Risk Of Foot Ulceration Research Articles

The effectiveness of motivational interviewing on adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration: A multicenter cluster-randomized controlled trial

AimTo evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration. MethodsPeople with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months. ResultsThe proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025). ConclusionsOne podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion.Trial registration: Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).

Evaluating the effectiveness of melatonin in reducing the risk of foot ulcers in diabetic patients.

Diabetes and its complications, as a major health concern, are associated with morbidity and mortality around the world. One of these complications is diabetic foot ulcer. Factors such as hyperglycemia, neuropathy, vascular damage and impaired immune system can cause foot ulcers. The present review aims to study the potential effects of melatonin, the main product of pineal glands, on diabetic foot ulcers. A narrative review was performed using present literature in an attempt to identify the different aspects of melatonin's impact on diabetic foot ulcers by searching related keywords in electronic databases without any restriction. This review shows that, melatonin has anti-diabetic effects. It is effective in reducing the risk of hyperglycemia, neuropathy, vascular damage and immune system impairment in diabetic patients. By reducing these complications with melatonin, correspondingly, the incidence of diabetic foot ulcers may also decrease in these patients. The results of this study indicate promising properties of melatonin while dealing with diabetic foot ulcers and their common underlying conditions, but still, it needs to be investigated more in future studies.

Footcare and peripheral arterial disease

Changes in the feet occur with age which can cause pain and other foot pathologies that can lead to falls, foot ulcers and amputation. Some older adults may have difficulty doing foot hygiene due to physical or mental decline such as body habitus, poor vision, arthritic problems to mention a few.1 The presence of PAD creates an increased risk of foot ulcers, leg/foot infection and lower extremity amputation, especially in diabetic patients. PAD is often asymptomatic;2 however PAD prevalence increases with age, the majority of which occurs over age 65.3 African-American and Native Americans have approximately twice the prevalence of PAD than that of non-Hispanic Whites.4 There is a 40% rate of death at 5 years following the development of a foot ulcer in PAD patients.5 Foot ulcers require increased medical office visits, increased resource utilization, increased patient anxiety/depression and reduced quality of life (QOL).6 However, routine foot examinations and educating patients and their families in proper footcare can detect common foot problems, uncover functional decline and PAD, and prevent falls. In patients at-risk for foot ulcers, a yearly comprehensive foot evaluation can prevent foot ulcers, foot pain, and lower extremity amputation. Evaluation and early recognition of PAD can reduce morbidity and mortality.6,8,13

Diabetes Mellitus: A Review and Update

Diabetes mellitus is a group of metabolic diseases which are typified by the development of hyperglycaemia which do emanate from defects in insulin secretion, insulin action, or both. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Various types of diabetes mellitus exist which have been discussed in the main part of this article. Many pathogenic processes are involved in the development of diabetes mellitus. These pathogenic processes range from autoimmune destruction of the beta-cells of the pancreas with consequent insulin deficiency to abnormalities which result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action ensues inadequate insulin secretion and / or diminished tissue responses to insulin at one or more points within the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycaemia. The manifestations of marked hyperglycaemia do include: polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also ensue chronic hyperglycaemia. Acute, life-threatening consequences of diabetes mellitus include: hyperglycaemia with ketoacidosis or the nonketotic hyperosmolar syndrome. Long-term complications of diabetes mellitus do include: diabetic retinopathy with potential loss of vision; diabetic nephropathy which leads to kidney (renal) failure; peripheral neuropathy with risk of foot ulcers, amputation, and Charcot joints; as well as autonomic neuropathy which cause gastrointestinal, genitourinary, as well as cardiovascular symptoms and sexual dysfunction. Glycation of tissue proteins and other macromolecules and excess production of polyol compounds from glucose are among the mechanisms that had been postulated to produce tissue damage from chronic hyperglycaemia. Patients who have diabetes mellitus do have an increased incidence of atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease. Hypertension, abnormalities of lipoprotein metabolism, and periodontal disease are often found in people who have diabetes mellitus. The emotional and social impact of diabetes mellitus as well as the demands of treatment of diabetes and its complications could cause significant psychosocial dysfunction in patients who have diabetes mellitus as well as their families. Even though there are many types of diabetes mellitus, the vast majority of cases of diabetes mellitus do fall into two broad etiopathogenetic categories which have been extensively discussed in the ensuing article below that has been divided into (a) Overview and (b) miscellaneous narrations. In one category of diabetes mellitus type 1 diabetes mellitus, the cause is an absolute deficiency of insulin secretion. Individuals at increased risk of developing this type of diabetes could often be identified by serological evidence of an autoimmune pathological process that occur within the pancreatic islets and by genetic markers. In the other type of diabetes mellitus, which is the much more prevalent category that is referred to as type 2 diabetes mellitus, the cause of the disease is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response. In the latter category, a degree of hyperglycaemia sufficient to cause pathological and functional changes in various target tissues, but without clinical symptoms, could be present for a long period of time before diabetes mellitus is diagnosed. During this asymptomatic period, it is possible to demonstrate an abnormality in carbohydrate metabolism by measurement of plasma glucose in the fasting state or after a challenge with an oral glucose load. Considering that diabetes mellitus is common as well as the symptoms of diabetes mellitus are non-specific symptoms that may simulate diabetes mellitus, a number of individuals who are afflicted by diabetes mellitus do not know they have diabetes mellitus, there is need for a global educational program on the manifestations and approach that is needed for early diagnosis of the disease so that all clinicians and the entire global population would have a high index of suspicion of the disease. There also a global life style education including regular exercise that would delay onset of or reduce the severity of type 2 diabetes and to improve the quality of life of patients who have diabetes mellitus. It is important to dedicate time to read the article carefully which contains documentations related to the World Health Organization’s global effort to reduce the incidence and severity of diabetes mellitus and all individuals globally should follow carefully recommendations of the World Health organization as well as recommendations of other organizations in the world that have devoted their time to health education on diabetes mellitus. and a number of people

