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Adu FA, Poku CA, Adu AP, Owusu LB. The role of social support and self-management on glycemic control of type 2 diabetes mellitus with complications in Ghana: A cross-sectional study. Health Sci Rep 2024; 7:e2054. [PMID: 38650722 PMCID: PMC11033339 DOI: 10.1002/hsr2.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Diabetes mellitus (DM) can result in detrimental complications which are connected with long-term impairments and disabilities. Chronic complications are well-known consequences of type 2 diabetes mellitus (T2DM) progression, which reduce patient quality of life, place a burden on the healthcare system, and increase mortality. Measures to promote health outcomes for people with DM are scanty; the study therefore aimed at determining the effects of self-management and social support on glycemic control of T2DM with complications in Ghana. Methods A cross-sectional design using convenience sampling was conducted on 400 T2DM patients using Hensarling's Diabetes Family Support Scale and Summary of Diabetes Self‑Care Activities scale. Data analysis was conducted using descriptive, Pearson Moment Product Correlation and Binary Logistic Regression on self-management, social support, and glycemic control in T2DM patients. Results Social support among participants was high and there was a positive correlation or relationship between social support and T2DM self-management. There was a correlation between social support and self-management (r = 0.149, p < 0.05) and diet control (r = 0.221, p < 0.05). The results also showed a significant correlation between medication adherence and glycemic management (r = 0.116, p < 0.05) while female T2DM participants, individuals with at least primary education were less likely to have low self-management relative to T2DM. Conclusion Though the level of T2DM self-management was high it does not translate to good glycemic control. Focused health education programs should be incorporated into patients' care plans which will be particularly relevant for patients with T2DM and will contribute to positive physiological and psychological outcomes. Furthermore, a more robust monitoring and follow-up scheme should be scaled up or instituted for patients with T2DM.
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Affiliation(s)
- Frank Amankwah Adu
- Medical Technology in the Xiangya School of NursingCentral South UniversityChangshaChina
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Collins Atta Poku
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Amanda Parko Adu
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Lydia Boampong Owusu
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
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Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open 2024; 14:e081006. [PMID: 38262651 PMCID: PMC10806612 DOI: 10.1136/bmjopen-2023-081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented. DESIGN We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance. DATA SOURCES We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022. ELIGIBILITY CRITERIA We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described. DATA EXTRACTION AND SYNTHESIS The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency. RESULTS Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes. CONCLUSION This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian Hodges
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- University Health Network, Toronto, Ontario, Canada
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
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Anuradha U, Mehra NK, Khatri DK. Understanding molecular mechanisms and miRNA-based targets in diabetes foot ulcers. Mol Biol Rep 2024; 51:82. [PMID: 38183502 DOI: 10.1007/s11033-023-09074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024]
Abstract
In today's culture, obesity and overweight are serious issues that have an impact on how quickly diabetes develops and how it causes complications. For the development of more effective therapies, it is crucial to understand the molecular mechanisms underlying the chronic problems of diabetes. The most prominent effects of diabetes are microvascular abnormalities such as retinopathy, nephropathy, and neuropathy, especially diabetes foot ulcers, as well as macrovascular abnormalities such as heart disease and atherosclerosis. MicroRNAs (miRNAs), which are highly conserved endogenous short non-coding RNA molecules, have been implicated in several physiological functions recently, including the earliest stages of the disease. By binding to particular messenger RNAs (mRNAs), which cause mRNA degradation, translation inhibition, or even gene activation, it primarily regulates posttranscriptional gene expression. These molecules exhibit considerable potential as diagnostic biomarkers for disease and are interesting treatment targets. This review will provide an overview of the latest findings on the key functions that miRNAs role in diabetes and its complications, with an emphasis on the various stages of diabetic wound healing.
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Affiliation(s)
- Urati Anuradha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, Hyderabad, Telangana, 500037, India
| | - Neelesh Kumar Mehra
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, Hyderabad, Telangana , 500037, India.
| | - Dharmendra Kumar Khatri
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, Hyderabad, Telangana, 500037, India.
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Prabhath S, Handady G, Herle G, Kamath MG, Ramanathan HP. Importance of interprofessional collaboration in teaching diabetic foot self-management: Perceptions of health care professionals. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Coppola A, Montalcini T, Gallotti P, Ferrulli A, Pujia A, Luzi L, Gazzaruso C. A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes. Can J Diabetes 2023; 47:73-77. [PMID: 36154986 DOI: 10.1016/j.jcjd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU. METHODS We evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period. RESULTS We identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in the non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in the non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016). CONCLUSION A comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pietro Gallotti
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Anna Ferrulli
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Arturo Pujia
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Livio Luzi
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Owolabi EO, Chu KM. Knowledge, attitude and perception towards lower limb amputation amongst persons living with diabetes in rural South Africa: A qualitative study. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [PMID: 36226936 PMCID: PMC9623825 DOI: 10.4102/phcfm.v14i1.3398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery. Aim This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention. Setting Nqamakwe, a rural community in the Eastern Cape province of South Africa. Method This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed and translated, and an inductive approach was used for thematic analysis. Results A total of 15 individual interviews were conducted. Of those, 13 were persons with DM, five with LLA, including one with bilateral LLA. There was a gap in knowledge on foot self-examination as a measure of preventing LLA amongst persons with DM. The attitude of persons without LLA was mostly fearful and their fears centred around perioperative death, risk for contralateral amputation, loss of limb and independence. Consent to LLA procedure was a last resort and only when pain levels were unbearable. Family support and information on rehabilitation services and assistive devices also fostered consent to LLA surgery. Conclusion There is a need for awareness creation and adequate health education for persons living with DM on LLA and its prevention measures, especially foot care practices. Also, health education programmes for persons living with DM in rural areas should address the various misperceptions of LLA to reduce delays. Contribution The article revealed gaps in knowledge on LLA and its prevention among individuals living with diabetes as well as areas of concerns that may potentially delay acceptance when LLA is inevitable. Findings from our study may assist primary health care providers to determine important issues to be addressed during routine and pre-operative patient education.
