Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

Adherence to ADA Clinical Guidelines in Type 2 Diabetes Management in Public Health Clinics in Palestine

Background

The prevalence of type 2 diabetes is a significant global public health concern. Adherence to established guidelines is essential for effective management of this metabolic disease.

Objective

This study aimed to evaluate the current practices of physicians in Palestine regarding their adherence to ADA guidelines for type 2 diabetes management.

Methods

A retrospective, cross-sectional, multicenter study was conducted by reviewing patients' medical records. This study included 362 patients aged ≥ 18 years diagnosed with type 2 diabetes for at least one year and receiving treatment at multiple outpatient clinics in Palestine. Adherence to ADA guidelines was assessed by selecting an appropriate antidiabetic agent based on patient confounding factors and comorbidities, frequency of diabetes monitoring, screening, glycemic control, and optimization of hypertension and dyslipidemia medication.

Results

Half of the participants were female. 53% of the participants did not achieve their A1c target goal. Adherence to ADA guidelines for selecting the preferred antidiabetic medication was only 32.22%. Very low adherence to prescribing GLP1 agonists (0.5%) and SGLT2 inhibitors (7%) when indicated. Biguanides were the most prescribed medications (83.1%), followed by sulfonylurea (35.1%), and insulin (28.2%). Only 43% and 66% of the patients were on appropriate lipid and hypertension medications, respectively, as recommended by ADA guidelines. Foot assessment and eye examinations were performed in only 27% and 55% of the patients, respectively. Age, atherosclerotic cardiovascular disease, and sulfonylurea use were significantly associated with lower glycemic control.

Conclusion

This study demonstrated that Adherence to ADA guidelines for diabetes management is suboptimal in selecting appropriate antidiabetic medication based on patient confounding factors, potentially contributing to the high prevalence of complications and comorbidities observed in patients with diabetes in Palestine. Medical associations and health institutions must adopt programs to increase professional education and awareness of the current guidelines to improve outcomes.

Healthcare workers' perspectives on diabetic foot complications among type 2 diabetes mellitus patients in Fiji

INTRODUCTION

Diabetic Foot Complications (DFCs) are a growing cause of morbidity and mortality with less than one third of physicians able to discern the signs of diabetes related peripheral neuropathy. DFCs and resultant amputations account for a considerable proportion of surgeries in Fiji, with very limited literature available to verify the factors that influence these alarming figures. This study aimed to explore Health Care Workers' (HCWs) perspectives on diabetic foot complications and challenges of foot care management in Fiji.

METHOD

An exploratory descriptive qualitative design was used among HCWs at the Sigatoka Sub Divisional Hospital (SDH), Fiji in 2021. HCWs at the SDH were required to have a minimum work experience of at least six months in public health. All participants who met the inclusion criteria were selected through purposive sampling. Data was collected using a focus group discussion guide composed of semi-structured open-ended questions to guide the Focus Group Discussions (FGDs). Focus discussions were audio recorded and transcribed with thematic analysis applied to derive the themes and sub-themes outlined in the study.

RESULTS

Twenty HCWs participated in four FGDs with four major themes identified. The first theme was HCWs' perceptions and practice of foot care which revealed that all participants had adequate diabetic foot care knowledge. The second theme was factors affecting foot care which was mainly focused on identified barriers such as inadequate patient foot care knowledge, the lack of resources such as manpower, and health system challenges like the COVID-19 pandemic. The third theme is creating awareness among patients and HCWs to improve foot care practices. The fourth theme is strengthening foot care practices at the different levels of health care that is aimed at optimizing diabetic foot outcomes.

CONCLUSION

Various foot care barriers namely patient factors and the lack of resources is a concern depicted in this study. There is a need to address health system barriers and enforce diabetic foot education, screening and care for patients and the community.

Portuguese validation of the foot health status Questionnaire in patients with diabetic foot disease

PURPOSE

This study aims to adapt and validate the Foot Health Status Questionnaire, developed by Bennett et al., in Portuguese patients with diabetic foot.

MATERIALS AND METHODS

A cross-sectional study was conducted with 143 patients with diabetic foot. A principal component analysis with oblique rotation and a confirmatory factor analysis using structural equation modeling were performed.

RESULTS

The Portuguese version of the FHSQ (FHSQ-PT) in patients with diabetic foot remains equal to the original version, although with all factors correlated with each other. All scales presented high internal consistency values (pain: ω = 0.884; function: ω = 0.890; general foot health: ω = 0.910; and footwear: ω = 0.702), except for the footwear scale, although with a minimum acceptable coefficient. The FHSQ-PT scales showed good convergent validity and good discriminant validity. The FHSQ-PT scales were also able to discriminate between male and female patients as well as between patients with an active diabetic foot ulcer from those who did not.

CONCLUSIONS

The results of the validated FHSQ-PT for Portuguese patients with diabetic foot showed good psychometric properties, being a useful, objective, and small instrument that may be used in clinical practice by health professionals without consuming too much time.

