### Target Population
Designed for patients aged 18-75 with Type 1 or Type 2 diabetes. The measure aims to ensure these patients receive a comprehensive foot exam, which includes visual inspection, sensory exam with a monofilament, and a pulse exam. Patients with bilateral amputations above or below the knee or those who were in hospice care during the measurement year are excluded.
### Recommendations

Clinicians are recommended to conduct an annual comprehensive foot exam for patients with diabetes. 

This exam should include:
 - Visual inspection of the feet.
 - Assessment of foot pulses.
 - Sensory testing for loss of protective sensation using a 10-g monofilament, with additional testing such as vibration using a 128-Hz tuning fork, pinprick sensation, temperature, ankle reflexes, or vibration perception threshold.
### Importance
Foot exams are crucial for diabetic patients due to the high risk of complications like ulcers and amputations resulting from diabetes. Ensuring regular foot exams can help in early detection of issues and potentially prevent serious outcomes such as limb amputations. This measure also aligns with American Diabetes Association guidelines and contributes to reducing the significant healthcare costs associated with diabetes complications.
### Conclusion
Implementing this protocol helps in monitoring and improving the quality of foot care for diabetic patients. By systematically assessing whether patients have received the recommended foot exams, clinicians can ensure adherence to best practices and potentially reduce the incidence of severe complications. This can also streamline clinician workflow by automatically flagging patients who are due for their exams and facilitating timely follow-ups.