ANALYSIS OF RISK FACTORS OF DIABETIC FOOT ULCER IN DIABETES MELLITUS PATIENTS

Diabetes Mellitus (DM) is a chronic metabolic disorder caused by the pancreas not using insulin effectively, if the management is not good, one of the risks of complications in DM patients is Diabetic Foot Ulcer. Behaviors at risk for causing Diabetic Foot Ulcer are smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The behavior of DM patients greatly influences the incidence of Diabetic Foot Ulcer, therefore it is very important to analyze the behavioral factors of DM patients who are at risk for Diabetic Foot Ulcer. The aim of this research is to analyze the behavioral factors that are at risk for the occurrence of Diabetic Foot Ulcer and to look for the most dominant factors that are at risk of causing Diabetic Foot Ulcer. The research was conducted using a descriptive method on 30 respondents using a total sampling technique. The data collection process used questionnaires about smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The results obtained for risk behaviors for Diabetic foot ulcers were 70% normal BMI, 93.7% had non-smoking habits, 50% did physical activity, 66.67% used footwear, 66.67% went on a diet and 100% did glycemic control . The behavior of DM patients who are at risk of developing Diabetic Foot Ulcer are all indicators only if sorted from the most dominant, namely Physical Activity, Diet and Use of Footwear, BMI, Smoking Habits and Glycemic Control. Suggestions for the pronalis program to provide education that emphasizes behavior that is at risk of developing diabetic foot ulcers. Key Word : Behavioral, Diabetes Mellitus, Diabetic Foot Ulcer,

Profile of people served through telemedicine by the diabetes unit of a digital hospital in Chile

Traditionally, diabetes management has involved a face-to-face meeting between the doctor and the patient. However, incorporating new tools such as telemedicine into clinical practice may be beneficial for controlling this disease. To describe, according to sociodemographic and clinical characteristics, the people treated through telemedicine by the diabetes cell of the Digital Hospital in Chile. descriptive study with secondary data of 1427 people from the clinical registry of the diabetes cell of the Digital Hospital. The analysis included percentages, measures of central tendency, and X2 or UMann-Whitney test (p-value < 0.05) to test for independence between gender strata. 61% of the people were women, and the median age was 62 years. About 65% presented arterial hypertension and/or dyslipidemia, almost 55% of adults presented obesity, and more than 90% did not perform physical activity. More than 80% use insulin, and just over 45% of adults have HbA1c > 10%. Approximately 20% presented retinopathy, 17% neuropathy, and 13% risk offoot ulceration. Almost 45% of those diagnosed with nephropathy had a prognosis of very high-risk chronic kidney disease. The people who are treated through telemedicine by the diabetes cell of the Digital Hospital are mostly women and older adults from Familiy Health Care Centres (CESFAM), who present comorbidities, use insulin, are sedentary, have malnutrition due to excess, deficient metabolic control and their main diabetic complication is retinopathy.

