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Hancox JE, Chaplin WJ, Hilton CE, Vadaszy N, Gray K, Game F, Vedhara K. Motivation communication training programme for healthcare professionals to support adherence in patients with diabetic foot ulcers: Proof of concept study. PLoS One 2024; 19:e0295180. [PMID: 38330087 PMCID: PMC10852232 DOI: 10.1371/journal.pone.0295180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/16/2023] [Indexed: 02/10/2024] Open
Abstract
Patients with diabetic foot ulcers have poor adherence to treatment recommendations. However, the most effective way to support adherence in this population is unknown. This study aimed to assess the preliminary effectiveness of a motivation communication training programme for healthcare professionals working with these patients, using theory and evidence-based strategies.A proof-of-concept study using a non-randomised, controlled before-and-after design. Six podiatrists took part in the motivation communication training programme. Pre-training, observation was undertaken to examine the communication style currently used by podiatrists in routine consultations. Patients' (n = 25) perceptions of podiatrist autonomy support, self-determination for limiting weight-bearing activity and average daily step count were also assessed. Post training, observations and patient measures were repeated with a different group of patients (n = 24). Observations indicated that podiatrists exhibited a more need-supportive communication style (e.g., taking time to understand patients' perspectives) after undergoing the training programme. Patients in the post-training group reported higher levels of autonomy support, while self-determination to limit weight-bearing activity remained unchanged. Although the post-training group had a lower average daily step count, the difference was not statistically significant. This is the first study to investigate implementation of motivation communication strategies in routine consultations with patients with diabetic foot ulcers. Results suggest that training can enhance healthcare professionals' motivation communication skills with potential for addressing adherence issues, however, a larger cluster randomised controlled trial is necessary to confirm this.
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Affiliation(s)
- Jennie E. Hancox
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Wendy J. Chaplin
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Noemi Vadaszy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Katie Gray
- Derbyshire Community Health Services NHS, Bakewell, United Kingdom
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Hancox JE, Hilton C, Gray K, Game F, Vedhara K. Adherence to limiting weight-bearing activity in patients with diabetic foot ulcers: A qualitative study. Int Wound J 2023; 20:3945-3954. [PMID: 37312664 PMCID: PMC10681470 DOI: 10.1111/iwj.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Abstract
Patients with diabetic foot ulcers are advised to limit weight-bearing activity for ulcers to heal. Patients often disregard this advice although the reasons are not yet fully understood. This study explored (1) patients' experiences of receiving the advice and (2) factors influencing adherence to the advice. Semi-structured interviews were conducted with 14 patients with diabetic foot ulcers. Interviews were transcribed and analysed using inductive thematic analysis. Advice regarding limiting weight-bearing activity was described by patients as directive, generic and conflicting with other priorities. Rapport, empathy and rationale supported receptivity to the advice. Barriers and facilitators to limiting weight-bearing activity included demands of daily living, enjoyment of exercise, sick/disabled identity and burden, depression, neuropathy/pain, health benefits, fear of negative consequences, positive feedback, practical support, weather and active/passive role in recovery. It is important that healthcare professionals pay attention to how limiting weight-bearing activity advice is communicated. We propose a more person-centred approach in which advice is tailored to individuals' specific needs with discussion around patient priorities and constraints.
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Affiliation(s)
- Jennie E. Hancox
- School of MedicineUniversity of NottinghamNottinghamUK
- Loughborough UniversityLoughboroughUK
| | | | - Katie Gray
- Derbyshire Community Health Services NHSBakewellUK
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Bays HE. Why does type 2 diabetes mellitus impair weight reduction in patients with obesity? A review. OBESITY PILLARS (ONLINE) 2023; 7:100076. [PMID: 37990681 PMCID: PMC10661899 DOI: 10.1016/j.obpill.2023.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 11/23/2023]
Abstract
Background A common adiposopathic complication of obesity is type 2 diabetes mellitus. Healthful weight reduction in patients with obesity can improve glucose metabolism and potentially promote remission of type 2 diabetes mellitus. However, weight-reduction in patients with increased adiposity is impaired among patients with type 2 diabetes mellitus compared to patients without diabetes mellitus. Methods Data for this review were derived from PubMed and applicable websites. Results Among patients with increased body fat, the mechanisms underlying impaired weight reduction for those with type 2 diabetes mellitus are multifactorial, and include energy conservation (i.e., improved glucose control and reduced glucosuria), hyperinsulinemia (commonly found in many patients with type 2 diabetes mellitus), potential use of obesogenic anti-diabetes medications, and contributions from multiple body systems. Other factors include increased age, sex, genetic/epigenetic predisposition, and obesogenic environments. Conclusions Even though type 2 diabetes mellitus impairs weight reduction among patients with increased adiposity, clinically meaningful weight reduction improves glucose metabolism and can sometimes promote diabetes remission. An illustrative approach to mitigate impaired weight reduction due to type 2 diabetes mellitus is choosing anti-diabetes medications that increase insulin sensitivity and promote weight loss and deprioritize use of anti-diabetes medications that increase insulin exposure and promote weight gain.
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Affiliation(s)
- Harold Edward Bays
- Diplomate of American Board of Medicine, Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Fernando ME, Blanchette V, Woelfel SL, Armstrong A, DuBourdieu C, Shin L, Armstrong DG. Prescribing Home Digital Thermometry Coupled with Activity Dosing and Optimized Offloading to Prolong Diabetic Foot Remission: A Case Report. INT J LOW EXTR WOUND 2023:15347346231184008. [PMID: 37401842 DOI: 10.1177/15347346231184008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
People with a history of diabetic foot ulcers (DFUs) experience diminished health-related quality of life and are at a 40% annual risk of DFU recurrence. Due to a fear of DFU recurrence, people in DFU remission participate less in physical activity and moderate-intensity exercise when compared to people with diabetes who have not had wounds. There is novel evidence to suggest that too little activity during DFU remission contributes to only low magnitudes of repetitive tissue loading creating a higher susceptibility to skin trauma during inadvertent high-activity bouts. Conversely, a hasty return to too much activity could lead to rapid recurrence. There is now high-level evidence from multiple meta-analyses to indicate that home-based foot temperature monitoring, coupled with activity modification and daily inspection of the feet for impending signs of ulceration, could reduce the risk of ulcer recurrence by 50%. There is little evidence, however, to guide the decision-making regarding the appropriate quantity and frequency of physical activity during DFU remission and the acceptability from the patient perspective. This has resulted in limited uptake of this novel intervention in clinical practice. Earlier, we proposed that activity can be dosed for people in foot ulcer remission, just like insulin or medication is dosed. Here, we describe a patient-centered approach to implementing home foot temperature monitoring coupled with daily foot checks and dosage-based return to physical activity in a patient in DFU remission, including his perspective. We believe using such an approach could maximize ulcer-free days in remission, thereby improving quality of life.
