Prevention Of Diabetic Foot Complications Research Articles

O papel do enfermeiro na prevenção das lesões na síndrome do pé diabético

The aim was to identify the role of nurses in preventive care for Diabetic Foot injuries. Descriptive-exploratory study, of a quantitative nature. Carried out in a health clinic located in the city of São Paulo, with 65 diabetic patients, between 18 and 90 years old. Among the study participants, the highest percentage of those who showed signs and symptoms of Diabetic Foot Syndrome were among those who had the diagnosis a longer time ago, had greater resistance to changes in habits and adherence to treatment, did not follow the guidelines on foot care and/or had other associated chronic diseases. The nurse is fundamental in early diagnosis, interventions and education on preventive care. The prevention of Diabetic Foot complications depends on the commitment, communication and training of the multidisciplinary team to reduce amputations and morbidity and mortality of diabetics.

Practice and Associated Factors Regarding Foot Care among Diabetes Mellitus Patients Attending a Rural Primary Health Center in South India.

Background:Diabetes mellitus patients are more likely to undergo nontraumatic foot or leg amputations because they have decreased circulation to the feet or reduced sensation. This condition may cause ulcerations, infections, and delayed wound healing, leading to amputations. Adequate knowledge and practices regarding foot care will be vital in the prevention of diabetic foot complications. Hence, this study aimed to determine the level of knowledge and practices of foot care among diabetes mellitus patients attending a rural primary health center in Belagavi-South India.Materials and Methods:A cross-sectional study was conducted in the rural field practice area of J.N. Medical College, Belagavi, for 7 months (November 2019 to May 2020). A pretested questionnaire was administered to 461 diabetes patients attending the health center. A written informed consent was obtained from each participant. They were interviewed with a questionnaire consisting of 15 “yes” or “no” questions, each on foot care knowledge and practice.Results:The mean age of the study participants was 50.28 ± 9.48 years. The mean duration of diabetes was 10.69 ± 7.09 years. Majority, i.e., 296 (64.2%) participants showed satisfactory knowledge and 293 (63.6%) showed satisfactory practice. Only 97 (21%) had poor knowledge, 90 (19.5%) had poor practice, 68 (14.8%) patients had good knowledge, and 78 (16.9%) had good practice about diabetic foot care.Conclusions:The low level of knowledge and practice in patients with diabetes regarding foot care necessitates an educational program to increase awareness related to foot complications of diabetes, thereby motivating diabetic patients to incorporate foot care practices in their day-to-day routine.

Diabetic foot complications-lessons learned from real-world data derived from aspecialized Austrian hospital.

Diabetic foot complications, one of the most severe late complications of type2 diabetes mellitus, are associated with a tremendous personal and financial burden. In order to drive the prevention of diabetic foot complications forward and facilitate early detection and personalized screening of high-risk patients, longitudinal studies are needed to identify risk factors associated with diabetic foot complications in large patient datasets. This is aretrospective cohort study on 3002patients with type2 diabetes mellitus aged ≥ 18years without prior foot complications. The data were collected between 2006 and 2017 in an Austrian hospital department specialized for diabetic patients. In addition to aunivariate Cox regression analysis, multivariate Cox regression models were established to identify independent risk factors associated with diabetic foot complications and adjust for potential confounders. We observed atotal of 61diabetic foot complications in 3002patients. In the multivariate Cox regression model, significant risk factors (hazard ratio, 95% confidence interval) for foot complications were age at diagnosis > 70years (3.39, 1.33-8.67), male gender (2.55, 1.42-4.55), neuropathy (3.03, 1.74-5.27), peripheral arterial disease (3.04, 1.61-5.74), hypertension > 10years after diagnosis (2.32, 1.09-4.93) and HbA1c > 9% (2.44, 1.02-5.83). The identified risk factors for diabetic foot complications suggest that personalized early detection of patients at high risk might be possible by taking the patient's clinical characteristics, medical history and comorbidities into account. Modifiable risk factors, such as hypertension and high levels of blood glucose might be tackled to reduce the risk for diabetic foot complications.