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Affiliation(s)
- Eyitayo O Owolabi
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Park JH, Park JU. Flap monitoring with incisional negative pressure wound therapy (NPWT) in diabetic foot patients. Sci Rep 2022; 12:15684. [PMID: 36127377 PMCID: PMC9489718 DOI: 10.1038/s41598-022-20088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative monitoring procedure implemented in conjunction with negative pressure wound therapy immediately after flap operations for treating diabetic foot. A retrospective analysis was performed on diabetic foot patients who underwent free flaps and perforator flaps from March 2019 through August 2021. The surgical outcomes of interest were the rates of survival and complications. On the third postoperative day, patients underwent computed tomography angiography to check for pedicle compression or fluid collection in the sub-flap plane. Monitoring time, as well as comparisons between NPWT and conventional methods, were analyzed. Statistical analysis was performed between the two groups. This study included 26 patients. Among patients, the negative pressure wound Therapy treated group included 14 flaps and the conventional monitoring group included 12 flaps. There was no significant intergroup difference in flap survival rate (p = 0.83). In addition, there was no significant intergroup difference in the diameters of perforators or anastomosed vessels before and after negative pressure wound therapy (p = 0.97). Compared with conventional monitoring, flap monitoring with incisional negative pressure wound therapy was associated with a significantly lower mean monitoring time per flap up to postoperative day 5. Although conventional monitoring is widely recommended, especially for diabetic foot ulcer management, the novel incisional negative pressure wound therapy investigated in this study enabled effortless serial flap monitoring without increasing complication risks. The novel flap monitoring technique is efficient and safe for diabetic foot patients and is a promising candidate for future recognition as the gold standard for flap monitoring.
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Affiliation(s)
- Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Anumah FO, Mshelia-Reng R, Omonua OS, Mustapha J, Shuaibu RA, Odumodu KC. Impact of Diabetes Foot Care Education on Amputation Rate in the University of Abuja Teaching Hospital, Nigeria. INT J LOW EXTR WOUND 2022; 21:275-278. [DOI: 10.1177/1534734620934578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Alshehri FM, Ahmed SA, Ullah S, Ghazal H, Nawaz S, Alzahrani AS. The Patterns of Acquired Upper and Lower Extremity Amputation at a Tertiary Centre in Saudi Arabia. Cureus 2022; 14:e24026. [PMID: 35463563 PMCID: PMC8996339 DOI: 10.7759/cureus.24026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Upper and lower extremity amputations are associated with variable degrees of physical disability. In Saudi Arabia, disability still represents a major challenge for healthcare systems. There are insufficient data to describe the incidence and prevalence of impairment and disability. This study attempts to identify the patterns of limb amputations at a tertiary centre. Methods: A retrospective chart review of the data of patients who received integrated tertiary healthcare in an amputation rehabilitation program (ARP) from 2013 to 2018 at King Fahad Medical City, Riyadh, Saudi Arabia was conducted. Data were collected using the demographic data and clinical history of amputees. Results: A total of 412 patients were included in the study. Transtibial amputation (70%) and partial hand amputation (48%) were the most common levels for lower and upper limb amputations, respectively. There was a significantly higher rate of lower limb amputations secondary to vascular causes than that of upper limb amputations, which were more related to traumatic causes. Most patients, 213 (52%), were enrolled in an amputation rehabilitation program over a year after their amputation. Conclusion: Vascular amputation is the most common cause of amputation. Most patients entered the rehabilitation program over a year after amputation. National guidelines for the prevention and management of the risk factors for vascular amputations should be developed.
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Affiliation(s)
- Fayez M Alshehri
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
| | - Salwa A Ahmed
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
| | - Sami Ullah
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
| | - Haitham Ghazal
- Department of Physical Therapy, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
| | - Shah Nawaz
- Department of Rehabilitation Technology, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
| | - Ahmed S Alzahrani
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, SAU
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Lee DM, Grose E, Cross K. Internet-Based Patient Education Materials Regarding Diabetic Foot Ulcers: Readability and Quality Assessment. JMIR Diabetes 2022; 7:e27221. [PMID: 35014960 PMCID: PMC8790680 DOI: 10.2196/27221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/11/2021] [Accepted: 10/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While diabetic foot ulcers (DFU) are a common complication of diabetes, little is known about the content and readability of online patient education materials (PEM) for DFU. The recommended reading grade level for these materials is grades 6-8. OBJECTIVE The aim of this paper was to evaluate the quality and readability of online PEM on DFU. METHODS A Google search was performed using 4 different search terms related to DFU. Two readability formulas were used to assess the readability of the included PEM. These included the Flesch-Kincaid grade level and the Flesch-Reading ease score. The DISCERN tool was used to determine quality and reliability. RESULTS A total of 41 online PEM were included. The average Flesch-Reading ease score for all PEM was 63.43 (SD 14.21), indicating a standard difficulty level of reading. The average reading grade level was 7.85 (SD 2.38), which is higher than the recommended reading level for PEM. The mean DISCERN score was 45.66 (SD 3.34), and 27% (11/41) of the articles had DISCERN scores of less than 39, corresponding to poor or very poor quality. CONCLUSIONS The majority of online PEM on DFU are written above the recommended reading levels and have significant deficiencies in quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients' self-management.