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Affiliation(s)
- Malindu E Fernando
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- National Rehabilitation Center at Rancho Los Amigos National Rehabilitation Center, Los Angeles, California, USA
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- VITAM - Sustainable Health Research Centre, Québec, Québec, Canada
| | - Stephanie L Woelfel
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Alexandria Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- National Rehabilitation Center at Rancho Los Amigos National Rehabilitation Center, Los Angeles, California, USA
| | - Charles DuBourdieu
- Department of Prosthetics and Orthotics, National Rehab Center at Rancho Los Amigos, Los Angeles, California, USA
| | - Laura Shin
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- National Rehabilitation Center at Rancho Los Amigos National Rehabilitation Center, Los Angeles, California, USA
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- National Rehabilitation Center at Rancho Los Amigos National Rehabilitation Center, Los Angeles, California, USA
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Beauchesne N, Wagenaar-Tison A, Brousseau-Foley M, Moisan G, Cantin V, Blanchette V. Using a contralateral shoe lift to reduce gait deterioration during an offloading fast-walk setting in diabetic peripheral neuropathy: A comparative feasibility study. Diabetes Res Clin Pract 2023; 199:110647. [PMID: 37003479 DOI: 10.1016/j.diabres.2023.110647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
AIMS Diabetic peripheral neuropathy (DPN) is a predictor of foot ulcers and leads to sedentary behaviour. This comparative study evaluated gait and feasibility of a 20-minute fast walk, at 40-60% of cardiopulmonary capacity, in individuals with DPN wearing an offloading boot and a contralateral shoe balancer. METHODS Gait parameters were measured with inertial sensors on 32 individuals (group with DPN [n = 16], group with diabetes but without DPN [n = 9], and a group without diabetes/DPN [n = 7]). Feasibility was assessed by feedback on perceived effort and adverse events. Gait outcomes were compared between groups with or without a shoe balancer using one-way ANOVAs. RESULTS The three groups were equivalent in terms of activity level and age and gender except for the body mass index. Both groups with diabetes exhibited minimal decreased gait speed (p > 0.005) and the DPN group exhibited increased double-support percentage (+4.6%, p = 0.01) while walking with an offloading boot and contralateral shoe balancer. The use of a contralateral shoe balancer reduced gait asymmetry. Lower physical activity level was associated with further gait deterioration in all groups. Few adverse events were reported, and 91% of participants reported that the proposed activity would be feasible daily. CONCLUSIONS The offloading boot deteriorated gait function, but a contralateral shoe balancer minimized its impact, especially in the context of physical activity in people with diabetes and DPN.
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Affiliation(s)
- Nikolas Beauchesne
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | | | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affiliated to Université de Montréal, Faculty of Medicine, Trois-Rivières Family Medicine University Clinic, 731, rue Ste-Julie, 2nd Floor, Trois- Rivières G9A 1X9, Canada
| | - Gabriel Moisan
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | - Vincent Cantin
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches (CISSS-CA), 143 rue Wolfe, Lévis G6V 3Z1, Canada; VITAM - Sustainable Health Research Centre, 2480, Rue de la Carnardière, Québec G1J 2G1, Canada.
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Aitken E, Hiew J, Hamilton EJ, Manning L, Ritter JC, Raby E, Gittings PM. Exercise in adults admitted to hospital with diabetes-related foot ulcers: a pilot study of feasibility and safety. J Foot Ankle Res 2023; 16:18. [PMID: 36978157 PMCID: PMC10043540 DOI: 10.1186/s13047-023-00616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Background Diabetes-related foot ulcers result in significant mortality, morbidity and economic costs. Pressure offloading is important for ulcer healing, but patients with diabetes-related foot ulcers are presented with a dilemma, because whilst they are often advised to minimise standing and walking, there are also clear guidelines which encourage regular, sustained exercise for patients with diabetes. To overcome these apparently conflicting recommendations, we explored the feasibility, acceptability and safety of a tailored exercise program for adults admitted to hospital with diabetes-related foot ulcers. Methods Patients with diabetes-related foot ulcers were recruited from an inpatient hospital setting. Baseline demographics and ulcer characteristics were collected, and participants undertook a supervised exercise training session comprising aerobic and resistance exercises followed by prescription of a home exercise programme. Exercises were tailored to ulcer location, which complied with podiatric recommendations for pressure offloading. Feasibility and safety were assessed via recruitment rate, retention rate, adherence to inpatient and outpatient follow up, adherence to home exercise completion, and recording of adverse events. Results Twenty participants were recruited to the study. The retention rate (95%), adherence to inpatient and outpatient follow up (75%) and adherence to home exercise (50.0%) were all acceptable. No adverse events occurred. Conclusions Targeted exercise appears safe to be undertaken by patients with diabetes-related foot ulcers during and after an acute hospital admission. Recruitment in this cohort may prove challenging, but adherence, retention and satisfaction with participation in exercise were high. Trial registration The trial is registered in the Australian New
Zealand Clinical Trials Registry (ACTRN12622001370796). Supplementary Information The online version contains supplementary material available at 10.1186/s13047-023-00616-0.
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Affiliation(s)
- Emily Aitken
- grid.415051.40000 0004 0402 6638Physiotherapy Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
| | - Jonathan Hiew
- grid.415051.40000 0004 0402 6638Podiatry Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
- grid.459958.c0000 0004 4680 1997Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Emma J Hamilton
- grid.459958.c0000 0004 4680 1997Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- grid.415051.40000 0004 0402 6638Endocrinology Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
- grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Perth, Western Australia
| | - Laurens Manning
- grid.459958.c0000 0004 4680 1997Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Perth, Western Australia
- grid.415051.40000 0004 0402 6638Infectious Diseases and Microbiology Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
| | - Jens Carsten Ritter
- grid.459958.c0000 0004 4680 1997Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- grid.415051.40000 0004 0402 6638Vascular Surgery Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
- grid.1032.00000 0004 0375 4078School of Medicine, Curtin University, Perth, Australia
| | - Edward Raby
- grid.415051.40000 0004 0402 6638Infectious Diseases and Microbiology Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
| | - Paul M Gittings
- grid.415051.40000 0004 0402 6638Physiotherapy Department, Fiona Stanley and Fremantle Hospital Group, Murdoch, Western Australia
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Ma L, Chen J, Sun Y, Feng Y, Yuan L, Ran X. The perceptions of living with diabetic foot ulcers: A systematic review and meta-synthesis of qualitative studies. J Tissue Viability 2023; 32:39-50. [PMID: 36470779 DOI: 10.1016/j.jtv.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diabetic foot ulcers are associated with decreased quality of life in patients with diabetes and impose a heavy burden on patients, their families, and the health care system. For health providers, a deeper understanding of the perceptions of patients is significant. They can provide better management and direction to patients with diabetic foot ulcers, thus improving their quality of life. OBJECTIVES To synthesize the findings of qualitative studies to explore the perceptions of individuals living with diabetic foot ulcers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Published qualitative research articles were identified in PubMed, CINAHL, Embase, ISI Web of Science, Ovid, and Scopus from inception to January 2022, and bibliographical reports were reviewed. In addition, combing with the search for unpublished studies in the Google Scholar ProQuest Dissertations and Theses Database, we conducted a meta-synthesis. RESULTS Fourteen articles were eligible for inclusion, and the total number of included individuals was 226, with ages ranging from 28 to 84 years. The perceptions of individuals with diabetic foot ulcers synthesized four overarching themes and their subthemes: perceptions of diabetic foot ulcers (Realization, Reasons), living with diabetic foot ulcers (Change in life, Physical burdens, Emotional burdens, Economic burdens), coping with diabetic foot ulcers (Hospital attendance, Attitude toward amputation, Treatment, Management), and expectations (Expectation of health-personnel, Future expectation). CONCLUSIONS Individuals with diabetic foot ulcers suffer greatly in their physical, psychological, and social aspects. Comprehensive and individualized patient-centered care and appropriate families and social support for patients with diabetic foot ulcers should be provided.
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Affiliation(s)
- Lin Ma
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Yue Feng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Yuan
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Prior SJ, Luccisano SP, Kilpatrick ML, Murfet GO. Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12894. [PMID: 36232191 PMCID: PMC9565125 DOI: 10.3390/ijerph191912894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.