Educational Interventions on Diabetic Foot Self-Care: A Study Protocol for a Pragmatic Randomized Controlled Trial

Diabetic foot is one of the most serious complications of diabetes and foot ulcer recurrence has been associated with poor foot care. Educational programs may work as a vehicle for promoting knowledge and adequate foot self-care behaviors, reducing potential ulcerative complications in the diabetic foot, and promoting a better quality of life. This study protocol will analyze the impact of two different educational strategies - an instructive video (Experimental Group 1) compared to a foot care leaflet with real-time guided reading (Experimental Group 2) and standard care (Control Group) - on adherence and knowledge about diabetic foot care and patients' perception of their foot health. This study is a Pragmatic Randomized Controlled Trial of a non-pharmacological treatment. Participants need to have a diabetic foot diagnosis and attend a Diabetic Foot Multidisciplinary Consultation at two hospitals from the North of Portugal. Participants will be assessed at the first appointment of the diabetic foot consultation (T0), two weeks after (T1), and three months later, at follow-up (T2). Primary outcomes will be adherence and knowledge about diabetic foot care and general foot health. Secondary outcomes will be illness representations regarding diabetic foot. The results of this study will inform educational interventions to decrease diabetic foot ulcers, amputation rates, and the costs associated with both, contributing to foot care adherence and improve patient's quality of life.

Status and Influencing Factors of Foot Care Behavior for Patients with Diabetic Foot Amputation: Across-Sectional Study

This study aimed to investigate the contemporary status and influencing factors of foot self-care behavior in diabetic foot amputation patients. A total of 250 patients with diabetic foot amputation were included. The general information questionnaire, Chinese Version of the Nottingham Assessment of Function Footcare (CNAFF), Knowledge of Diabetic Foot Questionnaire, and The Third Version of the Diabetes Attitude Scale were used to investigate the status and influencing factors of foot self-care behavior in patients with diabetic foot amputation. From our sample, the Chinese version of Nottingham foot care behavior score was 68.32 ± 10.35 points, which showed that the foot self-care behavior of patients with diabetic foot amputation is at a medium level. Multiple linear regression analysis showed that education level, the knowledge of how to choose shoes and socks, the knowledge of self-care for feet, the need for special training in education, and the patient's autonomy in diabetes care were the main factors influencing foot self-care behavior of patients with diabetic foot amputation (P < 0.05). The total variation of CNAFF score was 49%. The results of this study show that the level of foot care of diabetic amputees must be improved, and medical staffs need to take targeted intervention measures to help patients improve their self-care behavior after amputation, thereby reducing the recurrence rate of diabetic feet and improving their quality of life.

Effectiveness of educational interventions for diabetes-related foot disease: A systematic review and meta-analysis

This systematic review and meta-analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes-related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot-care knowledge and self-care behaviours. Meta-analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB-2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2  = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2  = 38%) and HbA1c levels (standardized mean difference -0.73; 95% CI -1.26, -0.20, I2  = 93%) without affecting all-cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2  = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self-care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self-care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow-up are needed.

A Comprehensive Review of the Vascular Consequences of Diabetes in the Lower Extremities: Current Approaches to Management and Evaluation of Clinical Outcomes

Diabetes mellitus is a global health concern characterized by chronic hyperglycemia, and its vascular consequences in the lower extremities pose significant challenges for individuals living with the condition. This comprehensive review delves into the multifaceted landscape of diabetes-related vascular complications in the lower limbs, with a primary focus on current strategies for management and the evaluation of clinical outcomes. This review achieves several critical objectives by synthesizing existing knowledge and research findings. It elucidates the intricate pathophysiological mechanisms underpinning these complications, shedding light on the cellular and molecular processes involved. Additionally, it outlines clinical assessment and diagnostic strategies used to identify and stratify risk, ranging from cutting-edge imaging techniques to clinical examinations. The review comprehensively examines current management strategies, encompassing lifestyle modifications, pharmacological interventions, surgical procedures, and wound care practices. Moreover, it assesses and analyzes clinical outcomes, including limb salvage rates, amputation rates, and overall quality of life for individuals undergoing treatment. In addressing the challenges faced in managing these complications, this review aims to contribute to improved patient care. It proposes future research directions to enhance the management and outcomes of diabetes-related vascular consequences in the lower extremities.

Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia

Background

Diabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia.

Methods

An institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance.

Result

The mean age of the study's participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08-10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74-6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08-3.66).

Conclusion

Increased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs.

Update on Medical Management of Diabetes: Focus on Relevance for Orthopedic Surgeons

Diabetes mellitus affects more than 30 million US adults and 537 million people worldwide and accounts for major complications, including more than 100,000 lower extremity amputations annually in the United States. Peripheral neuropathy, peripheral vascular disease, and foot ulcers are frequent findings in diabetes patients at risk for amputation. Suboptimal care of early foot lesions increases the risk of amputation. Studies have shown that these complications can be prevented in people with type 1 and type 2 diabetes by optimizing glycemic control and comorbid risk factors. This review focuses on evaluating and managing diabetes, which should interest orthopedic surgeons.

The association of peripheral neuropathy detected by monofilament testing with risk of falls and fractures in older adults

BACKGROUND

In persons with diabetes, annual screening for peripheral neuropathy (PN) using monofilament testing is the standard of care. However, PN detected by monofilament testing is common in older adults, even in the absence of diabetes. We aimed to assess the association of PN with risk of falls and fractures in older adults.

