Differences in foot self-care and lifestyle between men and women with diabetes mellitus

Diabetic foot self-care practices and its predictors among diabetes mellitus patients in Ethiopia: systematic review and meta-analysis

OBJECTIVE

The study aims to identify self-care practices related to diabetic foot care and determine their predictors among diabetes mellitus (DM) patients in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Data were collected from PubMed/MEDLINE, ScienceDirect, Google Scholar and grey literature sources. Databases were searched from inception to August 2024.

ELIGIBILITY CRITERIA

Observational studies (including cross-sectional, case-control, cohort and survey designs) reporting diabetic foot self-care practices and their predictors among DM patients in Ethiopia. Our inclusion criteria encompassed articles published in English, and we considered studies conducted in both healthcare institutions and community settings.

DATA EXTRACTION AND SYNTHESIS

Microsoft Excel was used for data extraction and summary, while the analysis was performed with R software V.4.3.2. The overall pooled prevalence of diabetic foot self-care practices and their predictors were estimated using a random-effects model. Publication bias was assessed both graphically, using funnel plots, and statistically, with tests such as Egger's regression test. The reviewers systematically assessed potential bias in individual studies using the Newcastle-Ottawa Quality Assessment Scale, and the certainty of evidence was assessed by Grade of Recommendations Assessment, Development and Evaluation (GRADE). Subgroup analysis was carried out to minimise random variations in the estimates from the primary studies.

RESULTS

The pooled prevalence of good diabetic foot self-care practice in Ethiopia was 51% (95% CI: 41% to 61%; I²=98%, p≤0.001). Factors associated with diabetic foot self-care practices among diabetic patients included knowledge of foot care (adjusted OR (AOR)=2.42; 95% CI: 1.20, 3.62), being female (AOR=1.23; 95% CI: 1.02, 1.98) and rural residency (AOR=1.23; 95% CI: 1.02, 1.98). Both Egger's test (p=0.4430) and Begg's test (p=0.501) indicated no significant evidence of publication bias. Regarding the certainty of evidence, the overall GRADE rating is categorised as low.

CONCLUSIONS

The overall prevalence of good diabetic foot self-care practices among DM patients in Ethiopia is relatively high. Residence, sex and knowledge of foot care were identified as key predictors of effective foot self-care practices in this population. To enhance diabetic foot self-care in Ethiopia, it is crucial to strengthen education on foot care. Tailored interventions should be developed specifically for men and rural residents to improve their diabetic foot self-care practices.

The role of social role strain, psychological resources and perceiving diabetes as a priority with self-care in women with type 2 diabetes mellitus

BACKGROUND

The burden of Type 2 Diabetes Mellitus (T2DM) has increased globally and a significant number of Malaysian women are being affected by this disease. Self-care plays a vital role in improving glycemic control and preventing complications. However, women with diabetes face barriers to practising good self-care. This study aimed to determine factors associated with self-care in women with T2DM: social role strain, psychological resources (problem-focused coping and social support) and perception of diabetes as a priority.

METHODS

A cross-sectional study was conducted among women with T2DM between January and April 2023 in a public primary care clinic in Seremban, Malaysia. The study instrument consists of the Summary of Diabetes Self-care Activities (SDSCA), scale for Measuring Role Strain in Women with Diabetes, problem-focused coping from brief COPE, Multidimensional Scale of Perceived Social Support (MSPSS) and an item to assess the perception of diabetes as a priority.

RESULTS

A total of 346 women participated in the study (mean age = 60.67, SD = 10.12). Most were elderly (60.4%), Indian (48.3%), had low education (80.6%) and from lower income (70.8%). The mean score for self-care was 2.81 (SD 0.80) days, indicating a suboptimal level. Multiple linear regression analysis revealed that higher income (β = 0.82, [95% CI 0.04, 1.59], p = 0.039), problem-focused coping (β = 0.47,[95% CI 0.03, 0.06],p < 0.001), and perceiving diabetes as a priority (β = 0.04, [95% CI 0.004, 0.09], p = 0.031) were positively associated with self-care. Meanwhile, older age (β= -0.02, [95% CI -0.03, -0.01], p < 0.001), low education (β = -0.25, [95% CI -0.03, -0.01], p = 0.007) and social role strain (β = -0.02, [95% CI -0.03, -0.01], p = 0.003) were negatively associated.

CONCLUSIONS

Our findings highlighted that women with a higher social role strain, older age and low education have poor self-care. In contrast, those with higher income, utilising problem-focused coping and prioritising diabetes, exhibit better self-care. Interventions for women with T2DM should focus on assisting them to alleviate their social role strain and develop their coping skills. Additionally, involving family in the intervention would help women prioritise self-care.

A Multi-Center Prospective Study on the Healing of Neuro-Ischemic Ulcers in Singapore: A Prospective Cohort Study

Background and Aims

Neuro-ischemic ulcers (NIU) present a substantial clinical and economic burden on the healthcare systems. This study aims to evaluate their healing rate, associated healthcare resource utilization, and prognostic factors influencing healing.

Methods

Consecutive patients attended specialist clinics or admitted to wards in three tertiary hospitals for new or existing NIUs from November 2019 to November 2021 were eligible for this study. Each participant was followed up three times (1-month, 3-month and 6-month after enrollment), with ulcer healing as the primary outcome of interest. Cox regression analysis was performed to identify independent predictors of NIU healing.