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Affiliation(s)
- Sarah J. Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia
| | - Sharon P. Luccisano
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
| | - Michelle L. Kilpatrick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Giuliana O. Murfet
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
- School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Vrátná E, Husáková J, Jarošíková R, Dubský M, Wosková V, Bém R, Jirkovská A, Králová K, Pyšková B, Lánská V, Fejfarová V. Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:869128. [PMID: 35865313 PMCID: PMC9294221 DOI: 10.3389/fendo.2022.869128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Diabetic foot syndrome (DFS) is a serious late diabetic complication characterised by limited joint mobility and other biomechanical and muscle abnormalities. AIM To evaluate the effect of an interventional exercise programme on anthropometric parameters, muscle strength, mobility and fitness in patients with diabetic foot in remission. DATA SOURCES AND STUDY SELECTION Thirty-eight patients with type 2 diabetes and DFS without active lesions (mean age 65 ± 6.9 years, BMI 32 ± 4.7 kg.m-2, waist-hip ratio (WHR)1.02 ± 0.06) were enrolled in our randomised controlled trial. All subjects were randomised into two groups: an intervention group (I; n=19) and a control group (C; n=19). The 12-week exercise intervention focused on ankle and small-joint mobility in the foot, strengthening and stretching of the lower extremity muscles, and improvements in fitness. Changes (Δ=final minus initial results) in physical activity were assessed using the International Physical Activity Questionnaire (IPAQ), with joint mobility detected by goniometry, muscle strength by dynamometry, and fitness using the Senior Fitness Test (SFT). DATA EXTRACTION Due to reulceration, 15.8% of patients from group I (3/19) and 15.8% of patients from group C were excluded. Based on the IPAQ, group I was more active when it came to heavy (p=0.03) and moderate physical activity (p=0.06) after intervention compared to group C. Group I improved significantly in larger-joint flexibility (p=0.012) compared to controls. In group I, dynamometric parameters increased significantly in both lower limbs (left leg; p=0.013, right leg; p=0.043) compared to group C. We observed a positive trend in the improvement of fitness in group I compared to group C. We also confirmed positive correlations between heavy physical activity and selected parameters of flexibility (r=0.47; p=0.007), SFT (r=0.453; p=0.011) and dynamometry (r=0.58; p<0.0025). Anthropometric parameters, such as BMI and WHR, were not significantly influenced by the intervention programme. CONCLUSION Our 12-week interventional exercise programme proved relatively safe, resulting in improved body flexibility and increased muscle strength in DF patients in remission.
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Affiliation(s)
- Eliška Vrátná
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
- Clinical Rehabilitation Division, Institute for Clinical and Experimental Medicine, Prague, Czechia
- *Correspondence: Eliška Vrátná,
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Radka Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Kateřina Králová
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Bára Pyšková
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
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An Enzymatic Multiplexed Impedimetric Sensor Based on α-MnO2/GQD Nano-Composite for the Detection of Diabetes and Diabetic Foot Ulcer Using Micro-Fluidic Platform. CHEMOSENSORS 2021. [DOI: 10.3390/chemosensors9120339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is widely considered as a silent killer which affects the internal organs and ultimately has drastic impacts on our day-to-day activities. One of the fatal outcomes of diabetes is diabetic foot ulcer (DFU); which, when becomes chronic, may lead to amputation. The incorporation of nanotechnology in developing bio-sensors enables the detection of desired biomarkers, which in our study are glucose and L-tyrosine; which gets elevated in patients suffering from diabetes and DFUs, respectively. Herein, we report the development of an enzymatic impedimetric sensor for the multi-detection of these biomarkers using an electrochemical paper-based analytical device (µ-EPADs). The structure consists of two working electrodes and a counter electrode. One working electrode is modified with α-MnO2-GQD/tyrosinase hybrid to aid L-tyrosine detection, while the other electrode is coated with α-MnO2-GQD/glucose oxidase hybrid for glucose monitoring. Electrochemical impedance spectroscopy has been employed for the quantification of glucose and L-tyrosine, within a concentration range of 50–800 mg/dL and 1–500 µmol/L, respectively, using a sample volume of approximately 200 µL. The impedance response exhibited a linear relationship over the analyte concentration range with detection limits of ~58 mg/dL and ~0.3 µmol/L for glucose and tyrosine respectively, with shelf life ~1 month. The sensing strategy was also translated to Arduino-based device applications by interfacing the µ-EPADs with miniaturized electronics.
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12
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Fernando ME, Woelfel SL, Perry D, Najafi B, Khan T, DuBourdieu C, Shin L, Armstrong DG. Dosing Activity and Return to Preulcer Function in Diabetes-Related Foot Ulcer Remission. J Am Podiatr Med Assoc 2021; 111. [PMID: 33783527 DOI: 10.7547/20-166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes-related foot ulcers are a leading cause of global morbidity, mortality, and health-care costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year after healing, and most occur in the first 3 months after wound healing. Hence, this period after ulceration is called "remission" due to this risk of reulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health-related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate off-loading and monitoring in people with a recently healed foot ulcer, foot reconstruction, or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring, which can identify dangerous "hotspots" prone to recurrence. By understanding areas at risk, patients are empowered to maximize ulcer-free days and to enable an improved quality of life. This perspective outlines a unified strategy to treat patients in the remission period after ulceration and aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patients to ensure a safe transition to footwear and return to activity.
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Brousseau-Foley M, Blanchette V, Trudeau F, Houle J. Physical Activity Participation in People with an Active Diabetic Foot Ulceration: A Scoping Review. Can J Diabetes 2021; 46:313-327. [DOI: 10.1016/j.jcjd.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/22/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
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14
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Orlando G, Reeves ND, Boulton AJM, Ireland A, Federici G, Federici A, Haxhi J, Pugliese G, Balducci S. Sedentary behaviour is an independent predictor of diabetic foot ulcer development: An 8-year prospective study. Diabetes Res Clin Pract 2021; 177:108877. [PMID: 34058300 DOI: 10.1016/j.diabres.2021.108877] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
AIMS To prospectively explore the association between sedentary time (SED-time) and the development of diabetic foot ulcer (DFU) in people with diabetic peripheral neuropathy (DPN). METHODS 175 DPN individuals who attended the annual evaluation for the SAMBA Study (2012-2019) were included. Main outcome measure was the first diagnosis of DFU. SED-time was measured by the PAS 2.1 questionnaire. Nerve function was evaluated by nerve conduction studies. Vascular function was assessed by Ankle-brachial index (ABI) and pedal pulses. Foot deformity and skin dryness were examined by visual inspection. RESULTS 62 participants (35.5%) developed a DFU during the study. SED-time was significantly higher in people who developed DFUs (12.8 ± 3.0 vs 9.4 ± 3.1 h/day). Logistic regression showed that among several nervous (motor amplitude, OR 0.33, 95% CI, 0.18-0.60; sensory amplitude, 0.85, 0.77-0.94) and vascular parameters (ABI, 0.23, 0.1-0.61; pedal pulses, 2.81, 0.12-0.63) and foot characteristics (deformity, 2.63, 1.30-5.32; skin dryness, 2.04, 0.95-4.37), SED-time was one of the strongest variables contributing to the development of DFUs (2.95, 1.45-6.44). CONCLUSIONS SED-time is an independent predictor of the risk of DFU in people with DPN. The monitoring of SED-time with strategies aimed at reducing it should be included in the standard care of diabetic patients.
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Affiliation(s)
- Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | - Neil D Reeves
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Andrew J M Boulton
- Department of Medicine, Manchester Royal Infirmary, Manchester, UK; Diabetes Research Institute, University of Miami, Miami, FL, USA
| | - Alex Ireland
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | | | | | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, "La Sapienza" University, and Diabetes Unit, Sant' Andrea University Hospital, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, and Diabetes Unit, Sant' Andrea University Hospital, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University, and Diabetes Unit, Sant' Andrea University Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
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15
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Duan Y, Ren W, Xu L, Ye W, Jan YK, Pu F. The effects of different accumulated pressure-time integral stimuli on plantar blood flow in people with diabetes mellitus. BMC Musculoskelet Disord 2021; 22:554. [PMID: 34144680 PMCID: PMC8214278 DOI: 10.1186/s12891-021-04437-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/03/2021] [Indexed: 01/13/2023] Open
Abstract
Background Exercise, especially weight-bearing exercise (e.g. walking), may affect plantar tissue viability due to prolonged repetitive high vertical and high shear pressure stimulus on the plantar tissue, and further induce development of diabetic foot ulcers (DFUs). This study aimed to investigate the effects of different accumulated pressure-time integral (APTI) stimuli induced by walking on plantar skin blood flow (SBF) responses in people with diabetes mellitus (DM). Methods A repeated measures design was used in this study. Two walking protocols (low APTI (73,000 kPa·s) and high APTI (73,000 × 1.5 kPa·s)) were randomly assigned to ten people with DM and twenty people without DM. The ratio of SBF measured by laser Doppler flowmetry after walking to that before (normalized SBF) was used to express the SBF responses. Results After low APTI, plantar SBF of people with DM showed a similar response to people without DM (P = 0.91). However, after high APTI, people with DM had a significantly lower plantar SBF compared to people without DM (P < 0.05). In people with DM, plantar SBF in the first 2 min after both APTI stimuli significantly decreased compared to plantar SBF before walking (P < 0.05). Conclusions People with DM had a normal SBF response after low APTI walking but had an impaired SBF response after high APTI walking, which suggests that they should avoid weight-bearing physical activity with intensity more than 73,000 kPa·s and should rest for more than 2 min after weight-bearing physical activity to allow a full vasodilatory response to reduce risk of DFUs.