METHODS

We included participants in the Atherosclerosis Risk in Communities (ARIC) Study who underwent monofilament testing at visit 6 (2016-2017). Incident falls and fractures were identified based on ICD-9 and ICD-10 codes from active surveillance of all hospitalizations and linkage to Medicare claims. We used Cox models to assess the association of PN with falls and fractures (combined and as separate outcomes) after adjusting for demographics and risk factors for falls.

RESULTS

There were 3617 ARIC participants (mean age 79.4 [SD 4.7] years, 40.8% male, and 21.4% Black adults), of whom 1242 (34.3%) had PN based on monofilament testing. During a median follow-up of 2.5 years, 371 participants had a documented fall, and 475 participants had a documented fracture. The incidence rate (per 1000 person-years) for falls or fractures for participants with PN versus those without PN was 111.1 versus 74.3 (p < 0.001). The age-, sex-, and race-adjusted 3-year cumulative incidence of incident fall or fracture was significantly higher for participants with PN versus those without PN (26.5% vs. 18.4%, p < 0.001). After adjusting for demographics, PN remained independently associated with falls and fractures (HR 1.48, 95% CI 1.26, 1.74). Results were similar for models including traditional risk factors for falls, when falls and fractures were analyzed as separate outcomes, and after adjustment for competing risk of death.

CONCLUSIONS

PN, as measured by monofilament testing, is common in older adults and associated with risk of falls and fracture. Screening with monofilament testing may be warranted to identify older adults at high risk for falls.

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

OBJECTIVE

This study aimed to estimate healthcare costs of diabetic foot disease (DFD) in a large population-based cohort of people with type-2 diabetes (T2D) in the Tuscany region (Italy).

DATA SOURCES/STUDY SETTING

Administrative healthcare data of Tuscany region, with 2018 as the base year.

STUDY DESIGN

Retrospective study assessing a longitudinal cohort of patients with T2D.

DATA COLLECTION/EXTRACTION METHODS

Using administrative healthcare data, DFD were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes.

METHODS

We examined the annual healthcare costs of these clinical problems in patients with T2D between 2015 and 2018; moreover, we used a generalized linear model to estimate the total healthcare costs.

PRINCIPAL FINDINGS

Between 2015 and 2018, patients with T2D experiencing DFD showed significantly higher average direct costs than patients with T2D without DFD (p < 0.0001). Among patients with T2D experiencing DFD, those who experienced complications either in 2015-2017 and in 2018 incurred the highest incremental costs (incremental cost of € 16,702) followed by those with complications in 2018 only (incremental cost of € 9,536) and from 2015 to 2017 (incremental cost of € 800).

CONCLUSIONS

DFD significantly increase healthcare utilization and costs among patients with TD2. Healthcare costs of DFD among patients with T2D are associated with the timing and frequency of DFD. These findings should increase awareness among policymakers regarding resource reallocation toward preventive strategies among patients with T2D.

Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

INTRODUCTION

Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives.

RESEARCH DESIGN AND METHODS

This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives.

RESULTS

Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients.

CONCLUSIONS

This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients' own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.

Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes

Globally, almost 9.3% of the population aged 20-80 years have been diagnosed with diabetes making diabetes management a global health problem beyond specific regions or races. This study aimed to determine the effect of diabetes knowledge, self-stigma, and self-care behavior on the quality of life of patients with diabetes. This descriptive research study evaluated 180 patients receiving diabetes treatment at the outpatient Department of Endocrinology at C University Hospital. Data were collected between 30 July 2019, and 30 August 2019. The study variables were general patient characteristics, disease-related characteristics, quality of life, diabetes knowledge, self-stigma, and self-care behavior. Factors affecting the quality of life were analyzed by hierarchical regression. Self-stigma (β = -0.298), monthly income (β = 0.270), and self-care behavior (β = 0.140) significantly affected the quality of life, in that order. The higher the self-stigma, the lower the quality of life, and the higher the monthly income and the level of self-care behavior, the higher the quality of life. A psychosocial support program to positively change the attitude toward diabetes is needed to improve the quality of life among patients with diabetes.

Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure

AIMS

To compare the correlates of foot self-care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF).

DESIGN

Cross-sectional, correlational, comparative design.

METHODS

A 210 T2D adults (105 with HF and 105 without HF) participated from August-December 2020. Foot self-care behaviour was measured using the foot care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self-care behaviour.

RESULTS

The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF-comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid T2D adults. Marital status, social support and body mass index predicted foot self-care behaviour in the non-HF group.

Validity and reliability of the German translation of the Diabetes Foot Self-Care Behavior Scale (DFSBS-D)

Introduction

Comprehensive regular foot self-care is one of the most critical self-management behaviors for people with diabetes to prevent foot ulcer development and related complications. Yet, adequate foot self-care is only practiced by very few of those affected. To improve diabetic foot syndrome prevention, a valid and reliable instrument for measuring daily foot-care routines in patients with diabetes is needed. However, no such instrument is currently available in the German language. This study, therefore, aims to translate and cross-culturally adapt the "Diabetic Foot Self-Care Behavior Scale" (DFSBS) into German (DFSBS-D) and evaluate its validity and reliability.

