Impact of a Preventive Program on Amputation Rates in the Diabetic Population

Impact of Diabetes Foot Care Education on Amputation Rate in the University of Abuja Teaching Hospital, Nigeria

Ulceration of the foot is a major problem for people with diabetes. In a developing country like Nigeria, huge challenge is caused by diabetes foot problems. The aim of this study was to determine the impact of diabetic foot care education of patients and health care staff on the outcome of diabetic foot complications in our hospital. This was a pre and post design carried out from April 2013 to March 2014 on 155 diabetes patients. Patient education was carried out by diabetes nurses and doctors, at diagnosis and re-enforced at follow-up clinics. At the end of 1 year, the impact of education was assessed. Descriptive statistics were generated as appropriate. A total of 155 patients, 64 (41%) males and 91 (59%) females, were studied with mean age of 49 ± 3 years and mean duration of diabetes 6 ± 2.6 years. At the onset of the program, 70% of the patients had no knowledge of foot care education. Only 13.5% knew that diabetes mellitus foot ulcer could be related to long duration of diabetes, nerve damage, blood vessel blockage, foot deformity, and uncontrolled blood glucose. Ninety-two percent of the patients preferred home remedies, herbal treatment, or chemist in the event of an ulcer. After the program, 77% would seek hospital care as first option, and amputation rate decreased from 50% in 2009 to 10% by 2017. Our experience has shown that education is the cheaper option for the prevention of lower limb amputation in a resource-poor setting like ours.

Knowledge, attitude, and practice of diabetic patients regarding foot care: Experience from a single tertiary care outpatient clinic

BACKGROUND

Foot complications are a common problem among the diabetic population globally. Proper preventive education by health care providers should be provided to the diabetic population. This study aims to assess the knowledge, attitude, and practice of diabetic patients regarding foot care.

METHODS

This study was carried out in the medicine outdoor patient department of Allied Hospital, Faisalabad. A total sample of 150 diabetic patients was taken. Sampling was done through a non-probability convenient sampling technique. The data was analyzed using SPSS version 20.

RESULTS

The mean age of the respondents was 52.49 ± 11.87 years. Most of the patients had moderate knowledge and also practiced a moderate level of foot care. 32.7% of the patients had good knowledge, 51.3% had moderate knowledge, and 16.0% had poor knowledge regarding foot care. 63.3% of the patients had moderate practice; 24.5%, poor practice; and 12.2%, good practice. Patients belonging to urban areas scored better on both knowledge and practice scales. A significant statistical association of education with knowledge (P = 0.012) and practice (P = 0.008) regarding foot care was found. The patients compliant with drug therapy also observed better foot care practices.

CONCLUSION

Education had a significant role in positively influencing the behavior of the patients. There was found a gap between knowledge and practice level of patients. Hence patients should be actively engaged in their health care plan with more emphasis on changing their behavior.

A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation

AIMS

To assess the impact of diabetic foot care delivery in preventing lower extremity amputation (LEA).

METHODS

We systematically searched the MEDLINE database for research evaluating the association between any aspect of diabetic foot care delivery and risk of LEA. Meta-analysis was conducted by calculating a pooled odds ratio through a random effects model.

RESULTS

Our search retrieved 5093 articles. In total, 58 articles were included: 9 addressing healthcare access, 4 educating health professionals, 2 implementing guidelines, 6 receiving chiropody/podiatry care services and 37 implementing structured diabetic foot care services (SDFC). All of these aspects of diabetic foot care seemed to have a positive impact on preventing LEA. Only SDFC literature met criteria for performing a meta-analysis. For SDFC impact on preventing overall and major LEA but not for minor LEA compelling evidence was observed [aggregated odds ratio (OR) of 0.45 (95% CI 0.37-0.57), 0.40 (95% CI 0.32-0.51), and 0.87 (95% CI 0.67-1.14), respectively]. However, high heterogeneity (superior to 60%) was observed for all outcomes.

CONCLUSIONS

Results support a reduction in diabetic LEA frequency in association with structured diabetic foot care, and, in particular, major LEA. Less evidence is available for the remaining aspects of diabetic foot care delivery.

Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study

BACKGROUND

Diabetic foot ulcers (DFU) are a critical complication of diabetes mellitus (DM) affecting life quality and significantly impacting healthcare resources.

OBJECTIVE

Determine the direct medical costs associated with treating DFU in King Fahad Hospital of the University and identify factors that could assist in developing resource management guidelines in Saudi Arabia.

DESIGN

Retrospective study.

SETTING

SETTING: King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.

PATIENTS AND METHODS

The study included diabetic patients admitted with foot ulcerations between 2007 and 2017 inclusive. We determined management costs including drug usage, wound dressings, surgical procedures, admissions, and basic investigation.

MAIN OUTCOME MEASURES

Factors affecting the direct perspective medical costs of managing DFU.

SAMPLE SIZE

99 patients.

RESULTS

The overall cost of managing 99 patients with DFU was 6 618 043.3 SAR ($1 764 632.68 USD), which further translates to approximately 6684.9 SAR per patient/year ($1782.6 USD). The highest cost incurred was for admission expenditure (45.6%), followed by debridement (14.5%) and intensive care unit (ICU) admission (10.4%).

CONCLUSION

The overall healthcare expenditure in treating DFU is high, with hospital admissions and surgical procedures adding a significant increase to the total cost. Focused patient education on overall glycemic control and prevention of DFU may decrease complications and hence, the overall cost.

LIMITATIONS

Identified only the direct medical costs of DFU as the indirect costs were subjective and more difficult to quantify.

CONFLICT OF INTEREST

None.

A pilot study investigating the utilization of crest pads for treatment of toe callus and ulceration

Patients with lesser-toe deformities are at increased risk of developing calluses and ulcers on the distal ends of the affected digits because of the increased pressures applied to these areas. The number of diabetic patients in the United States continues to increase, along with associated comorbidities such as peripheral vascular disease and peripheral neuropathy. These conditions predispose patients to developing foot ulcerations, especially if foot deformities are present. Crest pads are a simple-to-make, inexpensive option to treat calluses and ulcerations on the distal ends of digits; however, there is no research available that support their use. Crest pads consist of rolled gauze covered in moleskin, with a large opening that fits over several toes and lies on the dorsal aspect of the foot, with the padded portion resting under the toes. Over several days of use, the pad molds to the plantar aspect of the toes, offloading pressure from the distal end of the affected digit(s). The sample was obtained through a retrospective chart review of patients identified as having had at least one nail care visit and at least one follow-up visit at a vascular surgery practice between August 2011 and December 2014. Potential subjects with toe deformities who presented with callus or ulcer on the distal end of a digit were considered for inclusion, if they received a crest pad as part of their treatment plan. The scholarly project was a preintervention or postintervention design with subjects acting as their own controls. McNemar's test was used to analyze the results which were statistically significant (P < .0001 at first callus follow-up and P = .0002 at second callus follow-up) for callus, hemorrhagic callus, and/or ulcer improvement following the crest pad intervention. The results of this scholarly project support the use of crest pads in patients with lesser-toe deformities to treat distal toe calluses and/or ulcerations.

Impact of a diabetic foot care education program on lower limb amputation rate

Background

Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.

Method

This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.

Results

The before group contained 20 patients (17 males) and the after group contained 21 patients (16 males). There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.

Conclusion

The program, although evaluated at an early stage, has increased the awareness of both patients and health care staff about the prevention and management of diabetic foot disease, and decreased the rate of lower extremity amputation. We believe that the statistical proof of its impact will be evident in the final evaluation.