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Affiliation(s)
- David Michael Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elysia Grose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karen Cross
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Plastic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Amir AA, Khader SA, El Chami Z, Bahlas SM, Bakir M, Arifeen S. Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps. J Family Community Med 2021; 28:155-163. [PMID: 34703375 PMCID: PMC8496701 DOI: 10.4103/jfcm.jfcm_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/10/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%-65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%-80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%-65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%-62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.
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Affiliation(s)
- Ashraf A Amir
- Department of Family Medicine, International Medical Center Hospital, Salam Home Health Care (Geriatric Care), Riyadh, Saudi Arabia
| | - Said A Khader
- Department of Diabetes and Endocrine, Dr. Suliaman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Ziad El Chami
- Advanced Neuro- Musculoskeletal Care Center, Dr. Samir Abbas Hospital, Riyadh, Saudi Arabia
| | | | | | - Shams Arifeen
- Africa and Middle East Clusters, Upjohn Pfizer Africa and Middle East, Dubai, UAE
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Monteiro-Soares M, Vale-Lima J, Martiniano J, Pinheiro-Torres S, Dias V, Boyko EJ. A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation. J Diabetes Complications 2021; 35:107837. [PMID: 33423910 DOI: 10.1016/j.jdiacomp.2020.107837] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Matilde Monteiro-Soares
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Jorge Vale-Lima
- Unidade de Saúde Familiar Nova Salus, Agrupamento de Centros de Saúde Grande Porto VII, Vila Nova de Gaia, Portugal
| | - João Martiniano
- Escola Superior de Saúde da Cruz Vermelha Portuguesa de Lisboa, Portugal
| | - Sofia Pinheiro-Torres
- Unidade de Saúde Familiar Aldoar, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal
| | - Vanessa Dias
- Unidade de Saúde Familiar St André de Canidelo, Agrupamento de Centros de Saúde Grande Porto VII, Vila Nova de Gaia, Portugal; Centro de Investigação Interdisciplinar em Saúde(CIIS)- UCP- ICS Porto, Portugal
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs, Puget Sound Health Care System and the University of Washington, Seattle, WA, USA
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Aalaa M, Sanjari M, Amini MR, Ramezani G, Mehrdad N, Tehrani MRM, Bigdeli S, Adibi H, Larijani B, Sohrabi Z. Diabetic foot care course: a quasi-experimental study on E-learning versus interactive workshop. J Diabetes Metab Disord 2021; 20:15-20. [PMID: 34178821 DOI: 10.1007/s40200-020-00630-0] [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: 07/28/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
Background Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment. Methods This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant. Results The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01). Conclusions The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.
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Affiliation(s)
- Maryam Aalaa
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Sanjari
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghobad Ramezani
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shoaleh Bigdeli
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hosein Adibi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Sohrabi
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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14
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Wolderufael M, Dereje N. Self-Care Practice and Associated Factors Among People Living with Type 2 Diabetes in Addis Ababa, Ethiopia: A Facility-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:1-9. [PMID: 33442277 PMCID: PMC7797280 DOI: 10.2147/dmso.s287352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/04/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Diabetes is a global public health threat with a considerably high burden in low- and middle-income countries. The application of self-care practice by people living with diabetes helps to manage diabetes and its complications, and to lengthen their life. However, the level of diabetes self-care practice in Ethiopia is very low. METHODS A cross-sectional study was conducted among people living with type 2 diabetes who were on follow-up from January 01 to 31, 2019 at Yekatit 12 Hospital. A systematic sampling technique was employed to recruit 354 study participants. A face-to-face interview was administered by trained data collectors using a structured questionnaire. Diabetes self-care practice was assessed by using Summary of Diabetes Self-Care Activities (SDSCA) scale. Multi-variable binary logistic regression analysis was carried out to identify factors associated with diabetes self-care practice. RESULTS More than half (52.0%, 95% CI: 49.9% - 57.1%) of the people living with diabetes had poor diabetes self-care practice. Poor self-care practice was associated with being unemployed and retired (AOR= 3.57, 95% CI 1.65-7.72), having diabetes for ≥10 years (AOR= 1.78, 95% CI 1.07-2.95), having comorbidity (AOR= 2.15, 95% CI 1.35-3.43), not owning glucometer (AOR= 1.81, 95% CI 1.16-2.83), not receiving diabetes education (AOR= 1.95, 95% CI 1.20-3.18) and dissatisfaction with social support (AOR= 4.24, 95% CI 1.25-14.40). CONCLUSION Poor self-care practice was found to be substantial among people living with diabetes in Addis Ababa, with self-monitoring of blood glucose and regular exercise being the least performed. It is beneficial to focus more on lifestyle modifications and educating about the severity of the disease for better management of blood sugar levels and hindrance of complications.
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Affiliation(s)
- Meklit Wolderufael
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Nebiyu Dereje
- Department of Public Health, Myungsung Medical College, Addis Ababa, Ethiopia
- Correspondence: Nebiyu Dereje Department of Public Health, Myungsung Medical College, Addis Ababa14972, EthiopiaTel +251978788638 Email
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Abstract
Minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) is an effective procedure for the treatment of complicated chronic diabetic foot ulcers under the heads of all lateral metatarsal bones (including the fifth). Resistant toe ulcers and recurrent pressure ulcers can be treated effectively by DMDO. For diabetic patients, the main advantages of this method are minimal surgical scars and tissue damage, immediately postoperative weight bearing, absence of osteosynthesis and consequent potential infection of metal fixation, reduction of the previous high plantar pressures by the restoration of a harmonic balanced forefoot arch, and rapid ulcer healing.
