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><ref name="pmid9834731">{{cite journal| author=Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S | display-authors=etal| title=1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. | journal=CMAJ | year= 1998 | volume= 159 Suppl 8 | issue= | pages= S1-29 | pmid=9834731 | doi= | pmc=1255890 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834731 }} </ref><ref name="pmid9839111">{{cite journal| author=Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM| title=Preventive foot care in people with diabetes. | journal=Diabetes Care | year= 1998 | volume= 21 | issue= 12 | pages= 2161-77 | pmid=9839111 | doi=10.2337/diacare.21.12.2161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9839111 }} </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><ref name="pmid9834731">{{cite journal| author=Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S | display-authors=etal| title=1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. | journal=CMAJ | year= 1998 | volume= 159 Suppl 8 | issue= | pages= S1-29 | pmid=9834731 | doi= | pmc=1255890 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834731 }} </ref><ref name="pmid9839111">{{cite journal| author=Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM| title=Preventive foot care in people with diabetes. | journal=Diabetes Care | year= 1998 | volume= 21 | issue= 12 | pages= 2161-77 | pmid=9839111 | doi=10.2337/diacare.21.12.2161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9839111 }} </ref><ref name="pmid1425105">{{cite journal| author=Rith-Najarian SJ, Stolusky T, Gohdes DM| title=Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria. | journal=Diabetes Care | year= 1992 | volume= 15 | issue= 10 | pages= 1386-9 | pmid=1425105 | doi=10.2337/diacare.15.10.1386 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1425105 }} </ref> | ||
*Control of [[blood sugar]] levels | *Control of [[blood sugar]] levels | ||
*Pressure off loading | *Pressure off loading | ||
*Regular [[Physical examination|examinations]] | *Regular [[Physical examination|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]]). | **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]]). | ||
**A careful [[Physical examination|examinations]] should consist peripheral [[neuropathy]] assessment, which should be done by checking [[Ankle jerk reflex|ankle reflexes]], vibration (by using a [[Peripheral neuropathy screening|128-Hz tuning fork]]) and sensation (by utilizing a [[Peripheral neuropathy screening|10-g Semmes-Weinstein monofilament]]). | |||
**A study showed the importance of using a [[Peripheral neuropathy screening|10-g Semmes-Weinstein monofilament]] with a 10 fold risk elevation of [[foot]] [[ulcer]] development and 17 fold increase in [[amputation]] rate within a 32-month follow up in [[patients]] who had abnormal [[Peripheral neuropathy screening|10-g Semmes-Weinstein monofilament]] examinations. | |||
**Daily [[foot]] [[Physical examination|examination]] should be done by the [[patient]] him/herself. | **Daily [[foot]] [[Physical examination|examination]] should be done by the [[patient]] him/herself. | ||
*Prevention of [[infection]] | *Prevention of [[infection]] | ||
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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], Anahita Deylamsalehi, M.D.[4]
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][2][3][4]
- 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).
- A careful examinations should consist peripheral neuropathy assessment, which should be done by checking ankle reflexes, vibration (by using a 128-Hz tuning fork) and sensation (by utilizing a 10-g Semmes-Weinstein monofilament).
- A study showed the importance of using a 10-g Semmes-Weinstein monofilament with a 10 fold risk elevation of foot ulcer development and 17 fold increase in amputation rate within a 32-month follow up in patients who had abnormal 10-g Semmes-Weinstein monofilament examinations.
- 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".[6]
- National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients who are at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer", "specialist footwear and insoles" should be provided. [7]
- A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes". [8] However, the meta-analysis was published before the major trial that is in the table below.
- A small and non-randomized trial showed the benefits of custom footwear in patients with a prior footulceration, with a number needed to treat of 4 patients.[9]
- A major randomized controlled trial of specialized footwear showed no benefit for patients with a prior foot ulceration (see table below).[10]
| Trial | Patients | Intervention | Comparison | Outcome | Results | Comment | |
|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||
| Litzelman[5] 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[12] 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[11] 1998 |
2002 patients • High-risk • General diabetic clinic |
Screening and referral to foot-care clinic if they had prior ulcer, low ankle–brachial index (<0.75), or foot deformities | Usual care | • Ulceration within 2 years • Amputation rates |
• 2% • 0.1% |
4% 1.2% |
• Insignificant • Significant |
| Reiber[10] 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.
- ↑ Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S; et al. (1998). "1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association". CMAJ. 159 Suppl 8: S1–29. PMC 1255890. PMID 9834731.
- ↑ Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM (1998). "Preventive foot care in people with diabetes". Diabetes Care. 21 (12): 2161–77. doi:10.2337/diacare.21.12.2161. PMID 9839111.
- ↑ Rith-Najarian SJ, Stolusky T, Gohdes DM (1992). "Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria". Diabetes Care. 15 (10): 1386–9. doi:10.2337/diacare.15.10.1386. PMID 1425105.
- ↑ 5.0 5.1 5.2 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.
- ↑ 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.
- ↑ 10.0 10.1 10.2 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.
- ↑ 11.0 11.1 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.
- ↑ 12.0 12.1 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.