EFEKTIVITAS PENGGUNAAN METODE PENDIDIK TEMAN SEBAYA DALAM MENINGKATKAN PENGETAHUAN PENCEGAHAN KOMPLIKASI KAKI DIABETES DI PUSKESMAS BANGUNTAPAN 3 BANTUL

Diabetic foot is a common complication experienced by people with diabetes mellitus. Knowledge of the complications of diabetic foot is necessary to perform self-care properly. Objective: to analyze the effectiveness of peer educator method health education to increase knowledge of diabetes foot complications prevention. Methods: Quasi experimental with pre-post test control group design was used in this study. Peer educator intervention was used in this study on all patients with type 2 diabetes mellitus at Banguntapan 3 Community Health Center Bantul, as many as 30 patients. Sampling using total sampling, the respondents were divided into 2 (15 interventions and 15 controls). The research instrument was a questionnaire of knowledge about the prevention of diabetic foot complications given before and after the intervention, analyzed by using paired t-test. Results: the pretest in the control group was in the moderate category (73.3%) and the intervention group (66.7%). The posttest results of the control group were in the moderate category (66.7%) and an increase in the intervention group (67.7%). Results: Bivariate analysis showed that there was an influence between the control and experimental groups on knowledge of foot care in patients with diabetes using peer method health education with a p-value of 0.006. Conclusion: the peer educator method is proven to be effective in increasing knowledge of the prevention of diabetes foot complications in diabetes mellitus patients in the Banguntapan 3 Community Health Center, Bantul.

Risk factors for diabetic foot complications in type 2 diabetes-A systematic review.

AimsWith increasing numbers of patients with type 2 diabetes mellitus (T2DM) worldwide, the number of associated diabetic foot complications might also increase. This systematic review was performed to summarize published data about risk factors for the diabetic foot (DF) syndrome in order to improve the identification of high‐risk patients.Materials and methodsSix electronic databases were searched for publications up to August 2019 using predefined stringent inclusion and exclusion criteria.ResultsOf 9,476 identified articles, 31 articles from 28 different study populations fulfilled the criteria for our evaluation. The overall quality of the studies was good, and the risk of bias was low. There was large heterogeneity among the studies concerning study protocols and patient populations analysed. A total of 79 risk factors were analysed within this review. The majority of studies described a consistently positive association with different outcomes of interest related to DF for gender, peripheral neuropathy, retinopathy, nephropathy, poor glycaemic control, insulin use, duration of diabetes, smoking and height. For age, hypertension, dyslipidaemia and body mass index, the results remain inconsistent.ConclusionA most up‐to‐date literature review resulted in glycaemic control and smoking as the only amenable risk factors with a consistently positive association for DF. Due to the high personal and financial burden associated with DF and the large heterogeneity among included studies, additional longitudinal studies in large patient populations are necessary to identify more modifiable risk factors that can be used in the prediction and prevention of DF complications.

Elaboração e validação de um álbum seriado para prevenção do pé diabético

Introducción: A través de las tecnologías educativas, se proporcionan conocimientos de una manera más interactiva para promover la salud en la comunidad, lo que contribuye a la construcción de conocimiento entre sus usuarios. Sin embargo, estas tecnologías no se han orientado a las personas con diabetes mellitus. Objetivo: Desarrollar y validar el contenido y el diseño de una guía didáctica sobre la prevención del pie diabético para su uso por parte de los profesionales de la Atención Primaria de Salud. Materiales y métodos: Se llevó a cabo un estudio metodológico a través de la recolección de datos entre agosto y septiembre de 2018 mediante el envío de instrumentos de evaluación y validación por correo electrónico a especialistas seleccionados en la plataforma Lattes. Para el análisis de los datos se utilizó el Índice de Validez del Contenido (IVC) con un valor mínimo establecido de 0.78. Resultados: Se contó con la participación de siete especialistas con experiencia en educación sanitaria, tecnologías educativas y/o diabetes mellitus. En cuanto a los objetivos, la estructura, la presentación y la pertinencia, todos los temas presentaron un IVC global de 0.96. Conclusiones: Los expertos consideraron que la guía didáctica era válida, además de ser una herramienta que ayudaría al profesional de la salud durante el examen de pie en personas con diabetes mellitus.