Material and methods

The DFSBS was translated from English into German using a forward-backward procedure as per previous recommendations. Factor analysis was used to study structural validity. To establish construct validity, 21 a priori hypotheses were defined regarding the expected correlation between scores on the new German version (i.e., DFSBS-D) and those of the following questionnaires measuring related constructs: (1) German version "Diabetes Self-Care Activities Measure" (SDSCA-G), (2) "Frankfurter Catalogue of Foot Self-Care" (FCFSP), and (3) "Short Form 36" (SF-36) and tested in 82 patients. To assess test-retest reliability, patients completed the DFSBS-D again after a 2-week interval. Test-retest reliability was assessed from stable patients’ data (n = 48) by calculating two-way random-effects absolute agreement ICCs with 95% CI and Bland and Altman analyses. In addition, Cronbach’s alpha was calculated as internal consistency measure.

Results

The 7-item DFSBS-D showed good structural validity. Its single factor explains 57% of the total sample variance. Of the 21 predefined hypotheses, 13 (62%) were confirmed. The DFSBS-D’s internal consistency was good (Cronbach’s alpha = 0.87). Test-retest reliability over a 2-week interval was also good (ICC 0.76).

Conclusion

The DFSBS was successfully translated into German. Statistical analyses showed good DFSBS-D structural validity, test-retest reliability, and internal consistency. Yet, construct validity may be debated.

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

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

Knowledge and practice of diabetic foot care and the prevalence of diabetic foot ulcers among diabetic patients of selected hospitals in the Volta Region, Ghana

Diabetic foot ulcers (DFUs) are a common but serious complication of diabetes mellitus (DM). The factors distressing the worth of diabetic foot care (DFC) are knowledge and practice. Foot ulcers are the main cause of amputation and death in people suffering from DM. This study assessed the knowledge and practice of DFC and the prevalence of DFUs and its associated factors among diabetic patients of selected hospitals in the Volta Region, Ghana. A multihospital-based cross-sectional study was conducted among 473 patients with DM who were recruited using the systematic sampling method. Data were collected using a validated, pretested, and structured questionnaire, while medical variables were obtained from patient folders and analysed using SPSS version 23. All statistically significant parameters in bivariate analysis were incorporated in the multivariate logistic regression analysis. The results showed that 63% of diabetic patients had good knowledge of DFC, while 49% competently practiced it. A negative correlation was found between knowledge and practice levels of DFC (r = -0.15, P = <.01). The prevalence of DFUs was 8.7% among the studied diabetic patients. Male diabetic patients were 3.4 times more likely to develop DFUs than female diabetic patients (crude odd ratio [cOR] = 3.35; 95% confidence interval [CI] = 1.75-6.43; P = <.001). Type 1 diabetic patients were five times more likely to develop DFUs than those who had type 2 diabetes (cOR = 5.00; 95% CI = 2.50-10.00; P = <.001). Diabetic patients who had a family history of diabetes were 4.7 times more likely to develop DFUs than those without family history (adjusted odd ratio [aOR] = 4.66; 95% CI = 1.55-13.89; P = .006). Those who had diabetes for 5 to 10 years were 3.3 times more likely to develop DFUs than those who had diabetes for less than 5 years (aOR = 3.28; 95% CI = 1.40-7.67; P = .006). Diabetic patients who had comorbidity were 3.4 times more likely to develop DFUs than those without comorbidity (cOR = 3.35; 95% CI = 1.74-6.45; P = <.001). The study found that there was good knowledge but poor practices of DFC among patients. Health care providers are expected to better educate patients and emphasise self-care practices to patients. Health care providers should also give more attention to patients with associated risk factors to avoid further complications and reduce the occurrence of DFUs.

12. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes-2022

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Practices followed by type-II diabetes mellitus patients for prevention of foot ulcers

Background:

Type-II diabetes mellitus is a serious lifestyle-related health problem globally and its prevalence is rapidly increasing day by day. The main purpose of this study was to assess practices followed by Type-II diabetes mellitus patients regarding the prevention of foot ulcers.

Method:

This study was a cross-sectional study using a case series type of research design. Purposively, a total of 100 type-II diabetes mellitus patients were registered with AIIMS Rishikesh for their treatment. Data collection tools were a semi-structured questionnaire that included 20 items. By conducting an interview schedule, data was collected from each participant.

Results:

Majority of participants belong to age group of 51–60 years and were males. Practice score showed majority of Type-II DM patients were following moderate-level practices, followed by only few (15%) were following good practice for preventing foot ulcers.

Conclusion:

Health care professionals must empathize on educating type-II diabetes patients regarding preventive measures for foot ulcers. Educate patients regarding the importance of self-foot care practice and promoting them for proper follow-up as well to decrease incidence of diabetic foot ulcers.