Investigation of the Risk of Diabetic Foot Ulcers and Affecting Factors in Patients with Type 2 Diabetes

Investigation of the Risk of Diabetic Foot Ulcers and Affecting Factors in Patients with Type 2 Diabetes

Investigating the prevalence of diabetic peripheral neuropathy in patients diagnosed with type 2 diabetes mellitus

Abstract Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting millions of individuals reaching epidemic proportions globally. diabetic peripheral neuropathy (DPN) is one of the most prevalent and debilitating complications of T2DM, affecting the lower limbs and increasing the risk of foot ulcers, infections, and lower limb amputations. The current study aims to assess the prevalence and severity of DPN using monofilament and MNSI tests in patients diagnosed with T2DM and examine factors associated with the onset and progression of DPN. Objective: To study the prevalence of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Materials and Methods: A cross-sectional study was conducted at the Department of Medicine &amp; Diabetology, Marwari Hospital Assam. A total of 226 patients with type 2 diabetes were assessed for DPN using the Michigan Neuropathy Screening Instrument (MNSI). Results: The study assessed the prevalence of DPN among patients with diabetes mellitus. among the 226 participants, 32% had moderate neuropathy and 11% had severe neuropathy. Symptoms such as numbness, burning pain, and muscle cramps were reported by a significant proportion of participants. Examination findings showed foot-related complications and reduced nerve function in a considerable number of participants. The prevalence of neuropathy varied among different duration groups of patients with diabetes. The severity of neuropathy was higher among patients with longstanding diabetes. These findings emphasize the significant burden of DPN and the importance of diabetes management in managing and preventing diabetic neuropathy. Conclusion: This study revealed a considerable prevalence of DPN among patients with diabetes mellitus. The prevalence of neuropathy varied with the duration of diabetes, suggesting an increased risk with a longer disease duration. Timely intervention and appropriate diabetes management strategies are crucial in reducing the burden of DPN and improving patient outcomes.

The use of sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists versus sulfonylureas and the risk of lower limb amputations: a nation-wide cohort study

BackgroundNumerous studies have investigated the potential association of sodium-glucose co-transporter-2 inhibitors (SGLT2-Is) with an increased risk of lower limb amputations (LLAs), but have produced conflicting results. Particularly studies comparing SGLT2-Is to glucagon-like peptide-1 receptor agonists (GLP1-RAs) seem to find a higher LLA risk with SGLT2-I use. This raises the question whether the results are driven by a protective GLP1-RA-effect rather than a harmful SGLT2-I-effect. GLP1-RAs could promote wound healing and therefore reduce the risk of LLAs, but the associations between both drug classes and LLA remain uncertain. Therefore, the aim of the current study was to investigate the risk of LLA and diabetic foot ulcer (DFU) with SGLT2-I use and GLP1-RA use versus sulfonylurea use.MethodsA retrospective population-based cohort study was conducted using data from the Danish National Health Service (2013–2018). The study population (N = 74,475) consisted of type 2 diabetes patients aged 18 + who received a first ever prescription of an SGLT2-I, GLP1-RA or sulfonylurea. The date of the first prescription defined the start of follow-up. Time-varying Cox proportional hazards models estimated the hazard ratios (HRs) of LLA and DFU with current SGLT2-I use and GLP1-RA use versus current SU use. The models were adjusted for age, sex, socio-economic variables, comorbidities and concomitant drug use.ResultsCurrent SGLT2-I use was not associated with a higher risk of LLA versus sulfonylureas {adjusted HR 1.10 [95% confidence interval (CI) 0.71–1.70]}. Current GLP1-RA use, on the other hand, was associated with a lower risk of LLA [adjusted HR 0.57 (95%CI 0.39–0.84)] compared to sulfonylureas. The risk of DFU was similar to that with sulfonylureas with both exposures of interest.ConclusionSGLT2-I use was not associated with a higher risk of LLA, but GLP1-RAs with a lower risk of LLA. Previous studies reporting a higher risk of LLA with SGLT2-I use compared to GLP1-RA use might have been looking at a protective GLP1-RA effect, rather than a harmful SGLT2-I effect.