Prevention of diabetic foot complications.

This paper discussed the importance of prevention of diabetic foot ulcers and our institution's protocol for prevention, reviewing the existing evidence in the literature regarding the effectiveness of the preventive approach. Diabetes mellitus is the second most significant cause of disease in Singapore after ischaemic heart disease. National University Hospital, Singapore, adopts a two-pronged strategy for the management of diabetic foot ulcers. The most important strategy is prevention, and education is key. Education should mainly be directed at patients and caregivers, but also professionals (general practitioners, allied health professionals and nurses) so that they can effectively educate patients and caregivers. Patient education includes care of diabetes mellitus, care of the foot and use of appropriate footwear. Patients also tend to have poor foot hygiene. Annual foot screening for diagnosed diabetics plays an important role. However, prolonged and sustained government intervention is necessary to provide education and screening on a national scale.

Novel Use of Smartphone-based Infrared Imaging in the Detection of Acute Limb Ischaemia.

IntroductionInfrared thermal imaging is based on perfusion changes reflected by skin temperature variations. It is an established non-invasive diagnostic method within vascular surgery, with applications such as peripheral arterial disease assessment and prevention of diabetic foot complications. However, owing to hardware limitations or lack of resources, it is not yet widely used in clinical practice.ReportA novel portable infrared imaging camera, easily powered via a smartphone and free App software, was used to obtain digital thermograms during the clinical evaluation of acute limb ischaemia (ALI).DiscussionPortable infrared imaging represents a new promising tool for the assessment of tissue perfusion that can be applied at the bedside during clinical evaluation of suspected ALI.

Diabetic Foot Evaluation in Family Medicine

Introduction: Diabetes mellitus is characterized by the lack of glycemic control, which may cause damage to the small and large blood vessels and nerves, which could, among the other things, lead to changes in the foot. Most of diabetic foot complications that resulted in amputation begin with the formation of skin ulcers. The most important risk factors and predictors of diabetic ulcers are the presence of diabetic neuropathy and structural foot deformities, infections and peripheral occlusive arterial disease. Smoking, hypertension and hyperlipidemia also contribute to the increased prevalence. Objective: To analyze the effectiveness of recommended interventions, conducted by family medicine team, for the prevention of diabetic foot ulcers. Patients and methods: Data from the medical records of all patients with type 2 diabetes in the family medicine team 1 of Public Health Institution - Healthcare Center Kalesija were retroactively analyzed. Interventions that were implemented in the prevention of diabetic ulcers are as follows: screening for diabetic neuropathy using Semmes- Weinstein’s monofilament, regular and systematic examination of footwear and feet, education of patients and family members about proper hygiene and foot care, daily foot inspection by the patient, and other possible effective clinical interventions such as: optimizing the values of blood pressure, blood glucose, hyperlipidemia and smoking cessation. Results: From total of 80 patients with type 2 diabetes, in 45 (56%) was established peripheral neuropathy. From these 45 patients with neuropathy, in 40 (88%) there has been no development of ulcers due to regular implementation of recommended interventions for prevention during each visit, and in 5 patients (12.5%) the disease led to the development of diabetic ulcers. Of these 5 patients with diabetes that developed diabetic ulcer, 2 (40%) underwent amputation due to poor communication and cooperation, irregular visits and the impossibility of implementing intervention and prevention measures. Conclusion: The family medicine has a central role in the prevention and early diagnosis of diabetic foot complications. Patients with diabetes may benefit from preventive interventions, including screening for neuropathy, educating patients on every visit, wearing proper footwear, intensive care and supervision, as well as early identification of high risk for amputation and evaluation for surgical intervention. A multidisciplinary team approach is vital in the management of diabetic foot. Regular, careful and systematic review of the feet of patients with diabetes is one of the easiest, cheapest and most effective preventive intervention and measure for the prevention of diabetic foot complications.

