Open Access Highly Accessed Research article

Useful screening tools for preventing foot problems of diabetics in rural areas: a cross-sectional study

Chia-Hao Chang12, Yun-Shing Peng3, Chang-Cheng Chang4 and Mei-Yen Chen5*

Author Affiliations

1 Department of Nursing & the Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan

2 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan

3 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chiayi, Taiwan

4 Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

5 Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan

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BMC Public Health 2013, 13:612  doi:10.1186/1471-2458-13-612

Published: 27 June 2013



Preventing diabetic foot problems (DFP) and their associated consequences is a critical in rural regions. The objective is to present an association of non-invasive DFP assessment tools and physiological indicators for early detection among rural cases of diabetes in Taiwan.


Secondary data analysis of 387 participants previously diagnosed with type 2 diabetes was used. The Michigan Neuropathy Screening Instrument (MNSI), Ankle Brachial Index (ABI), optimal scaling combination (OSC) of MNSI, and age were used to examine peripheral neurovascular function. The King’s College classification (KC) and Texas risk classification (TRC) were used to understand diabetic foot complications.


The findings indicated that MNSI was negatively correlated with ABI, but positively with diabetes duration, age, KC, TRC, fasting blood glucose, low density of lipoprotein cholesterol, body mass index and waist circumference. The area under the receiver operating characteristic curves for assessing the risk of ABI based on OSC was larger than for MNSI, KC, and TRC.


It is shown that using OSC, MNSI, and ABI as community screening tools is useful in detecting early neurovasculopathy. In addition, where an ABI machine is unavailable, primary healthcare providers that perform MNSI or OSC may be cost-effective. The study was approved by the institutional review board of the ethical committee (No 98-2224-B).

Diabetic foot problems; Michigan neuropathy screening instrument; Ankle brachial index; Receiver operating characteristic curves