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Something is afoot in south central Idaho. After 2 years of work, the percentage of people with diabetes receiving recommended annual foot examinations has increased by 13.8%, exceeding the state average. This turnaround, from being the region with the lowest percentage of foot examinations in the state, was made possible when South Central District Health joined diabetes coalition members to develop a comprehensive program that maximizes limited resources in the rural, 8-county service area.
Key program components include (1) development of a curriculum on CD-ROM called 2 Minute Diabetes Foot Examination, (2) training area physicians and nurses in the curriculum, (3) incorporating the curriculum into the nursing program at the local college, (4) offering free foot-screening clinics to targeted populations, and (5) conducting public education and outreach.
Studies show that diabetes is the most frequent cause of all nontraumatic lower limb amputations in the United States, accounting for 82 000 amputations per year.1 Because people with diabetes are vulnerable to nerve and vascular damage, poor circulation, and poor healing of foot ulcers, the American Diabetes Association recommends that all individuals with diabetes receive a thorough foot examination, at least annually, to identify high-risk foot conditions and prevent amputations.
Unfortunately, aggregated data from the 1997-1999 Idaho Behavioral Risk Factor Surveillance System (BRFSS) showed that only 52.7% of people with diabetes in south central Idaho had received a foot examination in the previous year. This was the lowest percentage in the state.2
Resources are limited in south central Idaho. The region comprises 6 rural and 2 frontier counties (those with fewer than 6 people per square mile) with 162 284 residents, according to the 2000 census. There is no mass transit system, and over 91% of the 11 500-square-mile region is designated a health professional shortage area in primary care.3
These were the problems that the Magic Valley Diabetes Coalition chose to address. This local coalition, which is facilitated by South Central District Health, originally comprised dietitians, nurses, certified diabetes educators, physicians, and people with diabetes. Podiatrists joined once the coalition decided to focus on foot examinations. One podiatrist expressed great concern with the growing number of diabetic amputations nationwide and thought that local physicians were not conducting preventive foot examinations owing to lack of knowledge,...