The role of appropriate footwear in the management of diabetic foot: Perspective of clinicians in a low resource setting

Background: The use of appropriate footwear among patients with diabetes mellitus and those with diabetic foot problems has been documented to play a vital role in the prevention and treatment of the established foot disease. However, there is a paucity of literature on the role of clinicians in ensuring appropriate footwear among patients with diabetes mellitus. This paper explores current practice in the use of appropriate footwear in patients with diabetes mellitus among clinicians in Kaduna state, Nigeria. Materials and Methods: A self-administered structured questionnaire was developed. The questionnaire was divided into two sections: demographic (clinical area of specialization, number of years in practice) and footwear questionnaire. The footwear questionnaire focused on three themes: diabetic foot problems encountered, type of footwear worn, and the role of footwear in the prevention of diabetic foot complications. Data were processed and analyzed using Microsoft Excel 2007. Results: Almost all the participants, 41 (91%), reported that foot ulcers could be related to inappropriate footwear. Most participants, 37 (82%), reported that ill-fitting footwear could be a major problem that leads to amputation. The shoe type reported to be most frequently worn by men were sandals (35%), slippers (26%), and half shoes (17%). The three commonest shoe types that women were reported to wear were slippers (45%), sandals (24%), and half shoes (18%). Conclusion: This study shows that the use of appropriate footwear in the prevention of diabetic foot complications is suboptimal. It is important that healthcare professionals support and stimulate research in establishing a diabetic footwear program.

Plantar Pressure Distribution Patterns of Individuals with Prediabetes in Comparison with Healthy Individuals and Individuals with Diabetes

Since elevated mechanical stress along with loss of plantar protective sensation are considered relevant factors in skin breakdown resulting in diabetic foot ulcerations, the assessment of plantar pressure is important for the prevention of diabetic foot complications. Prediabetes subjects are at risk of chronic hyperglycemia complications, among them neuropathy, but information about plantar loading in this population is not available. We aimed to compare baropodometric parameters of individuals with prediabetes versus healthy persons and persons with diabetes mellitus (DM). Baropodometric data from 73 subjects (15 with prediabetes (pre-DM), 28 with type 2 DM, 30 healthy) aged between 29 and 69 years of both genders were registered through a pressure platform with self-selected gait speed and first-step protocol. Peak plantar pressure, stance time, percentage of contact time, percentage of contact area and pressure-time integral were assessed in five plantar foot regions: heel, midfoot, metatarsals, hallux, and toes 2 to 5. Groups were compared by one-way analysis of variance with Scheffé post hoc (α = 0.05). Age, body mass index, gender, and arch height index did not differ between groups. Pre-DM and DM subjects presented increased peak pressure and pressure-time integral in metatarsals (p = .010; p > .001), as well as increased percentage of contact time in midfoot (p = .006) and metatarsals (p = .004) regions when compared with healthy subjects. Stance time was significantly higher (p = .017) in DM subjects. Pre-DM subjects seem to exhibit an altered plantar pressure distribution pattern similar to that often found in DM subjects.

Validation of Plantar Pressure Measurements for a Novel in-Shoe Plantar Sensory Replacement Unit

Research concerning prevention of diabetic foot complications is critical. A novel in-shoe plantar sensory replacement unit (PSRU) has been developed that provides alert-based feedback derived from analyzing plantar pressure threshold measurements in real time. The purpose of this study was to compare the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of plantar pressure during walking. The PSRU had an array of eight sensors with a range of 10-75 mm Hg and collected data at 4 Hz, whereas the GS-PSD had 99 sensors with a range of 1-112 mm Hg and collected data at 100 Hz. Based on an a priori power analysis, data were collected from 10 participants (3 female, 7 male) while walking over ground in both devices. The primary variable of interest was the number of data points recorded that were greater than 32 mm Hg (capillary arterial pressure--the minimum pressure reported to cause pressure ulcers) for each of the eight PSRU sensors and corresponding average recordings from the GS-PSD sensor clusters. Intraclass correlation coefficient (2,1) was used to compare data between the two devices. Compared with the GS-PSD, we found good-to-very-good correlations (r-value range 0.67-0.86; p-value range 0.01-0.05) for six of the PSRU's eight sensors and poor correlation for only two sensors (r = 0.41, p = .15; r = 0.38, p = .18) when measuring the number of data points recorded that were greater than 32 mm Hg. Based on the results of the present study, we conclude the PSRU provides analogous data when compared with a GS-PSD.