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Affiliation(s)
- Carlo Biz
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic and Traumatologic Clinic, University of Padova, Via Giustiniani 2, Padova 35128, Italy; GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.
| | - Pietro Ruggieri
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic and Traumatologic Clinic, University of Padova, Via Giustiniani 2, Padova 35128, Italy
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Alshammary S, Othman SA, Alshammari E, Alarfaj MA, Lardhi HA, Amer NM, Elsaid AS, Alghamdi HM. Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study. Ann Saudi Med 2020; 40:425-435. [PMID: 33007171 PMCID: PMC7532050 DOI: 10.5144/0256-4947.2020.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Shadi Alshammary
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sharifah A Othman
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eiman Alshammari
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mosab A Alarfaj
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haitham Amer Lardhi
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nasser Mohamed Amer
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayman S Elsaid
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hanan M Alghamdi
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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17
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Selim O, Dueck A, Walsh CM, Brydges R, Okrainec A. Development of the Diabetic Wound Assessment Learning Tool (DiWALT) and validity evidence. J Vasc Surg 2020; 73:689-697. [PMID: 32707382 DOI: 10.1016/j.jvs.2020.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Diabetic foot wounds account for up to one-third of diabetes-related health care expenditure and are the greatest cause of extremity amputation in Canada. Physicians encounter patients with such wounds in all specialties, particularly as generalists in medical wards and emergency departments. However, there is a dearth of literature on the optimal way to teach and to assess the management of these patients. Given the importance of assessment for learning in the shift toward competency-based medical education, we aimed to develop an assessment tool and to build validity evidence for its use in this context. METHODS A consensus process involving nine Canadian experts in diabetic wound management was used to develop the Diabetic Wound Assessment Learning Tool (DiWALT) items and two 10-minute simulation-based testing scenarios. The simulators used were modified from commercially available models to serve the testing scenarios. Validity evidence for the DiWALT was subsequently evaluated by assessing 24 physician participants' performance during the two scenarios. All participants were novices (<50 cases managed). Two assessors independently rated participants using the DiWALT. Evidence was organized using Kane's validity framework and included Cronbach α for interitem consistency as well as test-retest and inter-rater reliability using the intra-class correlation coefficient (ICC). RESULTS Cronbach α was 0.92, implying high internal consistency. Test-retest reliability was also excellent with ICC of 0.89 (confidence interval [CI], 0.76-0.95) for single measures and ICC of 0.94 (CI, 0.86-0.98) for average measures. Inter-rater reliability was fair for single measures with ICC of 0.68 (CI, 0.65-0.71) and good for average measures with ICC of 0.81 (CI, 0.79-0.83). CONCLUSIONS These results demonstrate that the DiWALT consistently and reliably evaluates competence in diabetic wound management during simulated cases using a small, homogeneous sample of physicians. Further work is necessary to quantify sources of error in the assessment scores, to establish validity evidence when it is used to assess larger and more heterogeneous participants, and to identify how well the DiWALT differentiates between different experience levels.
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Affiliation(s)
- Omar Selim
- Temerty-Chang Telesimulation Centre, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada.
| | - Andrew Dueck
- Division of Vascular Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; The Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada
| | - Ryan Brydges
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Temerty-Chang Telesimulation Centre, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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18
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Albright RH, Manohar NB, Murillo JF, Kengne LAM, Delgado-Hurtado JJ, Diamond ML, Acciani AL, Fleischer AE. Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis. Diabetes Res Clin Pract 2020; 161:107996. [PMID: 31935416 DOI: 10.1016/j.diabres.2019.107996] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
AIMS To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes. METHODS A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. RESULTS Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. CONCLUSIONS Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on "possible limbs saved". FUNDING None.
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Affiliation(s)
- Rachel H Albright
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States.
| | - Nivethitha B Manohar
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States
| | - Jennifer F Murillo
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States
| | - Linda Anael M Kengne
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States
| | - Juan J Delgado-Hurtado
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States; Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Matthew L Diamond
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Alyse L Acciani
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Adam E Fleischer
- Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
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19
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Goodarzi G, Maniati M, Qujeq D. The role of microRNAs in the healing of diabetic ulcers. Int Wound J 2019; 16:621-633. [PMID: 30821119 PMCID: PMC7949391 DOI: 10.1111/iwj.13070] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022] Open
Abstract
MicroRNAs (miRNAs) are small protected molecules with a length of 18 to 25 nucleotides. Many studies have recently been conducted on miRNAs, illustrating their role in regulating many biological, physiological, and pathological activities, such as maintaining cellular signalling and regulating cellular pathways. The main role of miRNAs is to regulate the expression of genes after translation, which can lead to the destruction or suppression of translation by binding to mRNAs. As any change in the regulation of miRNAs is associated with several physiological abnormalities, such as type 2 diabetes and its complications, these molecules can be used for therapeutic purposes or as biomarkers for the diagnosis of diseases such as diabetes and its complications. In this review article, we will discuss important findings about the miRNAs and the role of these molecules in different phases of the wound-healing process of chronic wounds, especially diabetic ulcer.
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Affiliation(s)
- Golnaz Goodarzi
- Department of Medical Biochemistry and Biotechnology, School of MedicineNorth Khorasan University of Medical SciencesBojnurdIran
| | - Mahmood Maniati
- School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Durdi Qujeq
- Cellular and Molecular Biology Research Center (CMBRC), Health Research InstituteBabol University of Medical SciencesBabolIran
- Dental Materials Research Center, Institute of HealthBabol University of Medical SciencesBabolIran
- Cancer Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
- Department of Clinical Biochemistry, School of MedicineBabol University of Medical SciencesBabolIran
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20
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Al-Hamdan R, Avery A, Salter A, Al-Disi D, Al-Daghri NM, McCullough F. Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes. Nutrients 2019; 11:nu11051113. [PMID: 31109110 PMCID: PMC6566809 DOI: 10.3390/nu11051113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022] Open
Abstract
Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18–55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.
