Orthotic approach to prevention and management of diabetic foot: A narrative review

Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023

BACKGROUNDS

Diabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas.

PURPOSE

This study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field.

METHODS

Relevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries.

RESULTS

A total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that "amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. "Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as "pressure ulcers", "burden", and "chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies.

CONCLUSIONS

The current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.