Predicting diabetic foot ulceration using routinely collected data in a foot clinic. What level of prognostic accuracy can be achieved?

This study aimed to investigate the efficacy of using routinely collected clinical data in predicting the risk of diabetic foot ulcer (DFU). The first objective was to develop a prognostic model based on the most important risk factors objectively selected from a set of 39 clinical measures. The second objective was to compare the prediction accuracy of the developed model against that of a model based on only the 3 risk factors that were suggested in the systematic review and meta-analyses study (PODUS). In a cohort study, a set of 12 continuous and 27 categorical data from patients (n=203 M/F:99/104) who attended a specialised diabetic foot clinic were collected at baseline. These patients were then followed-up for 24months during which 24 (M/F:17/7) patients had DFU. Multivariate logistic regression was used to develop a prognostic model using the identified risk factors that achieved p<0.2 based on univariate logistic regression. The final prognostic model included 4 risk factors(Adjusted-OR [95% CI]; p) in total. Impaired sensation (116.082 [12.06-1117.287]; p=0.000) and presence of callus (6.257 [1.312-29.836]; p=0.021) were significant (p<0.05), while havingdry skin (5.497 [0.866-34.89]; p=0.071) and Onychomycosis (6.386 [0.856-47.670]; p=0.071) that stayed in the model were not significant. The accuracy of the model with these 4 risk factorswas 92.3%, where sensitivity and specificity were 78.9%, and 94.0% respectively. The 78.9% sensitivity of our prognostic 4-risk factor model was superior to the 50% sensitivity that was achieved when the three risk factors proposed by PODUS were used. Also our proposed model based on the above 4 risk factorsshowed to predict the DFU with higher overall prognostic accuracy. These findings have implications for developing prognostic models and clinical prediction rules in specific patient populations to more accurately predict DFU.

DEVELOPMENT OF A NOVEL DIABETIC FOOT RISK ASSESSMENT FOR LOW-RESOURCE HEALTHCARE SETTINGS: A CASE STUDY OF LEAN DESIGN

AbstractInterest in applying a “lean” philosophy to design has been slowly growing in recent years, but there are still few broadly applicable methodologies and illustrative cases published in the literature to guide lean design processes. Lean approaches promise cost reduction and increased product value, which could be particularly beneficial in product development for low- and middle-income country markets, where value demands are high. We use the clinical need of efficient diabetic foot risk assessment in lowresource healthcare settings to present an example of lean early-stage design of a medical device. The background of existing medical literature and commercial products is intentionally leveraged throughout the design process to streamline development and minimize the need for independent validation of product strategies and design features. Our approach resulted in an efficient design process that generated a novel, purely mechanical plantar pressure evaluation device that can indicate high risk of diabetic foot ulcer in resource-constrained settings. This case provides a practical example of how design processes can be adapted to be leaner where there are large gains from minimizing design cycle time and cost.

#4171 DIALYSIS WITHOUT SOCKS: DETECTION OF ULCERS AND AMPUTATIONS IN HEMODIALYSIS

Abstract Background and Aims Dialysis patients are at high risk of ischemia and foot ulcers (14.4%) that frequently precede severe complications, including amputations (5.9%), hospitalizations, and mortality. Critical ischemia in this location accounts for 20% of the annual causes of death in hemodialysis, produces pain that is difficult to control and greatly reduces the quality of life. The aim of this work was to analyze the prevalence and factors associated with amputations in hemodialysis patients, and to assess the evolution after amputation. Method Carrying out a survey by email sent by the SEN (Spanish Society of Nephrology) and SOMANE (Madrid Society of Nephrology). Retrospective, cross-sectional, multicenter study. The survey sent to all hemodialysis units nationwide. Answered by 47 Centers. The exclusion criteria were oncological-traumatic amputations. Results Conclusion

Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update).

