Knowledge and practices for the prevention of the diabetic foot

Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy

Abstract

Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet.

Objective

to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy.

Method

Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used.

Results

Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77).

Conclusion

The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.

Tendência temporal das complicações do pé diabético e da cobertura da Atenção Primária à Saúde nas capitais brasileiras, 2008–2018

Introdução: Complicações diabéticas são condições preveníveis em sua maioria, sendo o pé diabético uma das mais comuns. O manejo adequado do pé diabético mitiga eventos incapacitantes e maiores gastos ao sistema de saúde. As intervenções efetivas na Atenção Primária à Saúde (APS) possibilitam prevenir as complicações diabéticas. Objetivo: Analisar a tendência das complicações do pé diabético e sua relação com a cobertura da APS nas capitais brasileiras, entre 2008 e 2018. Métodos: Estudo ecológico de séries temporais das incidências acumuladas de complicações do pé diabético nas 27 capitais utilizando dados do Sistema de Informação sobre Hipertensos e Diabéticos. As variáveis independentes foram ano, cobertura da APS e da Estratégia Saúde da Família. Empregou-se modelo de regressão de Prais-Winsten. Resultados: No Brasil, ocorreram 45.095 casos de complicações do pé diabético no período, com média de 0,57 casos/100.000 habitantes (p<0,001) — estável em 14 capitais (p>0,05) e crescente em 13 capitais (p<0,05). Há associação entre elevação do nível de cobertura da APS e estabilidade na evolução das complicações diabéticas (p<0,05). Conclusões: Evidencia-se aumento da ocorrência das complicações do pé diabético, contudo, nas capitais com crescimento da cobertura da APS, houve controle da progressão.

Prácticas de autocuidado que realizan pacientes con diabetes mellitus tipo 2 de Cartagena-Colombia, 2021

Introducción: La diabetes es una enfermedad crónica que puede causar invalidez física por sus variadas complicaciones multiorgánicas. Las prácticas de autocuidado son esenciales para el mantenimiento de la salud y la prevención de estas. Objetivo: Analizar las prácticas de autocuidado los pacientes con diabetes mellitus tipo 2 en Cartagena, 2021. Materiales y Métodos: El estudio observacional, analítico de corte transversal con 100 pacientes con diabetes mellitus tipo 2. Cuestionario (aspectos sociodemográficos, antecedentes personales patológicos y prácticas de autocuidado) que evaluó análisis univariado, bivariado y multivariado con regresión logística. Resultados: La mayoría tiene un diagnóstico de diabetes de 1-5 años (33%) y glicemia de ≥140 mg/dl (40%). Hubo buenas prácticas en higiene (66%), dieta (60%), sueño (50%), pero bajo nivel de actividad física (61%). Con asociación significativa de riesgo en actividad física, no tener estudio o primaria (OR: 15.44; IC 95% 2.78-85.48) y como protector en la dieta, cuando se tiene entre 41 a 56 años (OR: 0.07; IC 95% 0.00-0.60), de 52 a 72 años (OR: 0.04; IC 95% 0.00-0.42) y mayor de 73 años (OR: 0.01; IC 95% 0.00-0.28). Discusión: La población tenían un nivel bueno de prácticas de autocuidado. Es concordante con lo observado por otros autores; que determinaron que gran parte de la muestra tenían un nivel de conocimiento general alto sobre el autocuidado. Conclusiones: Las prácticas de autocuidado que realizan los pacientes con diabetes mellitus tipo 2 por lo general son buenas en cuanto a higiene, dieta y sueño, y malas respecto a actividad física. Como citar este artículo: Madero Zambrano Kendy Paola, Orgulloso Bautista Claudia Alejandra. Prácticas de autocuidado que realizan pacientes con diabetes mellitus tipo 2 de Cartagena, Colombia. 2021. Revista Cuidarte. 2022; 13(3): e2534. http://dx.doi.org/10.15649/cuidarte.2534

Diabetic foot care knowledge and practice in type 2 diabetes and relation to microvascular complications in Alexandria (Egypt)

