Relaxation intervention to improve diabetic foot ulcer healing: Results from a pilot randomized controlled study

The impact of cold application on pain and comfort during the process of diabetic foot care

BACKGROUND AND AIM

Given the significance of pain management in the context of diabetic foot ulcer (DFU) care, particularly in terms of ensuring patient adherence to treatment regimens, this study was undertaken to ascertain the impact of cold washing on pain and comfort levels during diabetic foot care.

METHODS

A single-blind randomized controlled trial was conducted in the chronic wound care clinic of a teaching and research hospital in the southeastern region of Turkey. The sample consisted of 68 patients, with 34 assigned to the cold application group and 34 assigned to the control group. Pain and comfort levels were recorded at baseline, and during and after the application of a 0.9% NaCl solution (cold or warm) during DFU care.

RESULTS

A comparison of the Cold Application group with the control group revealed a statistically significant reduction in post-intervention pain scores (p = 0.000) and a statistically significant increase in comfort scores (p = 0.000) over time.

CONCLUSION

It can be posited that cold washing represents an efficacious intervention in the management of pain and discomfort associated with diabetic foot care.

The prevalence of depression among patients with diabetic foot ulcers at King Khalid University Hospital, Riyadh, Saudi Arabia

Background and Aim

The prevalence rates of depression and anxiety among diabetic patients with diabetic foot ulcers (DFU) vary from one study to the other. We aimed to determine the prevalence of depression and the associated risk factors among patients with DFU.

Methods

We conducted a cross-sectional study using a self-reported questionnaire on adult patients aged 18 years old and above with DFU at our institution. We used the 9-item Patient Health Questionnaire to evaluate the presence of depressive symptoms.

Results

A total of 75 patients, 56 (74.7%) males and 19 (25.3%) females, participated in the study; 33 (44.0%) were more than 60 years old. The prevalence of moderate to severe depression among our patients was 35 (46.7%). Patients who had DFU for more than 1 year had a higher proportion of moderate to severe depression (P = 0.032). There were no significant differences in the proportion of patients who had depression according to age groups (P = 0.456), gender (P = 0.095), level of education (P = 0.145), employment (P = 0.514), type of diabetes (P = 0.561), duration of diabetes (P = 0.704), level of HbA1c (P = 0.525), smoking history (P = 0.163), and previous history of DFU (P = 0.713). Logistic regression analysis showed that patients who had DFU for more than 1 year were three times more at risk to have moderate to severe depression (P = 0.049).

Conclusion

Patients with DFU have a high frequency of moderate to severe depression regardless of age, gender, or other sociodemographic characteristics, with patients with long-standing DFU having triple the risk of depression as those with freshly diagnosed DFU. Diabetic persons should be thoroughly assessed to reduce the diabetes result, and preventative actions and patient education about DFU are crucial.

Non-pharmacological interventions to improve cardiovascular risk factors in people with diabetic foot disease: A systematic review and meta-analysis

Cardiovascular disease (CVD) risk in those with diabetic foot disease is very high. Non-pharmacological interventions may improve this risk, though no previous evidence synthesis has been completed. This systematic review aimed to investigate the impact of non-pharmacological interventions on CVD risk factors in diabetic ulcer disease. Multiple databases and trials registers were searched from inception to December 6th 2023. We included reports of randomised controlled trials investigating the impact of non-pharmacological interventions on cardiovascular risk in those with type 1 or type 2 diabetes and current or previous diabetic foot disease. Twenty studies were included. Extracted data included: study design and setting; participant sociodemographic factors; and change in cardiovascular risk factors. Data were synthesised using random effects meta-analyses and narrative syntheses. Interventions included nutritional supplementation, collaborative care, hyperbaric oxygen therapy, patient education, nurse-led intervention, self-management, family support, relaxation and exercise, over a median duration of 12 weeks. Significant post-intervention changes were observed in fasting plasma glucose, serum insulin levels, insulin sensitivity and resistance, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol and C-reactive protein. No effects were detected in very low- or high-density lipoprotein-cholesterol or body mass index. Non-pharmacological interventions show promise in improving CVD risk in diabetic foot disease.