, Volume 62, Issue 1, pp 250–258 | Cite as

People with diabetes do not learn and recall their diabetes foot education: a cohort study

  • Julia YunckenEmail author
  • Cylie M. Williams
  • Renerus J. Stolwyk
  • Terry P. Haines
Clinical Management of Endocrine Diseases



Diabetes education for those patients at risk of diabetes complications remains a mainstay of diabetes treatment. This study aimed primarily to determine the retention of foot health information 6 months post delivery of education. The secondary aim was to determine the type and delivery method of diabetes-specific foot health information during a podiatry consultation.


This study was a prospective cohort study with two groups: patients with diabetes and their treating podiatrist. Baseline data collection included educational topics and delivery methods discussed during the consultation. The Problem Areas in Diabetes Questionnaire (PAID) and perceived key educational message were collected from each group's perspective at baseline and 6 months afterwards.


Three podiatrists and 24 participants with diabetes provided information at the two time points. At baseline, the key messages of 14 (58%) patient participant responses differed from their podiatrists and 15 (63%) differed 6 months later. Education covered up to seven separate topics, including neurological impact of diabetes, vascular supply and general foot care. The majority of consultations (n = 23, 96%) covered three or more topics.


Education is vital to effective treatment of people with diabetes. Current common approaches used in individual consultations such as verbal explanations appear ineffective in aiding the learning and retention of podiatry-specific diabetes education. This study highlights the need for research investigating more effective methods to deliver key education to this population to aid retention and therefore assist behaviour change.


Podiatry Diabetes education Foot education Education retention 



Blood sugar level


Interquartile range


Montreal Cognitive Assessment


Problem areas in diabetes questionnaire


Standard deviation



JY is support through an Australian Government Research Training Program. CW is supported by a National Health and Medical Research Council Early Career Health Professional Fellowship. This research did not recieve any additional funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research was approved by the Human Research Ethics committee of Peninsula Health (LRR/14/PH/14).


