Educational attainment as a predictor of diabetic foot disease: a quasi-experimental baseline analysis among type 2 diabetics in Kiambu, Kenya

Background: Diabetic foot disease is a chronic complication of diabetes mellitus, often overlooked and missed due to under-reporting of symptoms or the omission of routine foot examinations during diabetic clinic visits. This study sought to evaluate the individual-level factors that predispose to diabetic foot disease among patients with type 2 diabetes. Methods: A quasi-experimental study design was employed. A total of 188 respondents were engaged via the administration of a semi-structured questionnaire to collect data on their individual-level factors, such as sociodemographic characteristics and behavioral habits, like cigarette smoking, alcohol drinking, co-morbid conditions like hypertension, and their foot care practices. Central tendency measures were calculated in descriptive analysis. Univariate and multivariable analyses were carried out to reveal predictors significant at 95% confidence interval (p<0.05). Multivariable analysis was preceded by selecting specific variables using multicollinearity tests and forward stepwise selection based on the Akaike information criterion, followed by computing the coefficients to adjust for confounding factors. Results: The level of education was statistically significant, p=0.004 and p=0.006 at univariate and multivariable analysis, respectively. Conclusions: The study concluded that the level of education was the single most important predictor for diabetic foot disease among type 2 diabetic patients, affecting the behavioral and clinical factors of a type 2 diabetic patient, leading to the development of diabetic foot disease.  The study recommended the design of diabetic health education and promotive programs in a language that is cognizant of the low level of education amongst the diabetic patients attending the diabetic clinics.