"When nothing happens, nobody is afraid!" beliefs and perceptions around self-care and health-seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care

Self-management and self-care are the cornerstone of diabetes care and an essential part of successfully preventing or delaying diabetes complications. Yet, despite being armed with the required information and guidance for self-management, self-care and adherence to foot self-care recommendations and compliance to medication among patients with diabetic foot ulcer and diabetic lower extremity amputations remain low and suboptimal. This study reveals in-depth account of nine such patients' beliefs and perceptions around their illness, their self-care, and their health-seeking behaviours. Patients living with diabetic lower extremity amputation displayed profound lack of knowledge of self-care of diabetes and foot and passive health-related behaviours. The overarching sense that "when nothing happens, nobody is afraid," points to a lack of motivation in taking charge of one's own health, whether this is with reference to treatment or care adherence, following recommended self-care advice, or seeking timely treatment. The Health Beliefs Model provides the theoretical framework for probing into the factors for the participants' suboptimal self-care and passive health-seeking behaviours. Two themes emerged from data analysis: profound knowledge deficit and passive health-related behaviours. The beliefs and perceptions around self-care and health-seeking behaviours for patients with lower extremity amputation are interpreted as the "ignorant self" with passive health-seeking behaviours. Patients with diabetes and diabetic foot diseases may benefit from personalized education, motivational interviewing, and family support.

The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study

AIM

To investigate the barriers and facilitators of foot care practice in diabetic patients in Indonesia.

DESIGN

A qualitative content analysis with an inductive approach.

METHOD

Semi-structured interviews were conducted on 34 type 2 diabetes mellitus (T2DM) patients, health providers and family members in Purwokerto, Indonesia, between July 2020 and December 2020. The interview transcripts were coded using NVivo 12.

RESULTS

Four themes emerged from data analysis, including personal barriers (low susceptibility of developing foot ulcer, limited knowledge about foot care, fatalistic practices, financial problems, glucose control taking priority over foot care, lack of motivation, lack of confidence, fear of being labelled), environmental barriers (lack of knowledge and time of health providers, lack of family support and climate conditions), perceived foot health benefits (intention to feel better and desire to stay socially active) and religious practices (foot washing as part of religious practice and intention to feel clean before praying).

Exploring the Relationship of Health Beliefs and Self-Care Behaviors Related to Diabetic Foot Ulcers of Type II Diabetes Mellitus Patients: A Cross-Sectional Study

Objective: Diabetic foot ulcers are an invasive complication of diabetes and are increasing. This study investigates the relationship between health beliefs and foot self-care behaviors, among people with type II diabetes. Methods: A cross-sectional design was adopted, and 98 patients were recruited from outpatient clinics of the endocrine department. The questionnaires of Demographic, Diabetes Foot Ulcer Health Belief Scale (Health Beliefs, DFUHBS), and Diabetes Foot Self-Care Behavior Scale (Self Care, DFSBS) were used to collect data. Results: Among the subjects living alone or who had diabetes less than ten years, the score of DFSBS was significantly lower than among those living with families or who had diabetes for ten years or more. The frequency of performing diabetes foot self-care behavior, among males was lower than among females significantly. Although there was no significant difference in the Health Belief total score, there were differences in the benefit subscale. Those who had junior high school level or less or had diabetes less than ten years, their score was significantly lower than those with senior high school level or more or had diabetes ten years or more. In a multivariable regression model, living with family, diabetes duration, and health beliefs explained 42.9% of the variance of diabetic-foot self-care behaviors. Conclusions: Living alone, shorter duration of diabetes, male gender, and lower health belief scores predict less adequate diabetic foot self-care behavior. Health care providers should assess these factors when designing individual care plans.

Self-assessed foot health in older people with rheumatoid arthritis-A cross-sectional study

BACKGROUND

Foot and ankle problems are especially common in patients with RA, causing significant disability and limitation in daily activities. Previous studies have mainly focussed on foot problems in the adult population whilst the evidence of foot health in the older population is scarce.

OBJECTIVES

The aim of the study was to analyse self-assessed foot health and associated factors in older people with rheumatoid arthritis (RA).

METHODS

The study applied a descriptive cross-sectional survey design and recruited older people with RA from the member register of one patient association. We collected the data in January 2019 with the Self-administered Foot Health Assessment Instrument, and sociodemographic and foot-related background questions and analysed the data with descriptive and inferential statistics.

RESULTS

Older people with RA had many self-reported foot problems. The most common problems were foot pain, dry skin and thickened toenails. In addition, structural deformities of the foot were prevalent. The level of foot health associated with the amount of daily walking or standing, and using walking or running shoes outdoors. Individuals who had consulted a physician due to their foot problems had more structural deformities in the foot. Foot problems limited their ability to perform daily activities.

CONCLUSIONS

This study demonstrates that older people with RA not only live with a long-term health condition, but they also live with complex foot problems. Older people with RA need healthcare services due to their foot problems. There is a need to develop and implement care practices to alleviate foot pain and support and promote foot health and functional ability in older people with RA.

IMPLICATION FOR PRACTICE

Understanding the nature and consequences of foot problems in older people with RA allows healthcare professionals to perform more accurate clinical foot evaluations and develop effective interventions to prevent further foot problems.

Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement From the American Heart Association

Nontraumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with a high mortality and medical expenditure. There are ≈150 000 nontraumatic leg amputations every year in the United States, and most cases occur in patients with diabetes. Among patients with diabetes, after an ≈40% decline between 2000 and 2009, the amputation rate increased by 50% from 2009 to 2015. A number of evidence-based diagnostic and therapeutic approaches for PAD can reduce amputation risk. However, their implementation and adherence are suboptimal. Some racial/ethnic groups have an elevated risk of PAD but less access to high-quality vascular care, leading to increased rates of amputation. To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce the incidence of critical limb ischemia and enhance delivery of optimal care are needed. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation. Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (eg, smoking cessation, use of statins, and foot monitoring/care in patients with diabetes). To facilitate the implementation of these recommendations, we propose several regulatory/legislative and organizational/institutional policies such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. If these recommendations and proposed policies are implemented, we should be able to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030.

11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2021

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Skin and Soft Tissue Infections in Patients with Diabetes Mellitus

Skin and soft tissue infections are common in diabetics. Diabetic foot infection usually results from disruption of the skin barrier, trauma, pressure, or ischemic wounds. These wounds may become secondarily infected or lead to development of adjacent soft tissue or deeper bone infection. Clinical assessment and diagnosis of these conditions using a multidisciplinary management approach, including careful attention to antibiotic selection, lead to the best outcomes in patient care.

Role of self-care in COVID-19 pandemic for people living with comorbidities of diabetes and hypertension

People living with comorbidities especially chronic non-communicable disease (NCDs) like diabetes and hypertension are at greater risk of acquiring severe form of Corona Virus Disease (COVID-19) infection known to be caused by Severe Acute Respiratory Syndrome-CoV -2 (SARS-CoV-2) due to underlying immunodeficiency. The government has taken various public health measures to reduce the risk of infection, such as physical distancing, Information Education and Communication (IEC) messages regarding hand-washing, usage of masks, and avoidance of unnecessary travel including lockdown to combat the spread of disease. However, nationwide lockdown due to COVID-19 pandemic has also confronted the existing health care system (clinician centric approach) for the management of diabetes and hypertension in India. Using secondary source of data from specific website and search engine a review was done for existing guidelines and literature focusing on the various components of self-care management (patient-centered care) and highlights the importance of self-care management education to cope up with twin pandemic of COVID-19 and NCDs. An attempt was also made to highlight the use of eHealth to manage diabetes and hypertension which may act as a bridge to fill the gap between primary care physician and patient's amid lockdown and help physician to deliver comprehensive care for people suffering from comorbidities.

Relationship between Self Care Management with Glycemic Control in Type 2 Diabetic Patients

Background

The purpose of this study was to investigate the relationship between self-care management and HbA1c level of the patients with type 2 diabetes in YAZD.

Methods

This study was a cross-sectional study. The number of 376 diabetic patients referred to the Diabetes Research Center in Yazd entered the study. The data collection tool was a summary of Diabetes Self Care Activity questionnaire (SDSCA), which was collected through interviews with patients. Data analysis was performed using SPSS software V 16 and kruskalwallis and independent sample t tests.

Results

The results showed that of 376 patients, 218 (%58) were women and 158 (%42) were male. The mean age of the participants in the study was 54.5 ± 10.9 years old and the mean duration of the disease was 9.53 ± 8.39 years. The mean HbA1C in the patients was 7.93% ± 1.38%. The mean of BMI was 28.93 ± 6 kg/ m². The mean of self-care score in the patients under study was 30.53 ± 11.4. There was a significant relationship between the mean of self-care score, BMI, age and HbA1C (P value <0.05).

Conclusions

According to the results of the study, it can be concluded that the level of self-care in patients with controlled diabetes mellitus (HbA1C <7%) is more than patients with uncontrolled diabetes mellitus (HbA1c ≥9%).

Knowledge of diabetic foot care management among medical students at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

OBJECTIVES

To evaluate medical students' knowledge of diabetic foot care management and its related factors.

METHODS

This was a cross-sectional, descriptive study of 303 students studying at King Abdulaziz University Hospital, Jeddah, Saudi Arabia conducted from June to July 2019. Data were collected using a two-part questionnaire. The first one captured student information; the second assessed student knowledge. It consists of 68 true and false questions divided into 4 subscales (risk factors, foot examination, foot complications and footwear selection). The higher the total score is, the higher the students' knowledge.

RESULTS

The total average knowledge score was 55.5±5.5 out of 68. While the mean score was 14.11/16 for risk factors, 9.24/10 for foot examination, 24.21/32 for foot complications, and 7.88/10 for footwear selection subscales. Only 56.4% of students educated diabetic patients about diabetic foot risks;concurrently, only 63% performed foot examinations in diabetes patients. Students who educated diabetic patients, preformed foot exam, or attended extra elective clinical rotation in a diabetic foot team, had a significantly higher knowledge level. Conclusion: Students were found to have high level of knowledge regarding diabetic foot management. Students who educated patients about diabetic foot risk, performed foot examination on patients and students who took elective rotations in a diabetic foot care team had a higher knowledge level.

Development and Pilot Testing of a Diabetes Foot Care and Complications Questionnaire for Adults with Diabetes in Oman: The Diabetic Foot Disease and Foot Care Questionnaire

Objectives

Diabetic foot disease causes substantial morbidity and mortality, but it can be prevented. Our study examined the frequency of diabetes-related foot problems and foot self-care practices, as reported by consecutive patients attending primary and secondary diabetes services in Muscat, Oman.

