Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes

OBJECTIVE: The aim of this work was to study the frequency of examining for diabetic eye and foot complications in an Australian population and to study factors associated with regular screening. RESEARCH DESIGN AND METHODS: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. Participants identified as having previously diagnosed diabetes (n=475) were invited to participate in the complications study. Measures included foot examination, retinopathy photography, and self-report use of health care services. RESULTS: Seventy-seven percent of participants reported having an eye examination within the previous 2 years, and 50% reported having their feet examined by a health professional in the previous year. Type of diabetes treatment (odds ratio 1.46, 95% CI 0.85-2.50 for tablets versus diet alone and 4.17, 1.71-10.17 for insulin or insulin and tablets versus diet alone) and visiting a diabetes nurse educator in the previous 12 months (2.14, 1.18-3.87) were independent predictors of having had an eye examination. Duration of diabetes (1.33, 1.06-1.67 per year) and visiting a diabetes nurse educator in the previous 12 months (1.89, 1.20-2.95) were independent predictors of a foot examination. CONCLUSIONS: This study has shown that retinopathy screening is performed more frequently than foot screening in Australia. This may be due to the implementation of eye screening programs and awareness campaigns. Foot screening appears to be poor, with less than one-half of the population reporting a regular examination for foot complications. In Australia, diabetes nurse educators play a key role in promoting screening for diabetes complications.