Objectives. Egypt occupies the 8th rank in the prevalence of diabetes mellitus worldwide. The social and financial burden of diabetes and its complications represents a major health problem in Egypt. Diabetic foot and its consequences (ulcers and amputation) are preventable through good education for both physicians and patients. Methods. This cross-sectional study was conducted on 100 patients with type 2 diabetes attending diabetes outpatient clinic in Alexandria main university hospital (AMUH). Patients were subjected to history taking, physical examination, and laboratory investigations. Screening for peripheral neuropathy was done using Michigan Neuropathy Screening Instrument (MNSI). A pre-tested questionnaire was used to assess the diabetic foot care knowledge and practice in participants. Results. Only 25% and 24% of participants had good diabetic foot care knowledge and practice, respectively. There was a highly significant positive correlation between knowledge and practice in studied group (p<0.001). The presence of microvascular complications leads to a significantly higher knowledge, but not practice. Conclusions. Diabetic foot care knowledge and practice are poor in our community. Foot care knowledge, unlike practice, is increased with the presence of microvascular complications. We should develop effective educational programs for patients and physicians to increase knowledge and practice before the development of complications.

Prevención de la amputación en pacientes con pie diabético Prevention of amputation in patients with diabetic foot - Prevenção de amputação em pacientes com pé diabético

Introducción: las intervenciones estratégicas para reducir las tasas de amputación y mejorar la sobrevida de los pacientes con Diabetes Mellitus parte de la prevención, es decir, de la educación del paciente sobre los factores de riesgo y el tratamiento multidisciplinario de las heridas. Objetivo: describir cuáles son las intervenciones efectivas para prevenir la amputación en pacientes con pie diabético. Metodología: revisión integrativa de la literatura. Se incluyeron artículos en español, inglés y portugués de cualquier nacionalidad y diseño metodológico, publicados entre los años 2015 a 2020, en bases de datos como: Clinicalkey, BVS biblioteca virtual en salud, Scopus, EBSCOHost, Pubmed y Cuiden. Se filtraron por título, resumen y texto completo; se clasificaron según nivel de evidencia y grado de recomendación. Finalmente, se efectuó la lectura crítica mediante las escalas de Amstar, Consort, Strobe, CASPe y Trend. Resultados: se seleccionaron 29 artículos y se organizaron las estrategias en tres temáticas, por niveles de prevención: 1) promoción, prevención y mitigación del daño; 2) identificación, diagnóstico y tratamiento, y 3) rehabilitación. Conclusiones: la evaluación periódica del pie diabético es de vital importancia y debe ser realizada por el equipo interdisciplinario.

Knowledge, Attitude and Practice Regarding Risk of Diabetic Foot Among Diabetic Patients in Aseer Region, Saudi Arabia

Background

Diabetic foot care is vital as it is preventable complication but dangerous even a small trauma can end with serious consequences. Diabetes may cause nerve damage that affects feet sensation. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, patients may lose notice of early foot abnormalities. Diabetic patients’ awareness regarding how to care for their feet plays a significant role in preventing these complications.

Methods

A correlation cross-sectional study was conducted targeting all diabetic patients aging 20 years or more. Online questionnaire was used for data collection. Questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends. The questionnaire included patient personal data, patients’ knowledge regarding diabetic foot, attitude and practice regarding the risk of diabetic foot among diabetic patients.

Results

A total of 1,000 diabetic patients fulfilling the inclusion criteria completed the study questionnaire. Exact of 77.5% of the patients know that Diabetics can get gangrene in the foot, 74.9% know diabetics can develop ulcers in the foot, 66.7% reported that Diabetes can reduce blood flow to the feet of diabetic patients, 66.6% agreed that diabetic patients can suffer from a lack of sensation in the feet. Exact of 84.5% of the study participants agreed that Diabetics should check for any wounds on their feet daily, 78.7% agreed that Diabetics should visit a doctor when there is any infection or wound in the feet, 76.6% think that diabetic patients should wear specialized shoes to avoid diabetic foot according to the doctor's instructions. A total of 822 (82.2%) of the study patients wash their feet daily, and 295 (29.5%) usually wear cotton socks regularly and 39.6% sometimes wear the stock. Only 192 (19.2%) regularly walk barefoot and 41.7% sometimes do.

Conclusion

In conclusion, the current study results showed that nearly two out of each three diabetic patients were knowledgeable for diabetic foot and its care. High knowledge was associated with young age, high education and having family member with diabetes mellitus (DM). Also, patients had a good attitude towards diabetic foot care and the effect of diabetes on foot health with to some level accepted practice except for some issues.

Behaviour model for diabetic ulcer prevention

Purpose

Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour.

Methods

An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square.

Results

Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891).

Conclusion

Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.