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Affiliation(s)
- Rasha Al-Hamdan
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Amanda Avery
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Andrew Salter
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Dara Al-Disi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Fiona McCullough
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
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21
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Al Wahbi A. Operative versus non-operative treatment in diabetic dry toe gangrene. Diabetes Metab Syndr 2019; 13:959-963. [PMID: 31336551 DOI: 10.1016/j.dsx.2018.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.
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Affiliation(s)
- Abdullah Al Wahbi
- King Saud University for Health Sciences, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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22
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Riaz M, Miyan Z, Waris N, Zaidi SIH, Tahir B, Fawwad A, Basit A. Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan. Int Wound J 2019; 16:768-772. [PMID: 30767384 DOI: 10.1111/iwj.13095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 01/13/2023] Open
Abstract
To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group-A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group-B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P-value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.
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Affiliation(s)
- Musarrat Riaz
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Zahid Miyan
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Nazish Waris
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Syed I H Zaidi
- Department of Diabetic Foot, Baqai Medical University, Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan.,Department of Surgery, Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Bilal Tahir
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Asher Fawwad
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.,Department of Biochemistry, Baqai Medical University, Karachi, Pakistan
| | - Abdul Basit
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Rodrigues FFL, Alves D, Teixeira CRS, Arrelias CCA, Torquato MTCG, Santos MA, Zanetti ML. The hospitalization profiles of patients with or without diabetes treated for nontraumatic lower extremity amputation in Ribeirão Preto, São Paulo State, Brazil, 2001-2008. JOURNAL OF VASCULAR NURSING 2017; 35:64-69. [PMID: 28527729 DOI: 10.1016/j.jvn.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 10/19/2022]
Abstract
The aim of this retrospective study was to assess the hospitalizations of patients with or without diabetes mellitus (DM) who underwent nontraumatic lower extremity amputation (NLEA) with regard to demographic and hospitalization-related variables. It is a high proportion of hospital beds in developing countries, for patients with diabetes mellitus with lower extremity complications. Nontraumatic amputations of lower extremities rates is an important indicator to assess the effectiveness of efforts to reduce chronic complications related to diabetic foot.A total of 2,296 hospital admissions were analyzed with regard to gender, age, length of stay, type of financing, origin, diagnosis, number of hospital admissions and readmissions, and hospitalization outcome from 2001 to 2008 in a municipality of Southeast Brazil. The association between the independent variables and the number of hospitalizations of patients with or without diabetes was assessed using chi-square tests for gender, type of financing, and hospitalization outcome and using the Mann-Whitney U test for age and length of stay. A total of 58% were patients without diabetes, 62.6% were male, 74.5% were treated at a public health care service, and 7.6% died. The mean age was 62.7 years, the mean length of stay was of 9.5 days, and the mean number of readmissions was 2.29 times. The length of stay was higher (P < .001), and the number of men was lower (P = .001) among the patients with diabetes who were hospitalized compared with patients without diabetes.The number of hospitalizations related to NLEA increased among patients with diabetes but reduced among those without diabetes between 2001 and 2008.
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Affiliation(s)
| | - Domingos Alves
- School of Medicine of Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
| | - Carla R S Teixeira
- Nursing School of Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Manoel A Santos
- College of Philosophy, Science and Literature of Ribeirão Preto, USP, São Paulo, Brazil; Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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Moura J, Rodrigues J, Gonçalves M, Amaral C, Lima M, Carvalho E. Impaired T-cell differentiation in diabetic foot ulceration. Cell Mol Immunol 2016; 14:758-769. [PMID: 26996067 DOI: 10.1038/cmi.2015.116] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 12/31/2022] Open
Abstract
Foot ulceration is one of the most debilitating complications associated with diabetes, but its cause remains poorly understood. Several studies have been undertaken to understand healing kinetics or find possible therapies to enhance healing. However, few studies have been directed at understanding the immunological alterations that could influence wound healing in diabetes. In this study, we analysed the T-cell receptor (TCR) repertoire diversity in TCR-αβ+ T cells. We also analysed the distribution and phenotype of T cells obtained from the peripheral blood of healthy controls and diabetic individuals with or without foot ulcers. Our results showed that diabetic individuals, especially those with foot ulcers, have a significantly lower naive T-cell number and a poorer TCR-Vβ repertoire diversity. We also showed that the reduced TCR-Vβ repertoire diversity in diabetic individuals was mainly owing to the accumulation of effector T cells, the major source of tumour necrosis factor-α production, which was even more pronounced in patients with acute foot ulceration. Moreover, the expression of several inflammatory chemokine receptors was significantly reduced in diabetic patients. In conclusion, effector T-cell accumulation and TCR repertoire diversity reduction appear to precede the development of foot ulcers. This finding may open new immunological therapeutic possibilities and provide a new prognostic tool in diabetic wound care.