Reconsidering Nerve Decompression: An Overlooked Opportunity to Limit Diabetic Foot Ulcer Recurrence and Amputation

Nerve decompression for relief of subjective diabetic sensorimotor polyneuropathy pain and numbness has been labeled of "unknown" benefit. Objective outcomes in treatment and prevention of diabetic foot complications are reviewed. There is growing evidence that plantar foot ulceration and recurrence in high-risk feet are minimized with this operation. Avoiding neuropathic and neuroischemic ulcer wounds should theoretically reduce amputations and perhaps mortality risk. Protective effects are hypothesized to act via relief of neuro-vascular entrapment, thereby improving neurally modulated tissue homeostasis factors. Nerve decompression deserves considerable research attention to understand its role in limiting foot complications. Its apparent benefits challenge the paradigm that diabetic neuropathy is a purely length-dependent axonopathy and may necessitate appreciation of superimposed nerve entrapment as an significant operant factor.

A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented?

BackgroundLower extremity amputations are costly and debilitating complications in patients with diabetes mellitus (DM). Our aim was to investigate changes in the amputation rate in patients with DM at the Karolinska University Hospital in Solna (KS) following the introduction of consensus guidelines for treatment and prevention of diabetic foot complications, and to identify risk groups of lower extremity amputations that should be targeted for preventive treatment.Methods150 diabetic and 191 nondiabetic patients were amputated at KS between 2000 and 2006; of these 102 diabetic and 99 nondiabetic patients belonged to the catchment area of KS. 21 diabetic patients who belonged to KS catchment area were amputated at Danderyd University Hospital. All patients' case reports were searched for diagnoses of diabetes, vascular disorders, kidney disorders, and ulcer infections of the foot.ResultsThere was a 60% reduction in the rate of amputations performed above the ankle in patients with DM during the study period. Patients with DM who underwent amputations were more commonly affected by foot infections and kidney disorders compared to the nondiabetic control group. Women with DM were 10 years older than the men when amputated, whereas men with DM underwent more multiple amputations and had more foot infections compared to the women. 88% of all diabetes-related amputations were preceded by foot ulcers. Only 30% of the patients had been referred to the multidisciplinary foot team prior to the decision of amputation.ConclusionsThese findings indicate a reduced rate of major amputations in diabetic patients, which suggests an implementation of the consensus guidelines of foot care. We also propose further reduced amputation rates if patients with an increased risk of future amputation (i.e. male sex, kidney disease) are identified and offered preventive treatment early.

The Effect of A Self-Management Support Program on The Achievement of Goals in Diabetic Foot Care Behaviors in Indonesian Diabetic Patients

Introduction: Diabetic foot care behaviors (DFCB) are a fundamental component of the prevention of diabetic foot complications. This quasi-experimental study aimed to examine the effect of a self-management support program on the achievement of DFCB goals in Indonesian diabetic patients. Method: Thirty-five subjects were recruited from the diabetic unit of a district hospital in West Java, Indonesia. The subjects received a five-week diabetic foot care self-management (SM) support program. This program consisted of three sequential phases based on the self-management method proposed by Kanfer and Gaelick-Buys (1991): self-monitoring, self-evaluation, and self-reinforcement. The strategies used in this program consisted of individual foot care education, goal setting and action planning, and brief weekly counseling and follow-ups. The goals achieved from the second to the fourth weeks were evaluated weekly by phone call follow-ups with a face-to-face interview evaluation in the fifth week. The level of goal achievement was determined by counting the number of successfully implemented actions based on the subject’s action plans. The actual goal achievement was then classified into three levels: goal completely achieved, goal partially achieved and no behavioral change (no action) at all. Results Most of the subjects (94.3%) were able to completely achieve their first week goals whereas only approximately two-thirds of the subjects were able to completely achieve their goals in the second to the fourth weeks. Throughout the program, less than half of the subjects (42.9%) completely achieved all four weekly goals although only one subject (2.9%) was unable to achieve any of the weekly goals. The most improved DFCB component in each of the first to fourth weeks was foot hygiene, footwear, toenail care and a combination of foot hygiene and footwear, respectively. Conclusion: This SM support program effectively improved the Indonesian diabetic patients’ foot care behaviors. Therefore, nurses can apply this program in practice in enhancing DFCB in order to prevent diabetic foot ulceration.

