatry more than 12 months after. But this is followed by the second highest response being that 25.5% of respondents reporting that should be within 3 to 6 months. As you can see, this is evidence of an inconsistent and very wide range of time for podiatric referral for these prediabetic patients. The majority of respondents, 66.7%, answered that prediabetic patients should still have a diabetic foot check performed once a year. Then once diagnosed with diabetes, 80.4% answer that diabetic patients should be referred to podiatry for routine diabetic foot check. And 70.6% answered that even if a diabetic is asymptomatic for podiatric symptoms, that they should still be referred to podiatry.
 
However, once again, the timeline for how soon after the initial diagnosis of diabetes, a patient should be referred to podiatry varied. 33.3% of respondents answered that after initial diagnosis of diabetes, patients should be referred to podiatry within 1 to 3 months. This is followed by 25.5% of respondents selecting that the referral should be within 1 month.
 
What are the most effective ways to educate patients and how can the teach-back method help?
 
So most respondents, 62.7%, reported that it is better to educate patients immediately at an initial visit about all possible complications associated with both prediabetes and diabetes as compared to slowly educating patients over time. The majority of respondents answered that the best way to educate patients about healthcare included a verbal discussion, and 47.1% answered that they use a teach-back method to confirm patient understanding.
 
A teach-back method is a verbal communication method that is utilized by healthcare providers to confirm that patients are truly understanding information that is being presented to them, is done by having the patient explain back to you as the healthcare provider what you previously taught them regarding their health and treatment plan. It allows healthcare providers to identify any potential misunderstandings and correct the important information being shared with the patient about their diagnosis and health plans.
 
Where should future research into this topic lead?
 
So, future research on this topic can lead into the development of standardized clinical care protocols for the timing of pre-diabetes and diabetes diagnosis as well as the referral timeline for podiatric medical care in order to encourage health promotion and disease prevention of diabetes. Each patient's situation is unique, but at first, diabetic patients should be identified early and refer to podiatric medical professionals for an initial visit to pause the progression of their disease and decrease the possibility of adverse outcomes later.
 
Additionally, by effectively communicating with patients and educating them about their potential complications associated with uncontrolled diabetes, many patients can learn how to properly manage their diabetes diagnosis and have improved outcomes for their health and overall well-being.