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Affiliation(s)
- João Moura
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-517 Coimbra, Portugal
| | - João Rodrigues
- Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), 4099-001 Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB/ICBAS/UP), Porto, Portugal
| | - Marta Gonçalves
- Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), 4099-001 Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB/ICBAS/UP), Porto, Portugal
| | - Cláudia Amaral
- Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), 4099-001 Porto, Portugal
| | - Margarida Lima
- Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), 4099-001 Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB/ICBAS/UP), Porto, Portugal.,These authors contributed equally to this work
| | - Eugénia Carvalho
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-517 Coimbra, Portugal.,Department of Geriatrics, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72202, USA.,Arkansas Children's Hospital Research Institute (ACHRI), Little Rock, AR 72202, USA.,These authors contributed equally to this work
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25
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Gunggu A, Thon CC, Whye Lian C. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients. J Diabetes Res 2016; 2016:9158943. [PMID: 27563681 PMCID: PMC4987486 DOI: 10.1155/2016/9158943] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022] Open
Abstract
Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts.
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Affiliation(s)
- Azylina Gunggu
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Chang Ching Thon
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
- *Chang Ching Thon:
| | - Cheah Whye Lian
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
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Foot care practices of diabetic patients in Saudi Arabia. Saudi J Biol Sci 2015; 24:1667-1671. [PMID: 30294233 PMCID: PMC6169502 DOI: 10.1016/j.sjbs.2015.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 01/05/2023] Open
Abstract
Diabetic foot is a serious complication that causes lower extremity amputations. The aim of this study was to identify the patient’s awareness about risk factors for diabetic foot disease and to explore the knowledge and foot care practices among diabetic patients in a Saudi population. This cross-sectional study was conducted in King Khalid University Hospital (KKUH), King Abdulaziz University Hospital (KAUH), King Fahad Medical City, National Guard Hospital, Military Hospital, and Prince Salman Hospital capital city of Saudi Arabia. Patients were eligible if they had diabetes foot disease, signed the consent form, and completed the questionnaire. We selected 350 patients from different hospitals between November-2011 and April-2012. The majority of patients (68%) were selected from King Saud University hospitals. The mean age of patients was 50.87 ± 15.9 years with a range of 20–90 years. The majority of patients were male (64.3%) and had a family history of hypertension (55.4%), high total cholesterol (58.6%), and other diabetes (58.9%). A family history of smoking, a major risk factor for diabetic foot, was found in 20.3% of cases. Sixty percent of the patients were using oral medications, 27.1% were using insulin therapy, 10% were using both oral and insulin therapies, and 10% were on diet. In our study, 19.4% of participants were illiterate while 80.6% had a high school or university level education. Our findings also revealed that some patients had a lack of knowledge concerning diabetic foot disease and future complications. Patients are unaware of the risk factors for diabetes foot and practice poor foot care. Awareness programs should be mandatory in all hospitals and diabetes clinics to help compensate for the lack of awareness and lack of podiatric educational services. Such programs may decrease the risk of diabetes foot disease.
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Al-Kaabi JM, Al Maskari F, Cragg P, Afandi B, Souid AK. Illiteracy and diabetic foot complications. Prim Care Diabetes 2015; 9:465-472. [PMID: 26027780 DOI: 10.1016/j.pcd.2015.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes. METHODS Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist. RESULTS Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care. CONCLUSION Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications.
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MESH Headings
- Adult
- Aged
- Arabs/psychology
- Chi-Square Distribution
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/ethnology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/ethnology
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Diabetic Foot/diagnosis
- Diabetic Foot/ethnology
- Diabetic Foot/prevention & control
- Diabetic Foot/psychology
- Female
- Health Knowledge, Attitudes, Practice/ethnology
- Health Literacy
- Humans
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- Odds Ratio
- Patient Education as Topic
- Risk Assessment
- Risk Factors
- Risk Reduction Behavior
- Self Care
- Surveys and Questionnaires
- United Arab Emirates/epidemiology
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Affiliation(s)
- Juma M Al-Kaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University , Al-Ain, United Arab Emirates.
| | - Fatma Al Maskari
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Paul Cragg
- Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates
| | - Bachar Afandi
- Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates
| | - Abdul-Kader Souid
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Cardiovascular risk profiles of adults with type-2 diabetes treated at urban hospitals in Riyadh, Saudi Arabia. J Epidemiol Glob Health 2015; 6:29-36. [PMID: 26257035 PMCID: PMC7320523 DOI: 10.1016/j.jegh.2015.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/18/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022] Open
Abstract
Diabetes mellitus substantially increases cardiovascular disease (CVD) risk. Among Saudi Arabian citizens with diabetes, little is known about the prevalence and control of other CVD risk factors. We extracted data from medical records of a random selection of 422 patients seen between 2008 and 2012 at two diabetic clinics in Riyadh, Saudi Arabia. We calculated the proportion of patients who had additional CVD risk factors: obesity (body mass index ⩾ 30 kg/m2), hypertension (BP ⩾ 140/90 mmHg), elevated cholesterol fractions, and multiple risk factors). Further, we calculated the proportion of patients meeting the American Diabetes Association’s recommended care targets for each risk factor. Of 422 patients (mean age, 52 years), half were women, 56% were obese, 45% had hypertension, and 77% had elevated LDL concentrations. In addition to diabetes, 70% had two or more CVD risk factors. Although 9% met both target HbA1c and BP values, only 3.5% had optimum HbA1c, BP, and lipid values. In Saudi Arabia’s best diabetes clinics, most patients have poor control of their disease. This huge disease burden and related care gaps have important health and financial implications for the country.
