Patient education for preventing diabetic foot ulceration

Department of Internal Medicine, University Medical Center Utrecht, P.O.Box 85500, 3508 GA Utrecht, Netherlands.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 05/2010; 5(5):CD001488. DOI: 10.1002/14651858.CD001488.pub3
Source: PubMed


Foot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease (PVD)), or both. People with ulcers due to diabetes sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring. This review of high-level studies found that educating people with diabetes about the need to look after their feet seems to improve people's foot care knowledge and behaviour in the short term. There is insufficient evidence that education alone, without any additional preventive measures, will effectively reduce the occurrence of ulcers and amputations.

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Available from: Johannes AN Dorresteijn, May 21, 2014
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    • "As the burden of diabetic complications, including neuropathic foot ulceration, begins to outweigh that of glycaemic control some focus has shifted toward diabetic foot ulceration prevention [19]. Despite foot ulceration being preventable and there being a shift toward more patient centred approaches to ulcer prevention, a recent Cochrane review of randomised control trials found little evidence of a reduction in foot ulceration rate following a programme of patient education [20]. Vileikyte et al 2004 suggest that attention should now be directed toward the psychological influences and personal experiences affecting footwear daily life routines [5]. "
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    ABSTRACT: Previous work has found that people with diabetes do not wear their therapeutic footwear as directed, but the thinking behind this behaviour is unclear. Adherence to therapeutic footwear advice must improve in order to reduce foot ulceration and amputation risk in people with diabetes and neuropathy. Therefore this study aimed to explore the psychological influences and personal experiences behind the daily footwear selection of individuals with diabetes and neuropathy. An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of therapeutic footwear use in people living at risk of diabetic neuropathic foot ulceration. This study benefited from the purposive selection of a small sample of four people and used in-depth semi structured interviews because it facilitated the deep and detailed examination of personal thoughts and feelings behind footwear selection. Four overlapping themes that interact to regulate footwear choice emerged from the analyses: a) Self-perception dilemma; resolving the balance of risk experienced by people with diabetes and neuropathy day to day, between choosing to wear footwear to look and feel normal and choosing footwear to protect their feet from foot ulceration; b) Reflective adaption; The modification and individualisation of a set of values about footwear usage created in the minds of people with diabetes and neuropathy; c) Adherence response; The realignment of footwear choice with personal values, to reinforce the decision not to change behaviour or bring about increased footwear adherence, with or without appearance management; d) Reality appraisal; A here and now appraisal of the personal benefit of footwear choice on emotional and physical wellbeing, with additional consideration to the preservation of therapeutic footwear. For some people living at risk of diabetic neuropathic foot ulceration, the decision whether or not to wear therapeutic footwear is driven by the individual 'here and now', risks and benefits, of footwear choice on emotional and physical well-being for a given social context.
    Full-text · Article · Feb 2014 · Journal of Foot and Ankle Research
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    • "The effectiveness patient education on the prevention of DFUs has been analyzed in a Cochrane database review [most recently updated in 2012 (92)]. This review included 12 randomized clinical trials that assessed the impact of patient education interventions ranging from a 10–20 min educational session to multiple sessions covering various aspects of diabetes management with or without supplementary written materials and/or mailed care reminders for both patients and clinicians. "
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    ABSTRACT: Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment.
    Full-text · Article · Oct 2013 · Diabetic Foot and Ankle
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    • "The podiatrists working within the Podiatry Diabetes Model work within these guidelines. However, a Cochrane review suggests that patient education for the prevention of diabetes-related foot complications is yet to be proven to be effective, with education possibly having positive outcomes on foot-care behaviours in the short term only, with a yet unknown effect on long term foot-health outcomes [27]. In line with the monitoring and preventative programs required for patients at high risk, the few reported successful education programs for those at lower risk are also labour intensive and require adequate resourcing [28]. "
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    ABSTRACT: There is limited understanding of the foot-health of people with diabetes in Australian regional areas. The aim of this study was to document the foot-health of people with diabetes who attend publically funded podiatric services in a regional Australian population. A three month prospective clinical audit was undertaken by the publically-funded podiatric services of a large regional area of Victoria, Australia. The primary variables of interest were the University of Texas (UT) diabetic foot risk classification of each patient and the incidence of new foot ulceration during the study period. Age, gender, diabetes type, duration of diabetes and the podiatric service the patients attended were the other variables of interest. Five hundred and seventy six patients were seen during the three month period. Over 49% had a UT risk classification at a level at least peripheral neuropathy or more serious diabetes-related foot morbidity. Higher risk at baseline was associated with longer duration of diabetes (F = 31.7, p < 0.001), male gender (χ2 = 40.3, p <0.001) and type 1 diabetes (χ2 = 37.3, p <0.001). A prior history of foot pathology was the overwhelming predictor for incident ulceration during the time period (OR 8.1 (95% CI 3.6 to 18.2), p < 0.001). The publically funded podiatric services of this large regional area of Australia deal with a disproportionally large number of people with diabetes at high risk of future diabetes-related foot complications. These findings may be useful in ensuring appropriate allocation of resources for future public health services involved in diabetic foot health service delivery in regional areas.
    Full-text · Article · Mar 2012 · Journal of Foot and Ankle Research
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