This is the 2023 International Working Group on the Diabetic Foot guideline on the prevention of foot ulcers in persons with diabetes, which updates the 2019 guideline. This guideline is targeted at clinicians and other healthcare professionals. We followed the Grading of Recommendations, Assessment, Development and Evaluations methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature including, where appropriate, meta-analyses, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where (sufficient) evidence was not available, and a weighing of the desirable and undesirable effects of an intervention, as well as patient preferences, costs, equity, feasibility and applicability. We recommend screening a person with diabetes at very low risk of foot ulceration annually for the loss of protective sensation and peripheral artery disease, and screening persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate persons at-risk about appropriate foot self-care, educate not to walk without suitable foot protection, and treat any pre-ulcerative lesion on the foot. Educate moderate-to-high risk people with diabetes to wear properly fitting, accommodative, therapeutic footwear, and consider coaching them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking, to help prevent plantar foot ulcer recurrence. Consider advising people at low-to-moderate risk to undertake a, preferably supervised, foot-ankle exercise programme to reduce ulcer risk factors, and consider communicating that a total increase in weight-bearing activity of 1000 steps/day is likely safe with regards to risk of ulceration. In people with non-rigid hammertoe with pre-ulcerative lesion, consider flexor tendon tenotomy. We suggest not to use a nerve decompression procedure to help prevent foot ulcers. Provide integrated foot care for moderate-to-high-risk people with diabetes to help prevent (recurrence of) ulceration. These recommendations should help healthcare professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days and reduce the patient and healthcare burden of diabetes-related foot disease.

Deep Learning-Based Classification and Feature Extraction for Predicting Pathogenesis of Foot Ulcers in Patients with Diabetes.

The World Health Organization (WHO) has identified that diabetes mellitus (DM) is one of the most prevalent disease worldwide. Individuals with DM have a higher risk of mortality, and it is crucial to prioritize the treatment of foot ulcers, which is a significant complication associated with the disease, as they lead to the development of plantar ulcers, which results in the need to amputate part of the foot or leg. People with diabetes are at risk of experiencing various complications, such as heart disease, eye problems, kidney dysfunction, nerve damage, skin issues, foot ulcers, and dental diseases. Unawareness of the risk associated with diabetic foot ulcers (DFU) is a significant contributing factor to the mortality of diabetic patients. Evolving technological advancements such as deep learning techniques can be used to predict the symptoms of diabetic foot ulcers as early as possible, which helps to provide effective treatment to DM patients. This research introduces a methodology for analyzing images of foot ulcers in diabetic patients, focusing on feature extraction and classification. The dataset used in this study was collected from historical medical records and foot images of patients with diabetes, who commonly experience foot ulcers as a major complication. The dataset was pre-processed and segmented, and features were extracted using a deep recurrent neural network (DRNN). Image and numerical/text data were extracted separately, and the normal and abnormal diabetes ranges were identified. Foot images of patients with abnormal diabetes ranges were separated and classified using a pre-trained fast convolutional neural network (PFCNN) with U++net. The classification procedure involves the analysis of foot ulcers to predict their pathogenesis. To assess the effectiveness of the proposed technique, the study presented simulation results, including a confusion matrix and receiver operating characteristic curve. These results specifically focused on predicting two classes: normal and abnormal diabetes foot ulcerations. The analysis yielded various parameters, including accuracy, precision, recall curve, and area under the curve. The main goal of the study was to introduce an novel technique for assessing the risk of foot ulceration development in patients with diabetes, leveraging the analysis of foot ulcer images. The researchers collected a dataset of foot images and medical data from historical records of patients with diabetes and pre-processed and segmented the data. They then used a deep recurrent neural network to extract features from the segmented data and identified normal and abnormal diabetes ranges based on numerical and text data. Foot images of patients with abnormal diabetes ranges were classified using a pre-trained fast convolutional neural network with U++net to examine foot ulcers and forecast the development of the risk of diabetic foot ulcers (DFU). The study assessed the accuracy of the proposed technique as 99.32% by simulating results for feature extraction and the classification of diabetic foot ulcers. A comparison was made between this proposed technique and existing approaches.

PENYULUHAN KESEHATAN DIABETES MELLITUS DAN IDENTIFIKASI RESIKO DIABETIK FOOT ULCER DI DUSUN BON JERUK WILAYAH KERJA PUSKESMAS AMPENAN TAHUN 2022