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Affiliation(s)
- Yijie Duan
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Weiyan Ren
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China
| | - Liqiang Xu
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Wenqiang Ye
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Yih-Kuen Jan
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China. .,Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Fang Pu
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
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16
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Reeves ND, Orlando G, Brown SJ. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050457. [PMID: 34066681 PMCID: PMC8150714 DOI: 10.3390/medicina57050457] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.
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17
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Tran MM, Haley MN. Does exercise improve healing of diabetic foot ulcers? A systematic review. J Foot Ankle Res 2021; 14:19. [PMID: 33743791 PMCID: PMC7980337 DOI: 10.1186/s13047-021-00456-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/11/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND For patients with diabetic foot ulcers, offloading is one crucial aspect of treatment and aims to redistribute pressure away from the ulcer site. In addition to offloading strategies, patients are often advised to reduce their activity levels. Consequently, patients may avoid exercise altogether. However, it has been suggested that exercise induces an increase in vasodilation and tissue blood flow, which may potentially facilitate ulcer healing. The aim of this systematic review was to determine whether exercise improves healing of diabetic foot ulcers. REVIEW We conducted a systematic search of MEDLINE, CINAHL and EMBASE between July 6, 2009 and July 6, 2019 using the key terms and subject headings diabetes, diabetic foot, physical activity, exercise, resistance training and wound healing. Randomised controlled trials were included in this review. Three randomised controlled trials (139 participants) were included in this systematic review. All studies incorporated a form of non-weight bearing exercise as the intervention over a 12-week period. One study conducted the intervention in a supervised setting, while two studies conducted the intervention in an unsupervised setting. Two studies found greater improvement in percentage wound size reduction in the intervention group compared with the control group, with one of these studies achieving statistically significant findings (p < 0.05). The results of the third study demonstrated statistically significant findings for total wound size reduction (p < 0.05), however results were analysed within each treatment group and not between groups. CONCLUSION This systematic review found there is insufficient evidence to conclusively support non-weight bearing exercise as an intervention to improve healing of diabetic foot ulcers. Regardless, the results demonstrate some degree of wound size reduction and there were no negative consequences of the intervention for the participants. Given the potential benefits of exercise on patient health and wellbeing, non-weight bearing exercise should be encouraged as part of the management plan for treatment of diabetic foot ulcers. Further research is required to better understand the relationship between exercise and healing of diabetic foot ulcers.
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Affiliation(s)
- Morica M Tran
- Department of Podiatry, Eastern Health, Melbourne, Victoria, 3128, Australia.
| | - Melanie N Haley
- Department of Aged and Complex Medicine, Eastern Health, Melbourne, Victoria, 3128, Australia
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18
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Jahantigh Akbari N, Hosseinifar M, Naimi SS, Mikaili S, Rahbar S. The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review. J Diabetes Metab Disord 2021; 19:1995-2004. [PMID: 33553048 DOI: 10.1007/s40200-020-00652-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
Purpose Diabetic peripheral neuropathy (DPN) leads to decreased sole sensation and balance disorder, all of which increase the risk of falls and socioeconomic costs. Since the physiotherapists do not use the same manner to lessen the complications of this problem. Therefore, this review study was directed to appraise physiotherapy intervention efficiencies in diminishing DPN's symptoms and complications. Method A database search of Pubmed, Elsevier, Google Scholar, and Embase was performed to determine DPN's published documents. Finally, studies of DPN and treatments available in this field, particularly physiotherapy that included electrotherapy, exercise therapy, and other therapies, were identified. Result According to a database search on August 1, 2019, from 1989 to 2019, in the last 30 years, about 968 articles were found, 345 of which were free full text available, and finally, 19 articles were approved. These articles examined the effects of physiotherapy interventions, including exercise therapy, electrotherapy, and other treatment techniques on DPN patients. Conclusions The results showed that most diabetic peripheral neuropathy patients suffer from muscle weakness, pain, loss of balance, and lower limb dysfunction. As a result, their daily activity and Life satisfaction are gradually impaired. Exercise therapy, electrotherapy, and other physiotherapy methods have been used to reduce the mentioned cases. Among these interventions, exercise therapy has been the most effective. Although there was little evidence of aerobic exercise in these patients, further studies should be done on other therapies' effects.
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Affiliation(s)
- Narges Jahantigh Akbari
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosseinifar
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sedigheh Sadat Naimi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Mikaili
- Department of Physical Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soulmaz Rahbar
- Department of Physiotherapy, School of Rehabilitation, Hamadan University of Medical Sciences, Hamadan, Iran
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19
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Yalla SV, Crews RT, Patel NA, Cheung T, Wu S. Offloading for the Diabetic Foot: Considerations and Implications. Clin Podiatr Med Surg 2020; 37:371-384. [PMID: 32146989 DOI: 10.1016/j.cpm.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Offloading the diabetic foot remains the major consideration for ulceration prevention and healing. This narrative literature review presents a brief overview of current guidelines for offloading the diabetic foot and discusses the implications that come with offloading treatment modalities and their effects on the kinetic chain of the lower extremity. We also present the latest innovative studies from the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science that advance the knowledge in this field and provide avenues for future research opportunities.
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Affiliation(s)
- Sai V Yalla
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Ryan T Crews
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Niral A Patel
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine & Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Timothy Cheung
- School of Graduate and Postdoctoral Studies, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine & Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Stephanie Wu
- Podiatric Surgery and Applied Biomechanics, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
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20
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Effects of walking speeds and durations on plantar skin blood flow responses. Microvasc Res 2020; 128:103936. [DOI: 10.1016/j.mvr.2019.103936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022]
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Lee M, van Netten JJ, Sheahan H, Lazzarini PA. Moderate-to-Vigorous-Intensity Physical Activity Observed in People With Diabetes-Related Foot Ulcers Over a One-Week Period. J Diabetes Sci Technol 2019; 13:827-835. [PMID: 31137944 PMCID: PMC6955444 DOI: 10.1177/1932296819848735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Regular moderate-to-vigorous-intensity physical activity results in health benefits in people with diabetes. No study has observed the moderate-to-vigorous-intensity physical activity typically performed by people with diabetes-related foot ulcers (DFU) in their everyday free-living environments. We observed the bouts, and accumulated time, spent doing moderate-to-vigorous-intensity physical activity in cases with DFU compared with diabetes-related peripheral neuropathy (DPN) and diabetes (DM) controls over a one-week period. METHODS This was a secondary analysis of a cross-sectional case-control study. Participants wore a multisensor device for >5 days (>22 hours per day). Primary outcomes included the number, duration (minutes) and intensity (metabolic equivalent tasks [METs]) of bouts of moderate-to-vigorous-intensity physical activity (defined as at least >3 METs for >10 consecutive minutes). Secondary outcomes included the total accumulated times spent doing moderate-to-vigorous-intensity physical activity (>3 METs) and doing sedentary-intensity activity (<1.5 METs). DFU subgroups with minor amputations and nonremovable offloading devices were also analyzed. RESULTS Overall, 15 DM, 23 DPN, and 27 DFU participants were included. All groups recorded similar low median daily numbers (0.33, 0.29, 0.25 numbers, respectively), duration (15, 17, 14 minutes), and intensity of daily bouts of moderate-to-vigorous-intensity physical activity (4.1, 4.3, 3.9 METs) (all, P > .1). Median accumulated daily time spent doing moderate-to-vigorous-intensity physical activity was also similar (40, 37, 36 minutes; P > .8). Those with DFU had more mean accumulated daily time spent doing sedentary-intensity activity (796 minutes) compared to DPN (720 minutes; P < .05), but not compared to DM (728 minutes; P < .08). DFU subgroups with minor amputations had more median accumulated daily time spent doing moderate-to-vigorous-intensity physical activity (66, 28 minutes; P < .05) and less mean time doing sedentary-intensity activity (745, 837; P < .05) than those without amputations. CONCLUSIONS People with DFU performed similar low numbers of daily bouts of moderate-to-vigorous-intensity physical activity to controls, but spend more time doing sedentary-intensity activities. Interventions that gradually increase the moderate-to-vigorous-intensity physical activity in people with DFU should be investigated.
