Adherence to treatment recommendations and emotional status: older adults with and without diabetic foot complications

Abstract

Background: Age is a risk factor for diabetes. Diabetic foot (DF) is a serious complication of diabetes. Ongoing worldwide efforts to prevent this complication include a global evidence-based guidance on its prevention that emphasizes patients' education on appropriate self-care practices. This study aimed to evaluate differences between individuals with DF and individuals with diabetes without complications (NoDF) regarding adherence to medical recommendations and emotional well-being. Method: This case control study included 99 individuals with DF [58y±6.9, diabetes duration 15.1 years, 76% males]; and 95 controls [(61y±7, DD 13.4, 76% males]. Groups were matched for duration and gender. They completed: The Summary of Diabetes Self-Care Activity; The Patient Health Questionnaire (PHQ-9) for depression assessment; WHO-5 well-being index; Single General Self Rated Health Question. Additionally Hemoglobin A1c levels and BMI that may be considered as indicators of adherence were also collected. Results: DF had lower adherence to exercise, and higher adherence to blood tests. Adherence to nutrition was similar. Compared with NoDF, DF had higher hemoglobin A1c (8.81*** vs 7.56) and BMI (30.13** vs 28.17). DF had a higher risk for developing major depression compared to NoDF, with Odds Ratio>6. Perceived health and quality of life were significantly lower among DF. Adherence to nutritional and physical activity recommendations were positively associated with lower depression and higher quality of life and perceived health. Conclusions: Adherence to medical recommendations among DF was rather poor. Additionally, the DF complication seems to negatively affect the patients' emotional status beyond that known in the general diabetic population.