Diabetes Mellitus (DM) is a disease characterized by the occurrence of hyperglycemiaand disturbances of carbohydrate, fat, and protein metabolism associated with absoluteor relative deficiency of insulin action and/or secretion. Symptoms that people withDiabetes Mellitus complain about are polydipsia, polyuria, polyphagia, weight loss, andtingling. Diabetic foot ulcers are chronic complications arising from uncontrolledhyperglycemia, one of which is complications in the form of vascular disorders, chroniccomplications of diabetes mellitus in the form of open sores on the feet which can beaccompanied by local tissue death.The purpose of community service: is to identify theknowledge of the elderly about diabetes mellitus and identify the risk of developingdiabetic foot ulcers. The time required from preparation to implementation is 2 weeks.Respondents: All elderly people with a diagnosis of Diabetes Mellitus as many as 30people, participated in this activity until it was completed. The results identifiedknowledge of the elderly in a good category and from 30 elderly people 23 people wereidentified as having a risk of developing Diabetic foot ulcers. It is hoped that thePuskesmas can provide education about diet, physical activity and the use ofappropriate footwear to prevent the occurrence of Diabetic foot ulcers

Foot Care Behavior Among People With Type 2 Diabetes Mellitus: Overview and Sociodemographic Factors Impact

Foot care behavior is essential to prevent the risk of diabetic foot ulcers among people with type 2 diabetes mellitus (T2DM). The sociodemographic predisposing factors had determined mainly behavior. The study aimed to analyze sociodemographic factors' effect on foot care behavior in people with T2DM. This study was an analytical observational study with a cross-sectional design. The sample size was 130 respondents, with multistage random sampling. The instruments used were a questionnaire. The results showed that most of the respondents were 56-65 years (45.38%), women (62.31%), married (86.15%), basic education (46.15%) and income level were less than the district minimum wage (56.92%), Madurese (54.62%), nuclear family type (46.15%), and had foot care behavior in the good category (71.54%). Income level was the sociodemographic factor significantly affecting foot care behavior (p=0.019). Respondents with low-income levels (less than regency minimum wage) showed poor foot care behavior. At the same time, other sociodemographic factors, such as age, gender, marital status, education level, ethnicity, and family type, did not affect foot care behavior (p-value &gt; α = 0.05). The higher the income level, the better the foot care behavior. Providing diabetes education to increase awareness of diabetic patients about foot care is essential to paying attention to sociodemographic conditions, especially income levels. Good foot care behavior can reduce the risk of diabetic foot ulcers, minimize morbidity, and improve the quality of life of people with T2DM.&#x0D;

Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis.

Most interventions to prevent foot ulcers in people with diabetes do not seek to reverse the foot abnormalities that led to the ulcer. Foot-ankle exercise programs target these clinical and biomechanical factors, such as protective sensation and mechanical stress. Multiple RCTs exist investigating the effectiveness of such programs, but these have never been summarised in a systematic review and meta-analysis. We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on foot-ankle exercise programs for people with diabetes at risk of foot ulceration. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed the risk of bias of controlled studies and extracted data. Meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was performed when >2 RCTs were available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. We included a total of 29 studies, of which 16 were RCTs. A foot-ankle exercise programme of 8-12weeks duration for people at risk of foot ulceration results in:(a) no increase or decrease risk of foot ulceration or pre-ulcerative lesion (Risk Ratio (RR): 0.56 (95% CI: 0.20-1.57)); (b) no increase or decrease risk of adverse events (RR: 1.04 (95% CI: 0.65-1.67)); (c) not increase or decrease barefoot peak plantar pressure during walking (Mean Difference (MD): -6.28kPa (95% CI: -69.90-57.34)); (d) no increase or decrease health-related quality of life (no meta-analysis possible). Likely results in increases in ankle joint and first metatarsalphalangeal joint range of motion (MD: 1.49° (95% CI: -0.28-3.26)) may result in improvements in neuropathy signs and symptoms (MD: -1.42 (95% CI: -2.95-0.12)), may result in a small increase in daily steps in some people (MD: 131 steps (95% CI: -492-754)), and may not increase or decrease foot and ankle muscle strength and function (no meta-analysis was possible). In people at risk of foot ulceration, a foot-ankle exercise programme of 8-12weeks duration may not prevent or cause diabetes-related foot ulceration. However, such a programme likely improves the ankle joint and first metatarsalphalangeal joint range of motion and neuropathy signs and symptoms. Further research is needed to strengthen the evidence base, and should also focus on the effects of specific components of foot-ankle exercise programs.