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Affiliation(s)
- Maggie Lee
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Podiatry Department, Ng Teng Fong General Hospital, Singapore
| | - Jaap J. van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Helen Sheahan
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
- Department of Diabetes and Endocrinology, Sunshine Coast University Hospital, Birtinya, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Peter A. Lazzarini, PhD, School of Public Health and Social Work, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland 4059, Australia.
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Yu P, Guo J, Li J, Chen W, Zhao T. Co-expression network analysis revealing the key lncRNAs in diabetic foot ulcers. Arch Med Sci 2019; 15:1123-1132. [PMID: 31572456 PMCID: PMC6764308 DOI: 10.5114/aoms.2019.84699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Diabetic foot ulcers (DFUs) are the most common foot injuries leading to lower extremity amputation in diabetic patients. Recent studies showed that long non-coding RNAs (lncRNAs) played important roles in diverse biological processes. In this study, we focused on identifying differentially expressed long non-coding RNAs (lncRNAs) in DFU. MATERIAL AND METHODS Real-time PCR assay was performed to validate the expression pattern of lncRNAs in DFU. Moreover, co-expression networks were also constructed to identify hub lncRNAs in DFU. Specifically, gene ontology (GO) analysis was first performed to evaluate the potential roles of differentially expressed genes (DEGs) and lncRNAs in DFU. RESULTS In the present study, we identified 58 up-regulated lncRNAs and 42 down-regulated lncRNAs in DFU samples compared to non-diabetic foot skin samples by analyzing the GSE68186 dataset. Four lncRNAs (FLJ30679, LINC01193, LINC00692, and LINC00641) were observed to be up-regulated in DFU. Furthermore, we found that the down-regulated lncRNA-mediated co-expression network contained 42 lncRNAs and 700 DEGs and the up-regulated lncRNA mediated co-expression network contained 58 lncRNAs and 688 DEGs. CONCLUSIONS Bioinformatics analysis showed that differentially expressed lncRNAs were involved in regulating the ERK1 and ERK2 cascade, secondary alcohol biosynthetic process, centrosome duplication and DNA repair. These results suggested the potential prognostic value of lncRNAs in DFU.
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Affiliation(s)
- Pijun Yu
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Soochow University, Soochow, China
- Shanghai Eighth People’s Hospital, Shanghai, China
| | - Jian Guo
- Shanghai Eighth People’s Hospital, Shanghai, China
| | - Junjie Li
- Shanghai Eighth People’s Hospital, Shanghai, China
| | - Wei Chen
- Shanghai Eighth People’s Hospital, Shanghai, China
| | - Tianlan Zhao
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Soochow University, Soochow, China
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Poretti K, Peters J, Singh A. Effects of diabetic therapeutic footwear and traditional athletic footwear on gait:a cross-sectional investigation. FOOTWEAR SCIENCE 2019. [DOI: 10.1080/19424280.2019.1606092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kelly Poretti
- Department of Biomedical Engineering, Widener University, Chester, USA
| | - James Peters
- Department of Biomedical Engineering, Widener University, Chester, USA
| | - Anita Singh
- Department of Biomedical Engineering, Widener University, Chester, USA
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Francia P, Bellis AD, Seghieri G, Tedeschi A, Iannone G, Anichini R, Gulisano M. Continuous Movement Monitoring of Daily Living Activities for Prevention of Diabetic Foot Ulcer: A Review of Literature. Int J Prev Med 2019; 10:22. [PMID: 30820309 PMCID: PMC6390424 DOI: 10.4103/ijpvm.ijpvm_410_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023] Open
Abstract
Lower extremity ulcers represent the most ominous, feared, and costly complications of diabetes mellitus. The aim of this review is to highlight the role of daily life physical activities (PAs) and continuous movement monitoring (CMM) in the prevention of foot ulcers. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute, in turn, to the development of additional risk factors such as foot deformities and/or joint and muscular alterations. Moreover, a deficit of balance, posture abnormalities, followed by gait alterations, increases the risk of ulceration. PA can play a key role in the management of patients with diabetes and in the prevention of ulcers; however, even if it has been reported that some of these risk factors significantly improve after a few weeks of exercise therapy (ET), the real preventive role of ET has not yet been demonstrated. These uncertain results can occur due to some limitations in the management of the same relationship between PA and diabetic foot prevention. Technological advances during the last years enable timely management of overall daily PA. The use of these modern technologies and devices allows CMM assessment and description of daily PA even in the long term. The data collected from these devices can be used to properly manage patients' PA and thus contribute to the prevention of foot ulcers.
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Affiliation(s)
- Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | | | | | | | | | - Massimo Gulisano
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Abstract
OBJECTIVE To examine the experiences of patients with diabetic foot ulcers (DFUs). METHOD This qualitative study, using patient interviews, focused on how inpatients receiving treatment for diabetes experience the disease. Patients were selected using a purposive sampling method. RESULTS A total of 15 patients participated in the study. Following analysis of patient interviews, four main themes were determined: 'developing diabetic foot', 'living with diabetic foot', 'coping with diabetic foot' and 'expectations'. CONCLUSION Most of the patients were afraid of losing their feet and had difficulties in coping with the situation. Patients expected health professionals to understand the difficulties they were experiencing. To better understand the needs and experiences of patients, healthcare professionals should work with these patient groups as part of in-service training programmes. Such programmes should also include therapeutic communication techniques and models for professional patient-client communication.