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Navarro-Flores E, Morales-Asencio JM, Cervera-Marín JA, Labajos-Manzanares MT, Gijon-Nogueron G. Development, validation and psychometric analysis of the diabetic foot self-care questionnaire of the University of Malaga, Spain (DFSQ-UMA). J Tissue Viability 2014; 24:24-34. [PMID: 25523014 DOI: 10.1016/j.jtv.2014.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/27/2014] [Accepted: 11/20/2014] [Indexed: 01/14/2023]
Abstract
This paper assessed the reliability and construct validity of a tool to evaluate the foot self-care of diabetic patients. The education of diabetic patients about their foot care is a major issue to avoid complications like amputations and ulcers. Specific tools aimed to assess patient's knowledge in this area are needed. The study had two phases: in Phase 1, item-generation was carried out through a literature review, expert review by a Delphi technique and cognitive interviews with diabetic patients for testing readability and comprehension. In Phase 2, diabetic patients participated in a cross-sectional study for a psychometric evaluation (reliability and construct validity) was carried out on a sample of type I and II diabetic patients. The study was conducted at the University of Malaga (Spain), podiatric clinics and a Diabetic Foot Unit between October 2012 and March 2013. After psychometric-test analyses on a sample of 209 diabetic patients, the questionnaire resulted in 16 questions. Cronbach's alpha was 0.89 after removing 4 items because of their low reliability. Inter-item correlations gave a mean value of 0.34 (range: 0.06-0.74). The rotated solution showed a 3-factor structure (self-care, foot care, and footwear and socks) that jointly accounted for 60.88% of the variance observed. The correlation between the questionnaire scores and HbA1c was significant and inverse, (r = -0.15; p < 0.01). The findings show that the questionnaire is a valid and reliable tool for evaluating foot self-care behavior in diabetic patients.
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Affiliation(s)
- Emmanuel Navarro-Flores
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071 Málaga, Spain.
| | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071 Málaga, Spain.
| | - José Antonio Cervera-Marín
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071 Málaga, Spain.
| | - María Teresa Labajos-Manzanares
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071 Málaga, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071 Málaga, Spain.
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Moura J, Børsheim E, Carvalho E. The Role of MicroRNAs in Diabetic Complications-Special Emphasis on Wound Healing. Genes (Basel) 2014; 5:926-56. [PMID: 25268390 PMCID: PMC4276920 DOI: 10.3390/genes5040926] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/05/2014] [Accepted: 09/10/2014] [Indexed: 12/19/2022] Open
Abstract
Overweight and obesity are major problems in today’s society, driving the prevalence of diabetes and its related complications. It is important to understand the molecular mechanisms underlying the chronic complications in diabetes in order to develop better therapeutic approaches for these conditions. Some of the most important complications include macrovascular abnormalities, e.g., heart disease and atherosclerosis, and microvascular abnormalities, e.g., retinopathy, nephropathy and neuropathy, in particular diabetic foot ulceration. The highly conserved endogenous small non-coding RNA molecules, the micro RNAs (miRNAs) have in recent years been found to be involved in a number of biological processes, including the pathogenesis of disease. Their main function is to regulate post-transcriptional gene expression by binding to their target messenger RNAs (mRNAs), leading to mRNA degradation, suppression of translation or even gene activation. These molecules are promising therapeutic targets and demonstrate great potential as diagnostic biomarkers for disease. This review aims to describe the most recent findings regarding the important roles of miRNAs in diabetes and its complications, with special attention given to the different phases of diabetic wound healing.
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Affiliation(s)
- João Moura
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra 3004-517, Portugal.
| | - Elisabet Børsheim
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, AR 72202, USA.
| | - Eugenia Carvalho
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra 3004-517, Portugal.
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Dikeukwu RA, Omole OB. Awareness and practices of foot self-care in patients with diabetes at Dr Yusuf Dadoo district hospital, Johannesburg. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2013.10872314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Dikeukwu
- Department of Family Medicine, University of the Witwatersrand, Johannesburg
| | - OB Omole
- Clinical Unit (Family Medicine), Sedibeng District Department of Family Medicine, University of the Witwatersrand, Johannesburg
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Oliveira AFD, De Marchi ACB, Leguisamo CP, Baldo GV, Wawginiak TA. Estimativa do custo de tratar o pé diabético, como prevenir e economizar recursos. CIENCIA & SAUDE COLETIVA 2014; 19:1663-71. [DOI: 10.1590/1413-81232014196.09912013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho estimamos o custo do tratamento hospitalar do pé diabético e discutimos a literatura referente à profilaxia destas lesões. Para isto revisamos os prontuários dos pacien tes submetidos a tratamento cirúrgico num período de 16 meses em um hospital público e revisamos os métodos de prevenção do pé diabético. Foram 44 internações com duração média de 11,93 dias (± 6,34), 61 procedimentos cirúrgicos, com amputações em 65% dos casos. Encontramos um custo médio de R$ 4.367,05 (± 9.249,01) e um custo total de R$ 192.150,40 para estes tratamentos hospitalares. O tratamento do pé diabético teve um alto custo e exigiu amputações na maioria dos casos. A revisão da literatura evidenciou diversos modelos possíveis de serem adotados para atuar na profilaxia de lesões associadas ao pé diabético, os quais podem evitar amputações e economizar recursos.
