2.  Diabetes global epidemic  Diabetes related complications far outweigh prevalence rates in Maori  No standardised podiatry assessment in New Zealand  No specific podiatry diabetes course in New Zealand

3.  Determine key characteristics to establish a standardised and EVB assessment  Nationwide assessment for people with diabetes  Primary Health care setting

4.  120 patients recruited from two Maori PHO’s  Inclusion criteria: >18years with T2DM, Maori, no ‘Get Checked’ 1 >12mths / or demonstrated absence of pedal pulse, sensation, previous PVD history or ulceration.  53 patients included in study 1 New Zealand Guidelines Group: Management of Type 2 Diabetes, Wellington: 2003.

5.  Demographic / Clinical Characteristics  General Medical Characteristics  Vascular, Neurological & Musculoskeletal Foot Characteristics  Foot Education Characteristics

6. Demographic & Clinical characteristics Median age - 54 years Median BMI - 35.7 (kg/m 2 ) Diabetes Duration - 15 years % of patients with HbA1c >8% continuously – 42% Insulin (21%) OHAs (91%) diet (85%)

7. General Medical Characteristics % Nephropathy – 28% % Retinopathy – 21% % Dyslipidaemia – 55% % Hypertension – 49%

8. Vascular / Neurological / Musculoskeletal Characteristics 11% complained of claudication pain 11% pedal pulses detectable with Doppler only Ankle-brachial index median = 1.1mmHg (DP) Neuropathy Symptom/Disability score = 2 70 % dry skin 59 % restriction in ankle joint 21 % prayer sign 58 % pre-ulcerative lesions (Wagner scale)

9. Foot Education Characteristics 57% daily foot inspection 32% inspected footwear 34% regular moisturiser 1,2 98 % benefits of good glycaemic control 98 % the role of HT, dyslipidaemia and hyperglycaemia on foot health 86 % smoking effects on circulation 1 Ronnemaa et al (1997) Diab Care 20:1833-37. 2 Calle-Pascual et al (2002) Diab Res Clin Prac 57:111-117.

10.  64% of patients required more than 6 monthly visits to the podiatrist for review

11.  Podiatrists have an integrated role in the multidisciplinary team  Aim is to upskill podiatrists on evidence- based medicine assessment

12. Health Research Council New Zealand (05/286) Te Puna Hauora O Te Raki Pae Whenua PHO, Tamaki PHO, Raukura Hauora o Tainui PHO, and Waiora PHO