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Affiliation(s)
- Meltem Meriç
- Assistant Professor, Near East University, Faculty of Nursing. Near East Boulevard, Nicosia, Turkey
| | - Gül Ergün
- Assistant Professor, Mehmet Akif Ersoy University, Faculty of Heath Sciences, Department of Nursing, Burdur, Turkey
| | - Coşkun Meriç
- Associate Professor, Health Sciences University, Gülhane Training and Research Hospital, Department of Endocrinology and Metabolism Etlik-Ankara, Turkey
| | - İbrahim Demirci
- Health Sciences University, Gülhane Training and Research Hospital, Department of Endocrinology and Metabolism Etlik-Ankara, Turkey
| | - Ömer Azal
- Professor, Health Sciences University, Gülhane Training and Research Hospital, Department of Endocrinology and Metabolism Etlik-Ankara, Turkey
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Zubair M, Malik A, Ahmad J. Correlation of HbA1c and S. creatinine along with microbiological profiling of infected ulcers; cases of diabetic patients. Diabetes Metab Syndr 2019; 13:30-34. [PMID: 30641715 DOI: 10.1016/j.dsx.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
Abstract
STATEMENT OF THE PROBLEM The rate of diabetes mellitus is increasing globally as a result of increased levels of blood glucose. The elevated blood glucose level results due to impairment in the production and action of insulin. An increase in glycated hemoglobin is associated with higher blood glucose levels that further results in nephropathy, neuropathy, retinopathy, and cardiovascular disease. Therefore, the study has investigated the correlation between HbA1c and creatinine levels among diabetic patients, suffering from foot ulcerations. METHODS A prospective cohort hospital based-study has retrieved hospital records of patients during January 2009 and February 2015. A total of 192 patients, admitted in the Rajiv Gandhi Centre for Diabetes and Endocrinology, of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India were recruited. RESULTS It has been examined that there is a positive correlation between ulcer duration and BMI, amputation rate and BMI, gender and BMI, hospital stay and BMI, HbA1c and BMI, Hb and BMI and triglyceride and BMI at 5% level of significance. CONCLUSION Findings have shown positive association with gender, diabetes duration, ulcer size, grade of ulcer, amputation rate, hospital stay, Hb, SGOT/AST and triglyceride.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia; Former PDF, Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
| | - Abida Malik
- Former Chairperson, Department of Medical Microbiology, Former Dean, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India
| | - Jamal Ahmad
- Former Director, Rajiv Gandhi Centre for Diabetes and Endocrinology, Former Dean, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
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Nadi M, Bambaeichi E, Marandi SM. Comparison of the effect of two therapeutic exercises on the inflammatory and physiological conditions and complications of diabetic neuropathy in female patients. Diabetes Metab Syndr Obes 2019; 12:1493-1501. [PMID: 31692497 PMCID: PMC6708387 DOI: 10.2147/dmso.s206454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/29/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND AIM The purpose of this study was to compare the effect of 12 weeks of low-intensity resistance training and exercises for peripheral neuropathy (EPN) on the inflammatory and physiological conditions, balance, and complications of diabetic neuropathy in female patients. MATERIALS AND METHODS 45 women with mild to moderate diabetic neuropathy and an average age of 55.46±3.06 years voluntarily participated in the study. They were randomly assigned to either control (n=15), resistance (n=15), and EPN (n=15) groups. Both experimental groups were trained for 12 weeks (three sessions per week). EPN group did peripheral neuropathic exercises (12 lower extremity movements), and the resistance group performed their exercises with a 30% repetition maximum. During the intervention period, the control group only performed their daily activities. Blood samples were taken in both pre-test and post-test to investigate the levels of Tumor necrosis-α (TNF-α), Interleukin-10 (IL-10), C Reactive Protein (CRP), fast blood glucose (FBG) and Glycated hemoglobin (HbA1c). Complications of diabetic neuropathy were measured using the Michigan questionnaire and the Monofilament 10 g. In order to measure the balance, De Morton mobility index (DEMMI) was used. RESULTS The statistical analyses showed a significant decrease of FBG and HbA1c in the two experimental groups, as compared to the control group. TNF-α and CRP levels were decreased in both EPN and resistance groups, as compared to the control group. The observed increase in the serum IL-10 levels of the two experimental groups was not, however, significant, as shown in intra-group and inter-group comparisons. On the other hand, the two complications of pain and tingling in the lower limb extremities were improved in both experimental groups (p<0.05). However, the numbness complication showed no significant change (p=0.10). Static and dynamic balance was improved in the EPN group as well (p<0.05). CONCLUSION Since EPN exercises, in contrast to resistance exercises, are focused on the lower limb extremities and designed for diabetic neuropathy patients, they can improve the imbalance, pain and tingling, by significantly reducing TNF-α and CRP and improving the physiological conditions.
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Affiliation(s)
- Maryam Nadi
- Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Effat Bambaeichi
- Faculty of Sport Sciences Department, University of Isfahan, Isfahan, Iran
- Correspondence: Effat BambaeichiFaculty of Sport Sciences Department, University of Isfahan, Azadi Square, Isfahan8174673441, IranTel +98 913 205 0472 Email
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Palaya J, Pearson S, Nash T. Perception of social support in individuals living with a diabetic foot: A qualitative study. Diabetes Res Clin Pract 2018; 146:267-277. [PMID: 30389622 DOI: 10.1016/j.diabres.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
AIM To explore the perception of social support in individuals living with a diabetic foot in order to influence future service delivery in management of similar individuals. METHOD A purposive sample of eight participants with a diabetic foot were recruited from a public podiatry service in Tasmania, Australia. A hermeneutic phenomenology qualitative approach was used with individual semi-structured interviews conducted using an interview guide designed to gain insight into five pre-determined measures of social support. Hybrid thematic analysis was used to produce the final results. RESULTS Five clusters of themes emerged; emotional self-efficacy, isolation and stress; transport needs linked to physical or social functioning; perception of social support from health professionals; reciprocal support including health professionals facilitating support and financial support. CONCLUSION The findings have major implications for three broad areas; recognition and management of psychosocial well-being, the need for patient centred care approaches and inclusion and equity in health care and society. Adopting measures that are informed by these findings in current day management practices will complement the existing body of evidence on addressing factors for developing and treating ulceration.
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Affiliation(s)
- Joshua Palaya
- College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania 7000, Australia; Tasmanian Health Service - South, Podiatry Department, GPO Box 1061, Hobart, Tasmania 7001, Australia.
| | - Sue Pearson
- College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania 7000, Australia.
| | - Toni Nash
- Tasmanian Health Service - South, Podiatry Department, GPO Box 1061, Hobart, Tasmania 7001, Australia.
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Ibrahim M, Tuomilehto J, Aschner P, Beseler L, Cahn A, Eckel RH, Fischl AH, Guthrie G, Hill JO, Kumwenda M, Leslie RD, Olson DE, Pozzilli P, Weber SL, Umpierrez GE. Global status of diabetes prevention and prospects for action: A consensus statement. Diabetes Metab Res Rev 2018; 34:e3021. [PMID: 29757486 DOI: 10.1002/dmrr.3021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022]
Abstract
Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high-risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP-1 agonists, glitazones, and acarbose, can be considered for selected high-risk patients with prediabetes when lifestyle-based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.