Methods

A cross-sectional survey utilizing a newly developed and pre-tested questionnaire was conducted at eight primary health care centers and one polyclinic (secondary care) in A'Seeb, Muscat. A convenience sample of 353 consecutive Omanis, aged 20 years and above, diagnosed with diabetes were invited to participate in this study. We collected data on clinico-demographic characteristics, patient-reported foot complications, and foot self-care practices.

Results

Of the 350 patients who agreed to participate (mean diabetes duration 7.9±7.4 years, response rate: 99.2%), 62.3% were female, 57.4% were unemployed, more than half were illiterate (52.9%), and around three-quarters (71.4%) were unsure of the type of diabetes they had. More than half (55.1%) reported having at least one or more sensory peripheral neuropathy symptoms, almost half (49.1%) reported one or more peripheral vascular disease symptoms in the previous month, and 12.5% a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 54.7% did not examine the bottom of their feet each day.

Conclusions

Although self-reported diabetes-related foot complications were common in this population, foot self-care practices were inadequate. These findings suggest a need for the provision of regular foot care education to patients with diabetes. Future research should explore barriers to recommended foot self-care practices.

Educating patients of diabetes mellitus for diabetic foot care

Background and Purpose

Diabetes mellitus (DM) is a global pandemic. Among the spectrum of diabetic complications, diabetic foot is a leading cause of morbidity and hence awareness and education regarding primary healthcare inclusive of self-care pertaining to diabetic foot care is of paramount importance.

Aim

The aim of the study was to educate patients of DM regarding the disease and its associated complications, specifically pertaining to diabetic foot care.

Methodology

The study was carried out in three phases, first was to assess the diabetic patients related to their awareness on disease complications and diabetic foot care, through pretest questionnaire, the second phase was to sensitize patients and educate them on the same, the third phase was to re assess the knowledge gained by the patients through posttest assessment.

Results

The study evaluated the absolute and relative learning gain regarding the awareness and knowledge of foot care among diabetic individuals. The absolute learning gain was 40.92% and the relative learning gain was 76.48% and normalized learning gain was 0. 88, the normalized gain was assessed to be high.

Conclusion

The study concluded that training and sensitizing individuals with diabetes will definitely help reduce morbidity of diabetic foot and hence the medical and paramedical staff need to spread awareness regards the same.

Preventative and early intervention diabetes-related foot care practices in primary care

The aim of this study was to identify current preventative and early intervention diabetes-related foot care practices among Australian primary care healthcare professionals. A survey was developed to obtain information about preventative and early intervention foot care actions, priorities of care, access and referral to expert multidisciplinary foot care teams and adherence to best-practice diabetes-related foot care recommendations. The survey was distributed to GPs and Credentialled Diabetes Educators (CDEs). Surveys were completed by 10 GPs and 84 CDEs. Only 45% of all respondents reported removing the shoes and socks of their patients with diabetes at a consultation. Eighty-one percent of participants reported having access to specialist multidisciplinary foot care teams. Those in urban settings were significantly more likely to report access than those in rural areas (P=0.04). Median scores indicated that participants did not often utilise specialist teams to refer patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy. Only 16% of participants reported having access to specialist foot care telehealth services; patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy were rarely referred to these services. This study is the first Australian study to elicit information about preventative and early intervention diabetes-related foot care practices by GPs and CDEs working in Australian primary care. In the presence of acute diabetes-related foot complications, primary healthcare practitioners are not always adhering to best practice foot care recommendations. Further studies are required to understand the reasons for this and ensure evidence-based best practice foot care delivery to people with diabetes.

11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2020

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Associations of foot ulceration with quality of life and psychosocial determinants among patients with diabetes; a case-control study

Background

Patients with diabetic foot ulcers may have a lower quality of life. The objective was to compare the quality of life and its psychosocial determinants among patients with and without diabetic foot ulcers.

Methods

A case-control study was conducted in 2017 among patients with (cases) and without (controls) diabetic foot ulcers. The study tools included the World Health Organization’s Quality of Life scale (WHOQOL-BREF), the Hospital Anxiety and Depression (HAD) scale for anxiety and depression, the Patient Health Questionnaire Physical Symptoms (PHQ-15) for the severity of somatic symptoms, and the Summary of Diabetes Self-Care Activities (SDSCA) measure for self-management.

Results

A total of 209 patients (45 cases and 164 controls) were included. The average age was 56.2 ± 11.7 years, and 55.5% were female. The average scores of WHOQOL-BREF, PHQ-15, and SDSCA were 74.4% ± 12.1% and 8.1 ± 6.1, and 30.4 ± 21.8, respectively. The prevalence of anxiety and depression were 19.6 and 24.9%, respectively. SDSCA was the only psychosocial determinants higher in cases than controls (mean difference = 15.0, 95% CI = -8.0–22.0). The correlation coefficients of WHOQOL-BREF scores with anxiety, depression, and PHQ-15 scores in all patients were − 0.559 (p < 0.001), − 0.582 (p < 0.001), and − 0.532 (p < 0.001), respectively, with similar numbers in both groups. In multivariate analysis, only the association between quality of life and depression was maintained.