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Yan J, Liu Y, Zhou B, Sun M. Pre-hospital delay in patients with diabetic foot problems: influencing factors and subsequent quality of care. Diabet Med 2014; 31:624-9. [PMID: 24344813 DOI: 10.1111/dme.12388] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 10/23/2013] [Accepted: 12/12/2013] [Indexed: 12/11/2022]
Abstract
AIMS To assess pre-hospital patient delay and its associated variables in patients with diabetic foot problems. METHODS We classified 270 patients with diabetic foot problems retrospectively based on the distribution of pre-hospital delay. Clinical, demographic and socio-economic data were collected. Logistic regression analysis was performed to examine independent associations with patient delay. RESULTS The median pre-hospital delay time was 46.49 days. Patients reported short (≤ 1 week; 77 patients, 28.5%), moderate (> 1 week and ≤ 1 month; 106 patients, 39.3%) and long delays (> 1 month; 87 patients, 32.2%). In a univariate analysis, nine variables were associated with a longer delay (P < 0.05): (1) no previous ulcer; (2) no health insurance; (3) poor housing conditions; (4) low income level; (5) low educational level; (6) infrequent foot inspection; (7) few follow-up medical visits; (8) absence of diabetic foot education; (9) lack of knowledge of foot lesion warning signals. A multivariate analysis showed that absence of diabetic foot education (odds ratio 2.70, 95% CI 1.03-7.06, P = 0.043) and lack of knowledge of foot lesion warning signals (odds ratio 2.14, 95% CI 1.16-3.94, P = 0.015) were independent predictors of long patient delay. Long delay increased the risk of amputation (odds ratio 2.22, 95% CI 1.36-3.64, P = 0.002) and mortality (odds ratio 2.69, 95% CI 1.35-5.33, P = 0.005). CONCLUSIONS A number of factors were involved in pre-hospital delay among patients with diabetic foot problems and contributed to poor outcomes. We recommend developing a community intervention programme that targets at-risk communities to encourage earlier multidisciplinary team assessment to reduce disparities and improve foot outcomes in patients with diabetes.
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Affiliation(s)
- J Yan
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Salahuddin O, Azhar M, Imtiaz A, Latif M. A developing world experience with distal foot amputations for diabetic limb salvage. Diabet Foot Ankle 2013; 4:22477. [PMID: 24155996 PMCID: PMC3805841 DOI: 10.3402/dfa.v4i0.22477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/07/2013] [Accepted: 09/23/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients. MATERIALS AND METHODS This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage. RESULTS In total, 149 patients (mean age: 56±7.52 years) with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2%) patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2%) cases, second-toe amputation in 60 (35%) cases, hallux amputation in 41 (24%) cases, multiple toe amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal amputation was performed in 4 (2.3%) cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications. CONCLUSION With the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully achieved.
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Affiliation(s)
- Omer Salahuddin
- Department of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan
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35
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Alzahrani OH, Badahdah YS, Bamakrid MS, Alfayez AS, Alsaeedi MS, Mansouri AM, Alzahrani HA. The Diabetic Foot Research in Arabs’ Countries. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojemd.2013.33023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Malik ZA, Tabassum N, Sharma PL. Attenuation of experimentally induced diabetic neuropathy in association with reduced oxidative-nitrosative stress by chronic administration of <i>Momordica charantia</i>. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/abb.2013.43047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Griffin KJ, Rashid TS, Bailey MA, Bird SA, Bridge K, Scott JDA. Toe amputation: a predictor of future limb loss? J Diabetes Complications 2012; 26:251-4. [PMID: 22516530 DOI: 10.1016/j.jdiacomp.2012.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 02/08/2012] [Accepted: 03/06/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the "first stage in a predictable clinical course" leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation. We aim to study the experience from our institution, focussing on the risk factors for progression to future limb loss, by conducting a retrospective review of our practice. METHODS Sixty-three patients undergoing toe amputation within our institution were identified and the clinical notes retrospectively reviewed. A database of vascular risk factors and co-morbidity was constructed and correlation with future limb loss was analysed with Chi-squared testing and a logistic regression model. RESULTS Sixty-three patients with a mean age of 69 (IQR 62-76.5) years were identified. Thirty-five (55.6%) of these patients went on to have a further surgical amputation; 22 major amputations (16 below-knee and 6 above-knee amputations) and 23 minor amputations were performed in total. Forty three (68.3%) patients had diabetes and 31 (49.2%) patients had one or more revascularisation procedures undertaken. There was a significant correlation between patients who did not have diabetes and future limb loss (Chi-squared=4.31, p=0.038), however no other identified risk factor predicted the need for major amputation. CONCLUSION Toe amputation is a significant predictor of future limb loss. Our study identified that patients with diabetes are significantly less likely to progress to further limb loss than those with the disease. We hypothesise that this difference is due to the more intensive, multi-disciplinary foot care follow-up that diabetic patients receive. These results highlight the significance of toe amputation and contribute to the evidence for a more intensive out-patient service for these high risk patients.
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Affiliation(s)
- Kathryn J Griffin
- The Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, United Kingdom.
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Ryan GJ, Chesnut R, Odegard PS, Dye JT, Jia H, Johnson JF. The impact of diabetes concentration programs on pharmacy graduates' provision of diabetes care services. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2011; 75:112. [PMID: 21931450 PMCID: PMC3175678 DOI: 10.5688/ajpe756112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 04/24/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine practice outcomes associated with doctor of pharmacy (PharmD) graduates from 2 universities who completed a diabetes-concentration. METHODS An online survey instrument was sent to 93 PharmD graduates who completed a concentration in diabetes and 94 control graduates to determine their knowledge of and skills in providing diabetes care and how frequently they provided diabetes care services. RESULTS Ninety-seven graduates (52%) responded. Significantly more graduates with a diabetes concentration rated their ability to instruct patients on insulin administration, blood glucose monitoring, foot care, and insulin dose adjustment as good or excellent compared to a control group of graduates. Graduates with a diabetes concentration also rated their ability to perform blood glucose monitoring and foot examinations higher than graduates without a diabetes concentration (P < 0.05). CONCLUSION Completing a diabetes concentration increased graduates' knowledge of diabetes and confidence in their ability to provide care but did not appear to alter their practice patterns significantly. Further study is needed to determine whether other barriers to pharmacists providing diabetes care exist in practice settings.
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Affiliation(s)
- Gina J Ryan
- Mercer University College of Pharmacy and Health Sciences, USA.
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