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Affiliation(s)
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Kuwait, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland, and Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Bogota, Colombia
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, FL, USA
| | - Avivit Cahn
- Hadassah Hebrew University Hospital, The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Robert H Eckel
- University of Colorado Denver Anschutz Medical Campus, University of Colorado Hospital, Denver, CO, USA
| | - Amy Hess Fischl
- University of Chicago Kovler Diabetes Center, Chicago, IL, USA
| | - George Guthrie
- Florida Hospital Graduate Medical Education, Orlando, FL, USA
| | - James O Hill
- Colorado Nutrition Obesity Research Center (NORC), University of Colorado School of Medicine, Aurora, CO, USA
| | | | - R David Leslie
- Blizard Institute, Queen Mary, University of London, London, UK
| | - Darin E Olson
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Sandra L Weber
- Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
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Bohn B, Grünerbel A, Altmeier M, Giesche C, Pfeifer M, Wagner C, Heise N, Best F, Fasching P, Holl RW. Diabetic foot syndrome in patients with diabetes. A multicenter German/Austrian DPV analysis on 33 870 patients. Diabetes Metab Res Rev 2018; 34:e3020. [PMID: 29726089 DOI: 10.1002/dmrr.3020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/08/2018] [Accepted: 04/22/2018] [Indexed: 12/12/2022]
Abstract
AIMS The diabetic foot syndrome (DFS) is a serious complication in patients with diabetes increasing the risk for minor/major amputations. This analysis aimed to examine differences in diabetes patients with or without DFS stratified by type 1 (T1D) or type 2 diabetes (T2D). MATERIAL AND METHODS Adult patients (≥20y of age) with diabetes from the German/Austrian diabetes patients follow-up registry (DPV) were included. The cross-sectional study comprised 45 722 subjects with T1D (nDFS = 2966) and 313 264 with T2D (nDFS = 30 904). In DFS, minor/major amputations were analysed. To compare HbA1C , neuropathy, nephropathy, cardiovascular disease risk factors, and macrovascular complications between patients with or without DFS, regression models were conducted. Confounders: age, sex, diabetes duration. RESULTS In patients with DFS, a minor amputation was documented in 27.2% (T1D) and 25.9% (T2D), a major amputation in 10.2% (T1D) and 11.3% (T2D). Regression models revealed that neuropathy was more frequent in subjects with DFS compared with patients without DFS (T1D: 70.7 vs 29.8%; T2D: 59.4% vs 36.9%; both P < 0.0001). Hypertension, nephropathy, peripheral vascular disease, stroke, or myocardial infarction was more common compared with patients without DFS (all P < 0.0001). In T1D with DFS, a slightly higher HbA1C (8.11% vs 7.95%; P < 0.0001) and in T2D with DFS a lower HbA1C (7.49% vs 7.69%; P < 0.0001) was observed. CONCLUSIONS One third of the patients with DFS had an amputation of the lower extremity. Especially neuropathy or peripheral vascular disease was more prevalent in patients with DFS. New concepts to prevent DFS-induced amputations and to reduce cardiovascular risk factors before the occurrence of DFS are necessary.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Arthur Grünerbel
- Specialized Practice for Diabetes and Nutritional Medicine, Munich, Germany
| | | | - Carsten Giesche
- Clinic of Internal Medicine, Alexianer St. Hedwig Hospital, Berlin, Germany
| | | | | | - Nikolai Heise
- Alb Fils Kliniken, Helfenstein Clinic, Geislingen, Germany
| | - Frank Best
- Diabetes-Practice Dr. Best, Essen, Germany
| | - Peter Fasching
- 5th Medical Department, Wilhelminenspital, Vienna, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Abstract
Persons with diabetes might experience significant benefits through regular exercise. Not unlike the general population, those with diabetes could also lack motivation to participate in an exercise program. Often, those treating persons with diabetes lack training and/or interest in exercise prescription and are therefore unable to provide the needed information and encouragement. In many cases, reluctance to exercise could result from an inability to find an enjoyable exercise activity. Attempts to find activities that, not only provide effective aerobic challenges, but are also enjoyable to participate in are fraught with difficulty. Three electronic databases were searched in January 2017. Evidence for the merits of exercise for those with diabetes was robust. Numerous reports have addressed the degree of noncompliance to exercise recommendations and the barriers reported for this nonadherence. Additional studies concluded that most medical providers are deficient in formal training in the prescription of an exercise program. Newer studies are evaluating the effects of exercise and vitamin D supplementation and their interplay with diabetic peripheral neuropathy and ulceration. Exercise confers remarkable benefits to those with diabetes; however, the challenges to compelling patients with diabetes to exercise are formidable. An improved focus on exercise prescription and related motivation during provider training must be undertaken.
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Affiliation(s)
- David W Jenkins
- Professor, Arizona School of Podiatric Medicine, College of Health Sciences, Midwestern University, Glendale, AZ.
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Gao W, Sun L, Fu X, Lin Z, Xie W, Zhang W, Zhao F, Chen X. Enhanced diabetic wound healing by electrospun core–sheath fibers loaded with dimethyloxalylglycine. J Mater Chem B 2018; 6:277-288. [DOI: 10.1039/c7tb02342a] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
DMOG-loaded nanofibrous wound dressings enhanced diabetic wound healing by stabilizing HIF-1α.
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Affiliation(s)
- W. Gao
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - L. Sun
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - X. Fu
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - Z. Lin
- Department of Orthopedics
- Guangzhou General Hospital of Guangzhou Military Command
- Guangzhou
- China
- Guangdong Key Laboratory of Orthopedic Technology and Implant Materials
| | - W. Xie
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - W. Zhang
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - F. Zhao
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - X. Chen
- The School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510640
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
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Noroozi Z, Hamidian S, Khajeddin N, Mehrabi Zadeh Honarmand M, Zargar Y, Rashidi H, Dolatshahi B. Improving Depression, and Quality of Life in Patients with Type 2 Diabetes: Using Group Cognitive Behavior Therapy. IRANIAN JOURNAL OF PSYCHIATRY 2017; 12:281-286. [PMID: 29472955 PMCID: PMC5816918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Depression is a chronic condition comorbid with diabetes type 2 that often remains untreated. Dealing with diabetes is a challenging task for patients and can lead to depression in long term. These two conditions have a negative influence on each other and on the individual's quality of life. The purpose of this study was to investigate the effect of group cognitive behavior therapy on depression, quality of life in women with diabetes type 2. Method: We conducted a clinical trial among 30 women with diabetes type 2 comorbid with depression. The women were divided randomly into the two groups of intervention and control. Each group consisted of 15 individuals. The intervention group received 10 sessions of group cognitive behavior therapy while the control group didn't. Results: The results suggested that group cognitive-behavior therapy decreased depression symptoms (F=72.17, p<0.001), and improved quality of life of the patients (F=8.82, p<0.05) of the intervention group compared to the control group. Conclusion: The results shows that group cognitive behavior therapy can affect depression symptoms, and consequently patients' quality of life with diabetes type 2.
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Affiliation(s)
- Zahra Noroozi
- Department of Psychology, Shahid Chamran University, Ahvaz, Iran.
| | - Sajedeh Hamidian
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Corresponding Author: Address: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Koodakyar Alley, Student Blvd., Evin, Tehran, Iran. Tel: +989173915289,
| | - Niloofar Khajeddin
- Department of Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Yadollah Zargar
- Department of Psychology, Shahid Chamran University, Ahvaz, Iran.
| | - Homeira Rashidi
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Vileikyte L, Crews RT, Reeves ND. Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration. Curr Diab Rep 2017; 17:109. [PMID: 28942488 DOI: 10.1007/s11892-017-0945-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to elucidate how psychological and biomechanical factors interrelate in shaping patients' experience with diabetic symmetric polyneuropathy (DSPN) and its sequela-diabetic foot ulceration (DFU). RECENT FINDINGS Recent findings emphasize the importance not only of neuropathic pain but also of other DSPN symptoms, such as unsteadiness. We highlight the negative spiral between unsteadiness, falls, and psychological distress. Moreover, unsteadiness is a key determinant of non-adherence to offloading resulting in the delayed DFU healing. While depression is an established predictor of incident DFU, findings linking depression and DFU healing remain inconclusive. Examination of physical activity in DFU development and healing represents the most recent application of research to this field. Research evidence indicates that DSPN markedly impairs physical and emotional functioning and suggests that there is an unmet need for the development of multifaceted interventions that address both psychological distress and biomechanical challenges experienced by patients with this debilitating complication of diabetes.
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Affiliation(s)
- Loretta Vileikyte
- Department of Medicine, University of Manchester, Manchester, M13 9WL, UK.
| | - Ryan T Crews
- William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Neil D Reeves
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK
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35
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Bahador RS, Afrazandeh SS, Ghanbarzehi N, Ebrahimi M. The Impact of Three-month Training Programme on Foot Care and Self-efficacy of Patients with Diabetic Foot Ulcers. J Clin Diagn Res 2017; 11:IC01-IC04. [PMID: 28892930 DOI: 10.7860/jcdr/2017/29025.10261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/06/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patient's self-efficacy in disease management and foot care is considered as an important indicator in controlling the complications of diabetes. AIM This study was aimed to determine the effect of three-month training programme on foot care and self-efficacy of patients with diabetic foot ulcers. MATERIALS AND METHODS A quasi-experimental study was conducted on 60 patients with diabetic foot ulcers in Jiroft Imam Khomeini hospital from January 2016 to May 2016. These patients were randomly divided into intervention and control groups (30 patients in each group). The research instrument was a questionnaire on demographic data, self-efficacy questions for patients with diabetes and a researcher made questionnaire of diabetic foot care. Training programmes for foot ulcers care and prevention of new ulcers formation and other aspects of the disease were implemented during three months in the test group. Data were analysed using descriptive and analytic statistical tests (Mann-Whitney U, paired t-test and Pearson correlation coefficient) by SPSS version 18.0 software. RESULTS The results showed statistically significant difference (p<0.001) in the score of self-efficacy between intervention group (182.25) and control group (93.56), and the foot care score was 47.43 in the intervention group and 30.18 in control group after the intervention. The average scores of self-efficacy and foot ulcers care significantly increased in the intervention group after training programme (p<0.001). CONCLUSION The results showed that the implementation of training programme has been able to increase the self-efficacy of patients and the rate of their foot ulcers care and the prevention of new ulcers and effectively reduce the complications in diabetic patients.