  1. 1.
    International Diabetes Federation. International Diabetes Federation 7th Atlas. 2015; Accessed 1st September 2017.
  2. 2.
    Baker IDI. National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes). In: Baker IDI, ed. Melbourne, Australia: Commonwealth of Australia; 2011.Google Scholar
  3. 3.
    Shaw J, Tanamas S. Diabetes: The silent pandemic and its impact on Australia. Australia: Baker IDI Heartand Diabetes Institute; 2012.Google Scholar
  4. 4.
    J.A.N. Dorresteijn, D.M.W. Kriegsman, W.J.J. Assendelft, G.D. Valk, Patient education for preventing diabetic foot ulceration. Cochrane Database Syst. Rev. 12, CD001488–CD001488 (2014)Google Scholar
  5. 5.
    CB How, V Rimke, H Monique, M Maria-Inti, SR JPM, et al. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus.Cochrane Database of Systematic Reviews 9, CD011469 (2015).Google Scholar
  6. 6.
    M Attridge, J Creamer, M Ramsden, R Cannings-John, K Hawthorne, Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 9, CD006424 (2014).Google Scholar
  7. 7.
    Practitioners TRACoG. General practice management of type 2 diabetes: 2016–18. 2016; Accessed 1st March, 2018.
  8. 8.
    Victorian Government Department of Health. Community Health Priority Tools. In: Department of Health, ed. Victoria, Australia: Victorian Government Department of Health; 2009.Google Scholar
  9. 9.
    Z.S. Nasreddine, N.A. Phillips, V. Bedirian, S. Charbonneau, V. Whitehead et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 53, 695–699 (2005)CrossRefGoogle Scholar
  10. 10.
    Snoek FW, G. Problem Area in Diabetes (PAID). Adapted from DAWN Interactive 2. 2006; Accessed 1st September 2017.
  11. 11.
    Stata 13 [computer program]. 1985-2016 Texas, United States of America: StataCorp.Google Scholar
  12. 12.
    Portney LG, Watkins MP. Foundations of Clinical Research: Applications To Practice. United States of America: F.A. Davis Company/Publishers.Google Scholar
  13. 13.
    G. Ekong, J. Kavookjian, Motivational interviewing and outcomes in adults with type 2 diabetes: a systematic review. Patient Educ. Couns. 99, 944–952 (2016)CrossRefGoogle Scholar
  14. 14.
    D. Kent, G.D. Melkus, P.W. Stuart, J.M. McKoy, P. Urbanski et al. Reducing the risks of diabetes complications through diabetes self-management education and support. Popul. Health Manag. 16, 74–81 (2013)CrossRefGoogle Scholar
  15. 15.
    E. Loveman, G.K. Frampton, A.J. Clegg, The clinical effectiveness of diabetes education models for type 2 diabetes: a systematic review. Health Technol. Assess. 12, 1–136 (2008)Google Scholar
  16. 16.
    K. Wolff, L. Chambers, S. Bumol, R.O. White, B.P. Gregory et al.The PRIDE (Partnership to Improve Diabetes Education) toolkit: development and evaluation of novel literacy and culturally sensitive diabetes education materials. Diabetes Educ. 42, 23–33 (2016)CrossRefGoogle Scholar
  17. 17.
    A. Coppola, L. Sasso, A. Bagnasco, A. Giustina, C. Gazzaruso, The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 53, 18–27 (2016)CrossRefGoogle Scholar
  18. 18.
    J. Speight, E. Holmes-Truscott, D.M. Harvey, C. Hendrieckx, V.L. Hagger et al.Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: The OzDAFNE program. Diabetes Res. Clin. Pract. 112, 65–72 (2016)CrossRefGoogle Scholar
  19. 19.
    P.L. Rickheim, J.L. Flader, T.W. Weaver, D.M. Kendall, Assessment of group versus individual diabetes education—a randomized study. Diabetes Care 25, 269–274 (2002)CrossRefGoogle Scholar
  20. 20.
    C. Gazzaruso, M. Fodaro, A. Coppola, Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 53, 347–349 (2016)CrossRefGoogle Scholar
  21. 21.
    M.B.R. Callisaya, C. Moran, W. Wang, T.G. Phan, V. Srikanth, Longitudinal associations of type 2 diabetes mellitus with cognitive decline and brain atrophy. Alzheimers Dement. 13, P1425 (2017)CrossRefGoogle Scholar
  22. 22.
    C.A.P. Landim, M.L. Zanetti, M.A. Santos, T.A.M. Andrade, C.R.S. Teixeira, Self-care competence in the case of Brazilian patients with diabetes mellitus in a multiprofessional educational programme. J. Clin. Nurs. 20, 3394–3403 (2011)CrossRefGoogle Scholar
  23. 23.
    L.F. Fan, S. Sidani, A. Cooper-Brathwaite, K. Metcalfe, Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk for foot ulceration: a pilot study. Can. J. Diabetes 37, 195–201 (2013)CrossRefGoogle Scholar
  24. 24.
    M. Ren, C. Yang, D.Z. Lin, H.S. Xiao, L.F. Mai et al. Effect of intensive nursing education on the prevention of diabetic foot ulceration among patients with high-risk diabetic foot: a follow-up analysis. Diabetes Technol. Ther. 16, 576–581 (2014)CrossRefGoogle Scholar
  25. 25.
    C.A. Chrvala, D. Sherr, R.D. Lipman, Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ. Couns. 99, 926–943 (2016)CrossRefGoogle Scholar
  26. 26.
    M. Trento, P. Passera, E. Borgo, M. Tomalino, M. Bajardi et al. A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care 27, 670–675 (2004)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Peninsula HealthCommunity HealthFrankstonUSA
  2. 2.Department of PhysiotherapyMonash UniversityFrankstonUSA
  3. 3.School of Psychological SciencesMonash UniversityClaytonUSA
  4. 4.Monash Institute of Cognitive and Clinical NeurosciencesClaytonUSA
  5. 5.Monash-Epworth Rehabilitation Research CentreRichmondUSA
  6. 6.Monash Health, Allied Health Research UnitKingston CentreCheltenhamUSA
  7. 7.Department of School of Primary and Allied Health CareMonash UniversityFrankstonUSA

Personalised recommendations