Conclusion

Quality of life and psychosocial determinants with the exception of self-management were not associated with diabetic foot ulcers. Depressive symptoms were independent determinant of poor quality of life, irrespective of the status of diabetic foot ulcers.

Validity and Reliability of an Instrument for Assessing Self-Care Behaviours in Diabetes Mellitus Type 2 Patients in Binjai City, Indonesia

BACKGROUND:

Self-care behaviour becomes very important for diabetic patients; good self-care behaviour will prevent complications and improving the quality of life.

AIM:

The aim of this study was to provide a preliminary assessment of the validity and reliability of a new measure of self-care behaviour of Diabetes Mellitus Type 2.

METHODS:

The research was a cross-sectional study. The study population was T2DM patients from Primary Health Centers (PHC) in Binjai City, Indonesia. Sample determination using a single simple formula for the hypothesis of one population with calculation is 115 patients; sampling was done by convenience sampling with inclusion and exclusion criteria. Research questionnaire Self-care behaviour of T2DM patients was forming by knowledge, attitudes, communication, family support, financing, motivation, and self-efficacy. Each of the predictors forms self-care behaviour and finally, the instrument consists of 28 questions. The data analysis techniques were Confirmatory Factor Analysis (CFA) tests with Structural Equation Models (SEM) with AMOS aids.

RESULTS:

Based on the results of the confirmatory analysis proved that the instrument is valid and reliable, the measure the self-care behaviour of T2DM.

CONCLUSION:

The new instrument for assessing self-care behaviour of T2DM patients is valid and reliable, besides being able to assess self-care behaviour, they can also know the components that make up self-care.

Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria

OBJECTIVE

To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems.

METHOD

Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences.

RESULTS

30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%).

CONCLUSIONS

All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.

Associations of health literacy with risk factors for diabetic foot disease: a cross-sectional analysis of the Southern Tasmanian Health Literacy and Foot Ulcer Development in Diabetes Mellitus Study

OBJECTIVES

Poor health literacy (HL) is associated with poorer health outcomes in diabetes but little is known about its effects on foot disease. This study was aimed to determine the associations between HL and diabetic foot disease.

DESIGN

This is a cross-sectional analysis of baseline data from a prospective study of foot disease.

SETTING

Attendees of the Royal Hobart Hospital's Diabetes outpatient clinics.

PARTICIPANTS

222 people with type 1 or type 2 diabetes aged >40 years and without a history of foot disease, psychotic disorders or dementia.

MEASURES

Outcomes were peripheral neuropathy, peripheral arterial disease and foot deformity according to published guidelines. The exposure, HL, was measured using the short form Test of Functional Health Literacy in Adults (S-TOFHLA) and the Health Literacy Questionnaire (HLQ). Covariates included demographic characteristics, medical history, psychological measures and foot care behaviour.

RESULTS

Of 222 participants, 204 had adequate HL. (Mean (SD) S-TOFHLA scores were 31.9 (6.7)), mean(SD) HLQ scores were 134.4 (18.4)). In univariable but not multivariable analyses, higher S-TOFHLA scores were associated with lower overall risk for foot disease (OR 0.96, 95% CI 0.93 to 0.99) and loss of protective sensation (OR 0.95, 95% CI 0.91 to 0.995).

CONCLUSIONS

These data provide little support for clinically important impacts of HL on risk factors for diabetic foot disease. However, in the absence of longitudinal data, such effects cannot be ruled out. Longitudinal studies measuring incident foot disease are needed to properly judge the potential for interventions improving HL to reduce the incidence of diabetic foot disease.

Correlates of Self-Care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure

PURPOSE

The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).

METHOD

Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.

RESULT

Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.

CONCLUSION

Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.

Person-Centered Primary Care and Type 2 Diabetes: Beyond Blood Glucose Control

With an estimated 9% of persons in the United States diagnosed with diabetes, primary care providers such as midwives and nurse practitioners are increasingly working with persons who have diabetes and are seeking primary care services. This article reviews the current literature with regard to the initial evaluation of individuals who are diagnosed with diabetes, and what is entailed in comprehensive continuing management of care. A person-centered interprofessional approach to care of the person with diabetes is presented. Recommendations are given that address dietary habits, activities of daily living, medication regimens, and potential alternative therapies. Social constructs related to effective care of individuals with diabetes also are addressed. Knowledge of current research that has identified effective care practices for individuals with diabetes is imperative to ensuring their well-being, and promoting a person-centered and interprofessional approach is best for offering optimal care to those diagnosed with diabetes.

Hyperbaric Oxygen Indications: Diabetic Foot Ulcers and Intractable Management

Wound care remains an interdisciplinary specialty that can confront primary care physicians, emergency medicine physicians, and even specialists with increasingly challenging clinical dilemmas as well as an increasing array of possible additional therapies, like HBO₂. As everyone tries to offer what's best, it remains to each individual clinician to weigh the patient's presenting problem, like a lower extremity or diabetes mellitus foot ulcer and potential therapies, such as HBO₂.

Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline

OBJECTIVE

The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults.

CONCLUSIONS

Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.

A nursing metaparadigm perspective of diabetic foot ulcer care

Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.