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Affiliation(s)
- Raziyeh Sadat Bahador
- Instructor, Department of Nursing, Jiroft Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Seyedeh Sara Afrazandeh
- Instructor, Department of Nursing, Ferdows Paramedical School, Birjand University of Medical Sciences, Birjand, Iran
| | - Nezar Ghanbarzehi
- Instructor, Department of Nursing, Nursing and Midwifery School, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Maryam Ebrahimi
- Instructor, Department of Health Information Technology, Ferdows Paramedical School, Birjand University of Medical Sciences, Birjand, Iran
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36
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Sheahan H, Canning K, Refausse N, Kinnear EM, Jorgensen G, Walsh JR, Lazzarini PA. Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free-living environments. Int Wound J 2017; 14:1175-1182. [PMID: 28707412 DOI: 10.1111/iwj.12782] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 12/30/2022] Open
Abstract
The aims of our study were to investigate multiple daily activity outcomes in patients with diabetic foot ulcers (DFU) compared to diabetic peripheral neuropathy (DPN) and diabetes (DM) controls in their free-living environments. We examined daily activity outcomes of 30 patients with DFU, 23 DPN and 20 DM. All patients wore a validated multi-sensor device for > 5 days (>22 hours per day) to measure their daily activity outcomes: steps, energy expenditure (kJ), average metabolic equivalent tasks (METs), physical activity (>3·0 METs) duration and energy expenditure, lying duration, sleep duration and sleep quality. We found that DFU patients recorded fewer median (interquartile ranges, IQR) daily steps [2154 (1621-4324)] than DPN [3660 (2742-7705)] and DM [5102 (4011-7408)] controls (P < 0·05). In contrast, DFU patients recorded more mean ± SD daily energy expenditure (kJ) (13 006 ± 3559) than DPN (11 085 ± 1876) and DM (11 491 ± 1559) controls (P < 0·05). We found no other differences in daily activity outcomes (P > 0·1). We conclude that DFU patients typically take fewer steps but expend more energy during their normal daily activity than DPN and DM controls. We hypothesise that the increased energy expenditure for DFU patients may be due to wound healing or an inefficient gait strategy. Further investigations into this energy imbalance in DFU patients may improve healing in future.
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Affiliation(s)
- Helen Sheahan
- Community Diabetes Service, Metro North Hospital & Health Service, Brisbane, Australia.,Department of Podiatry, Metro North Hospital & Health Service, Brisbane, Australia
| | - Kimberley Canning
- Community Diabetes Service, Metro North Hospital & Health Service, Brisbane, Australia.,Department of Podiatry, Metro North Hospital & Health Service, Brisbane, Australia
| | - Nishka Refausse
- Community Diabetes Service, Metro North Hospital & Health Service, Brisbane, Australia.,Department of Podiatry, Metro North Hospital & Health Service, Brisbane, Australia
| | - Ewan M Kinnear
- Department of Podiatry, Metro North Hospital & Health Service, Brisbane, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Greg Jorgensen
- Department of Sleep Science, The Prince Charles Hospital, Brisbane, Australia
| | - James R Walsh
- Heart Lung Institute, The Prince Charles Hospital, Brisbane, Australia
| | - Peter A Lazzarini
- Department of Podiatry, Metro North Hospital & Health Service, Brisbane, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.,School of Clinical Science, Queensland University of Technology, Brisbane, Australia
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37
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Bohorquez Robles R, Compeán Ortiz LG, González Quirarte NH, Berry DC, Aguilera Pérez P, Piñones Martínez S. Knowledge and Practices of Diabetes Foot Care and Risk of Developing Foot Ulcers in México May Have Implications for Patients of Méxican Heritage Living in the US. DIABETES EDUCATOR 2017; 43:297-303. [PMID: 28459176 DOI: 10.1177/0145721717706417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the study was to examine the relationship between knowledge and foot care practices among adults with type 2 diabetes. Methods A descriptive correlational study examined 200 patients with type 2 diabetes in México. Data collected included the Knowledge and Practices Self-Care Questionnaire and a Podiatry Examination Questionnaire. Data analysis included Pearson’s correlations and chi-square tests. Results More than half of the participants had poor knowledge and poor foot care practices. A significant negative correlation between knowledge and practices of foot care and risk of developing diabetes foot ulcers was found. There was no relationship between sociodemographic variables and the risk of developing diabetes foot ulcers. Conclusions Patients with type 2 diabetes served in an outpatient clinic had poor knowledge and practices of foot care. They demonstrated decreased knowledge and practice of foot care and therefore showed a greater risk of developing diabetes foot, which may predispose patients to early complications.
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Affiliation(s)
- Rosa Bohorquez Robles
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
| | - Lidia G. Compeán Ortiz
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
| | - Nora H. González Quirarte
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
| | - Diane C. Berry
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
| | - Paulina Aguilera Pérez
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
| | - Socorro Piñones Martínez
- Clínic of Family Medicine of Surgical Specialties “ISSSTE,” Tampico Tamaulipas, México (Ms Bohorquez Robles)
- Universidad Autónoma de Tamaulipas School of Nursing, Tampico Tamaulipas, México (Dr Compeán Ortiz, Dr González Quirarte, Ms Aguilera Pérez, Dr Piñones Martínez)
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Berry)
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Clokie M, Greenway AL, Harding K, Jones NJ, Vedhara K, Game F, Dhatariya KK. New horizons in the understanding of the causes and management of diabetic foot disease: report from the 2017 Diabetes UK Annual Professional Conference Symposium. Diabet Med 2017; 34:305-315. [PMID: 28029181 DOI: 10.1111/dme.13313] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 01/24/2023]
Abstract
Diabetes-related foot disease remains a common problem. For wounds, classic teaching recommends the treatment of any infection, offloading the wound and ensuring a good blood supply, as well as ensuring that the other modifiable risk factors are addressed and optimized. There remain, however, several questions about these and other aspects of the care of diabetes-related foot disease. Some of these questions are addressed in the present report; in particular, the impact of newer technologies in the identification of any organisms present in a wound, as well as the use of novel approaches to treat infections. The use of new remote sensing technology to identify people at risk of developing foot ulceration is also considered, in an attempt to allow early intervention and prevention of foot ulcers. The psychological impact of foot disease is often overlooked, but with an increasing number of publications on the subject, the cause-and-effect role that psychology plays in foot disease, such as ulcers and Charcot neuroarthropathy, is considered. Finally, because of heterogeneity in diabetic foot studies, comparing results is difficult. A recently published document focusing on ensuring a standardized way of reporting foot disease trials is discussed.
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Affiliation(s)
- M Clokie
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, Rhondda Cynon Taf
| | - A L Greenway
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, Rhondda Cynon Taf
| | - K Harding
- Medical School, Cardiff University, Heath Park, Cardiff, Rhondda Cynon Taf
| | - N J Jones
- Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Rhondda Cynon Taf
| | - K Vedhara
- Department of Health Psychology, Division of Primary Care, Nottingham University, Nottingham, UK
| | - F Game
- Department of Diabetes, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - K K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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