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Patient education for preventing diabetic foot ulcerationValk GD, Kriegsman DM W, Assendelft WJJ
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SummaryEducating people with diabetes about foot care to help reduce foot ulcers and amputationsFoot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy) and/or the blood supply to their legs (peripheral vascular disease). People with ulcers due to diabetes will sometimes need an amputation (surgical removal of part of the limb). The review of trials found that educating people with diabetes about the need to look after their feet might help prevent ulcers and amputations, especially for people at high risk of developing these problems. Education seems to improve people's foot care knowledge and behaviour, but the research is not strong.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 23. 2001 AbstractBackgroundUlceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. ObjectivesTo assess the effectiveness of patient education on the prevention of foot ulcers in patients with diabetes mellitus. Search strategyEligible studies were identified by searching the Cochrane Wounds Group Specialised Register, (September 2004) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2004). Selection criteriaProspective randomised controlled trials (RCTs) which evaluated educational programmes for preventing foot ulcers in people with diabetes mellitus. There was no restriction on language of the publications. Data collection and analysisTwo authors independently undertook data extraction and assessment of study quality. Main resultsNine RCTs were included. Four trials compared the effect of intensive with brief educational interventions; two of these reported clinical endpoints. One study involving high-risk patients reported a reduction in ulcer incidence (Peto OR: 0.28 (95% CI 0.13 to 0.59)) and amputation rate (Peto OR: 0.32 (95% CI 0.14 to 0.71)) after one year. The other RCT did not find an effect at seven years follow-up. Participants' foot care knowledge significantly improved with education in two trials. In one trial foot care knowledge improved significantly in the control group, in contrast to the intervention group. Non-calcaneal callus was significantly reduced by education in one trial. One RCT did not find that patient foot care education, as part of a general diabetes education program, reduced foot ulceration compared with usual care. Patient education as part of a complex intervention, targeted at both people with diabetes and doctors, reduced the number of serious foot lesions at one year in one RCT (OR: 0.41(95% CI 0.16 to1.00)) and improved foot care behaviour. Evidence from three RCTs comparing the effect of patient-tailored education in addition to usual care was conflicting. Authors' conclusionsRCTs evaluating education for people with diabetes, aimed at preventing diabetic foot ulceration, are mostly of poor methodological quality. Weak evidence suggests that patient education may reduce foot ulceration and amputations, especially in high-risk patients. Foot care knowledge and behaviour of patients seem positively influenced by patient education in the short term. Because of conflicting results and the methodological shortcomings more RCTs are needed. |
