Diabetic foot primary prevention: Difference between revisions
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The primary prevention of diabetic foot ulcer includes control of blood sugar levels , pressure offloading, frequent physical examinations, good foot hygiene, [[diabetic sock]]s and shoes, and by avoiding injury. | The primary prevention of diabetic foot ulcer includes control of blood sugar levels , pressure offloading, frequent physical examinations, good foot hygiene, [[diabetic sock]]s and shoes, and by avoiding injury. | ||
==Primary Prevention== | ==Primary Prevention== | ||
Foot ulcers can be prevented by is by frequent physical examinations, good foot hygiene, [[diabetic sock]]s and shoes, and by avoiding injury.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | [[Foot]] [[ulcers]] can be prevented by is by frequent [[physical examinations]], good [[foot]] [[hygiene]], [[diabetic sock]]s and shoes, and by avoiding injury.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | ||
*Control of [[blood sugar]] levels | |||
* Control of blood sugar levels | *Pressure off loading | ||
* Pressure off loading | *Regular [[Physical examination|examinations]] | ||
* Regular examinations | **Studies recommend annual [[Screening (medicine)|screening]] for every [[diabetes|diabetic]] [[patient]] older than 15 years old by the physician and more frequent for [[patients]] who are at risk (such as [[neuropathy]]). | ||
* Prevention of infection | **Daily [[foot]] [[Physical examination|examination]] should be done by the [[patient]] him/herself. | ||
* Foot-care education combined with increased surveillance can reduce the incidence of serious foot | *Prevention of [[infection]] | ||
*[[Foot]]-care education: | |||
* | **Based on studies [[foot]]-care education combined with increased surveillance can reduce the [[incidence]] of serious [[foot]] problems. <ref name="pmid8498761">{{cite journal |author=Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F |title=Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial |journal=Ann Intern Med |volume=119 |issue=1 |pages=36-41 |year=1993 |pmid=8498761}}</ref> | ||
*Proper [[food]]wear | |||
**All major reviews recommend special [[foot]]wear for [[patients]] with a prior [[ulcer]] or with [[foot]] deformities. | |||
**One review added [[neuropathy]] as an indication for special [[foot]]wear. | |||
**Although the comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear. | |||
====Clinical Trials==== | ====Clinical Trials==== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2], Usama Talib, BSc, MD [3]
Overview
The primary prevention of diabetic foot ulcer includes control of blood sugar levels , pressure offloading, frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury.
Primary Prevention
Foot ulcers can be prevented by is by frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury.[1]
- Control of blood sugar levels
- Pressure off loading
- Regular examinations
- Studies recommend annual screening for every diabetic patient older than 15 years old by the physician and more frequent for patients who are at risk (such as neuropathy).
- Daily foot examination should be done by the patient him/herself.
- Prevention of infection
- Foot-care education:
- Proper foodwear
Clinical Trials
Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customized shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option".[3]
National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided. [4]
A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes". [5] However, the meta-analysis was published before the major trial that is in the table below.
The major randomized controlled trial of specialized footwear show no benefit in patients with a prior foot ulceration (see table below).[6] A prior, smaller, non-randomized trial that showed benefit of custom foot wear in patients with a prior foot ulceration.[7] In this trial, the number needed to treat was 4 patients.
| Trial | Patients | Intervention | Comparison | Outcome | Results | Comment | |
|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||
| Litzelman[2] 1993 |
395 patients • General medicine practice |
Patient and provider education | Usual care | • Any foot lesion • Serious foot lesions at one year |
Not reported | • 11% • 2.9% |
• Insignificant • Significant reduction |
| Lincoln[9] 2008 |
172 patients • Prior ulceration • Specialist clinic |
Targeted, one-to-one education | Usual care | Re-ulceration at • 1 year 2 years |
• 30% • 41% |
• 20% • 41% |
• Insignificant • Insignificant |
| McCabe[8] 1998 |
2002 patients • High-risk • General diabetic clinic |
Screening and referral to foot-care clinic if they had prior ulcer, had low ankle–brachial index (<0.75), or had foot deformities | Usual care | • Ulceration within 2 years • Amputation rates |
• 2% • 0.1% |
4% 1.2% |
• Insignificant • Significant |
| Reiber[6] 2002 |
400 patients • Prior ulceration • Excluded severe deformity |
Therapeutic shoes | Usual footwear | Re-ulceration | 15% | 17% | Insignificant difference |
Video: Diabetic Foot Care
{{#ev:youtube|DASvmFJeYX8}}
References
- ↑ Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
- ↑ 2.0 2.1 2.2 Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial". Ann Intern Med. 119 (1): 36–41. PMID 8498761.
- ↑ Hunt D. "Foot ulcers and amputations in diabetes". Clin Evid: 455–62. PMID 16620415. Text " based on September 2005 search" ignored (help)
- ↑ "Scope: Management of type 2 diabetes: prevention and management of foot problems (update)" (PDF). Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems. National Institute for Health and Clinical Excellence. 20 February 2003. Retrieved 2007-12-04.
- ↑ Spencer S. "Pressure relieving interventions for preventing and treating diabetic foot ulcers". Cochrane Database Syst Rev: CD002302. doi:10.1002/14651858.CD002302. PMID 10908550.
- ↑ 6.0 6.1 6.2 Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C; et al. (2002). "Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial". JAMA. 287 (19): 2552–8. PMID 12020336.
- ↑ Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G (1995). "Manufactured shoes in the prevention of diabetic foot ulcers". Diabetes Care. 18 (10): 1376–8. PMID 8721941.
- ↑ 8.0 8.1 McCabe CJ, Stevenson RC, Dolan AM (1998). "Evaluation of a diabetic foot screening and protection programme". Diabet Med. 15 (1): 80–4. doi:10.1002/(SICI)1096-9136(199801)15:1<80::AID-DIA517>3.0.CO;2-K. PMID 9472868.
- ↑ 9.0 9.1 Lincoln NB, Radford KA, Game FL, Jeffcoate WJ (2008). "Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial". Diabetologia. 51 (11): 1954–61. doi:10.1007/s00125-008-1110-0. PMID 18758747.