In-shoe plantar pressure depends on walking speed and type of weight-bearing activity in people with diabetes at high risk of foot ulceration

BackgroundIn evaluating therapeutic footwear, in-shoe plantar pressure is usually obtained during mid-gait steps at self-selected walking speed in a laboratory setting. However, this may not accurately represent plantar pressures or indicate the cumulative stress experienced in daily life. We investigated the effects of walking speed and different weight-bearing activities on in-shoe plantar pressure in people with diabetes at high risk of ulceration. MethodsIn a cross-sectional study including 30 participants we compared in-shoe plantar pressures between three standardized walking speeds (0.8, 0.6 and 0.4 m/s) and between walking at self-selected speed and eight other weight-bearing activities (3 components of the Timed Up and Go test, accelerating, decelerating, stair ascending and descending, and standing). Mean forefoot regional peak plantar pressure and pressure-time integral were statistically assessed per foot using linear mixed models (α < 0.05) with Holm-Bonferroni correction. FindingsWith increasing walking speed, peak pressures increased and pressure-time integrals decreased (P ≤ 0.014). Peak pressures during standing, decelerating, stair ascending and Timed Up and Go test were lower (P ≤ 0.001), and with other activities not different to walking at self-selected speed. Pressure-time integrals during stair ascending and descending were higher (P ≤ 0.001), during standing lower (P ≤ 0.009), and with other activities not different to walking at self-selected speed. InterpretationIn-shoe plantar pressure depends on walking speed and type of weight-bearing activity. Only measuring pressures to evaluate footwear at self-selected walking speed in a laboratory setting may not accurately represent the stress on the foot in daily life of the high-risk patient; a more comprehensive assessment is suggested.

Edukasi Perawatan Kaki pada Penderita Diabetes Mellitus di Wilayah Kerja Puskesmas Syamtalira Aron

&#x0D; &#x0D; &#x0D; &#x0D; A serious complication that is often found in people with Diabetes Mellitus (DM) is diabetic foot ulcers. One of the primary prevention efforts for complications of diabetes mellitus such as the risk of neuropathy and foot ulcers is to provide health education about foot care for people with diabetes mellitus to increase knowledge and skills in performing routine and independent foot care. The target of this community service program is people with diabetes mellitus in the working area of the Syamtalira Aron Health Center, Syamtalira Aron District, totaling 25 people. The problem encountered is that DM sufferers still lack information about how to properly and correctly treat diabetic feet. There is no health team that provides direct education to DM sufferers about diabetic foot care techniques. The method used in this activity is to provide education and simulation/practice of diabetic foot exercises using power point media and distributing leaflets about the management and care of feet in people with DM. After educational activities and foot care simulations were carried out on November 14 and 15 2022 there was an 80% increase in knowledge in the good category and after the foot exercise simulation/exercise there was an increase in skills in doing foot care, namely 96%. This shows the target achievement in accordance with the expected results. The output that is expected to be achieved from this activity is that this program can provide benefits to the community, especially the target audience, thereby increasing the quality of human resources and the results can be published nationally with the ISSN and e-ISSN.&#x0D; &#x0D; &#x0D; &#x0D;

The effect of different inflated air insole in the foot plantar pressure

Exercise promotes health in people with diabetes. Weight-bearing activities increase the risk of foot ulcers. Air-pressure shoes may relieve high plantar pressure. Nevertheless, no study has investigated whether air-pressure shoes affect the plantar foot. A repeated measures study design, with five healthy subjects were tested with three inner air pressures (80, 160, and 240 mmHg) and 20 minutes of walking to examine their effects on peak plantar pressure (PPP). PPP after walking was measured from the forefoot in the big toe (T1), first metatarsal head (M1), and second metatarsal head (M2). We used a one-way ANOVA to analyze the results. We found that after walking for 20 min, inner air pressure significantly affected plantar pressure in the M1 and M2 (P = 0.008 and 0.006, respectively). Regarding the inner air pressure effect, there was a significant difference in the M1 head between 80 and 240 mmHg (274.2 ± 35.6 kPa vs. 689.4 ± 106.3 kPa, P = 0.002) at 20 minutes of walking duration. Moreover, there was a significant difference in the M2 head between 80 mmHg and 240 mmHg (250.6 ± 30.1 kPa vs. 572.4 ± 87.3 kPa, P = 0.002) and 160 and 240 mmHg (396.6 ± 35.3.7 kPa vs. 572.4 ± 87.3 kPa, P = 0.050). This finding is significant because the higher inner air pressure shoes can increase plantar pressure compared to 80 mmHg inner air pressure. This study suggests that individuals who are at high risk of developing foot ulcers should wear shoes with an inner air insole (80 mmHg).