Hospital separations indicate increasing need for prevention of diabetic foot complications in central Australia.

The aim of this study was to guide service provision for prevention of diabetic foot complications through the analysis of hospital separation data for those with diabetes in central Australia. We reviewed the hospital separation data for central Australia from 1992 to 1997 for adults known to be diabetic and those with diabetic foot complications. Foot complications were identified from International Classification of Diseases-9th Revision (ICD-9) codes. Additionally, we assessed the proportion of cases with diabetic foot, identified by ICD-9 coding and confirmed by record review, that were identified by Australian National-Diagnostic Related Group-Version 3 (AN-DRG-3) coding. Separations with diabetes doubled from 352 in 1992 to 796 in 1997. This represents an increase from 1232 to 2521 separations per 100,000 people over 15 years of age. Separations with foot complications increased threefold from 28 in 1992 to 90 in 1997, a rate increase from 98 to 285 per 100,000 people over 15 years of age. The proportion of diabetes separations that had foot complications remained around 10% during the 6 year period. Aboriginal people made up 89% of the individuals with foot complications and 91% of separations for diabetic foot. Foot complications were predominantly of the more acute type (90%), amenable to early intervention. The AN-DRG-3 code for diabetic foot identified only 59% (37/63 in 1997) of the separations identified by the ICD-9 codes, and admitted primarily for foot complications in Alice Springs Hospital. The known burden of hospital care for diabetes and diabetic foot complications has increased markedly in recent years. A combination of changes in prevalence, primary care utilisation, detection, hospital access or re-admission rates may underlie the observed increases. As it is very unlikely that diabetes or diabetic foot complications are being over diagnosed, or that the hospitals are over utilised, this analysis shows there is an increasingly apparent need for improved prevention of diabetic foot complications. Therefore primary health care systems should ensure that they implement evidence-based care for preventing foot complications among people with diabetes.

Foot Ulcers in Patients with Diabetes Mellitus

Foot ulceration in patients with diabetes is a common complication that previously has often led to lower-limb amputation. The primary underlying factors involved with ulceration in this population are peripheral neuropathy and ischemia. Through the aggressive, innovative approaches of a multidisciplinary foot ulcer team, most neuropathic foot ulcers now heal. For those with primarily ischemic ulcers, surgical revascularization as far distal as the dorsalis pedis artery has significantly improved the salvage rate of diabetic limbs in patients who otherwise would have proceeded to limb loss. Essential components of foot ulcer care incorporate debridement of the ulcer to a clean base, addressing the possibility of wound infection and osteomyelitis, maintenance of an optimal, moist wound-healing environment, and avoidance of further trauma by ensuring adequate off-loading of the ulcerated foot. Newer therapies such as human recombinant platelet-derived growth factor and tissue-engineered skin replacements have added further tools to help close hard-to-heal neuropathic foot ulcers. The ultimate goal is primary prevention of diabetic foot complications. This is achievable in many circumstances by improved patient and physician education regarding diabetes and the principles of good foot care.

Therapeutic footwear for patients with diabetes

The proper prescription and utilization of therapeutic footwear is crucial to successful prevention of diabetic foot complications. The author reviews shoe alternatives' characteristics and proper fit. The concept of foot risk categories is explained and appropriate shoe selections are discussed.