Results

In total, 439 patients were recruited. Six months after they seek care in the tertiary healthcare setting, 36.0% of the participants had their ulcer fully healed. Male gender (adjusted HR: 0.71, 95% CI: 0.53-0.93), history of coronary intervention (adjusted HR: 0.62; 95% CI: 0.41-0.93), requirement of lower extremity revascularization (adjusted HR: 0.72; 95% CI: 0.54-0.98) and offloading (adjusted HR: 0.61; 95% CI: 0.46-0.81) were found to be associated with failure to heal. Ulcers located over the toes (adjusted HR: 1.64; 95% CI: 1.17-2.32) was associated with better healing. Dependent activity of daily living (adjusted HR: 0.74; 95% CI: 0.55-1.01) was also potentially a risk factor for slow healing with borderline significance.Nonhealed group of patients incurred higher requirement of revascularization (42.3% vs. 25.3%, p < 0.001), negative pressure wound therapy (40.6% vs. 29.7%, p = 0.03), off-loading (57.3% vs. 46.8%, p = 0.04) and antibiotic treatment (45.2% vs. 26.6%, p < 0.001), compared to those in the healed group.

Conclusion

NIU imposes a significant burden on both patients and the healthcare system in Singapore, with low healing rates even after 6 months of tertiary-level care. Early identification and risk stratification of high-risk patients may help improve outcomes.

A machine learning approach to predict foot care self-management in older adults with diabetes

BACKGROUND

Foot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach.

METHOD

This cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score.

RESULTS

XGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score.

CONCLUSION

The study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group.

Knowledge and Practice of Foot Care among Patients with Diabetes Attending Diabetes Center, Saudi Arabia

Background: Diabetic foot is a serious and often debilitating diabetes complication that poses a significant risk of morbidity and even mortality. However, ensuring good knowledge and good practice of appropriate foot care for patients with diabetes has been frequently neglected in diabetes management. Objectives: This study aimed to assess foot care knowledge and practice in patients with diabetes. Methods: We conducted a cross-sectional study on 400 patients with diabetes at Madinah Diabetes Center, Madinah City, Saudi Arabia, in 2023. Sociodemographic, knowledge score, practice of foot care, and diabetes-related data were collected using a valid interview structured questionnaire. The prevalence of good knowledge and practice level was calculated and compared using the studied patients' characteristics using appropriate statistical tests. Results: The prevalence of good knowledge of foot care and its practice was 35% and 27%, respectively. The knowledge level showed statistically significant differences among patients based on their age and diabetes type and duration. Patients who were >50 years (70.1%), had type 2 diabetes (89.5%), and with diabetes duration >10 years (65%) showed significantly better knowledge. Female patients (65.7%) had a higher good practice level compared with male patients (34.3%) (p < 0.001). Conclusions: This study highlights the insufficient knowledge and inadequate foot care practice among patients with diabetes in the studied population. Educational interventions and targeted strategies are necessary to improve knowledge about the importance of foot care and promote better foot care practices among patients with diabetes.

Evaluation and Management of Diabetic Neuropathy from the Perspective of People with Diabetes

Diabetic foot ulcers (DFU) and infections are the most common complications of diabetic foot disease. Mortality and financial burdens for both patients and society on the whole are caused by the prevalence of complications. Peripheral neuropathy, peripheral arterial disease, and immune response dysfunction are just a few of the main contributing factors that must be understood in order to effectively treat the condition. In order to treat diabetic foot disease, you must first get a comprehensive physical examination and a detailed history of your condition. Diabetic neuropathy and peripheral vascular disease, as well as any evidence of diabetic foot ulcers or infection, should be examined during this procedure. Patients with diabetes mellitus were studied to see if there was a link between cognitive impairment and the condition of their feet and whether or not they followed their doctor's recommendations for glycemic control. Using a random sample of diabetes patients, researchers conducted a prospective study to see how many people had the condition. The Mini-Mental State Valuation, the Trail Making Judgments, and the Michigan Screening Instrument were used to assess cognitive abilities. In the one-month follow-up, glycated hemoglobin (HB1Ac >7 %) was linked to the MMSE and medication adherence, but no link was seen between cognitive function and neuropathy. According to the results of a ROC curve investigation, HB1Ac and the MNSI score both significantly (p< 0,05) mitigate towards eventual adherence to medicine for foot problems. For the purpose of determining if DFU was associated with cognitive impairment, the Chi square valuation was used in the statistical examination. As a determinant of MMSE and MoCA scores, the researchers used linear regression to come to their conclusion. Diabetic foot issues should be managed with good blood sugar control and less acute neuropathy, and this does not seem to be linked to cognitive dysfunction. More study is required in order to personalize treatments for diseases of the central and peripheral nervous systems appropriately. Cognitive dysfunction should be taken into account by doctors and podiatrists while treating diabetic foot problems  

Development and Testing of the Foot Care Scale for Older Japanese Diabetic Patients

We aimed to develop and test the reliability and validity of a foot care self-management assessment tool for older Japanese patients with diabetes. In this cross-sectional observational study, which was carried out according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, additional items were developed and selected to reflect older Japanese patients' needs a thorough investigation with experts in diabetes and geriatrics. A total of 200 older patients with diabetes in a foot care outpatient clinic were included in the study to finalize the scale items and verify the scale's reliability and validity. A factor analysis yielded a 4-factor, 9-item scale. Factors 1 to 4 were "skin condition" (3 items), "nail clipping" (2 items), "attention to wounds" (2 items), and "relationships with others" (2 items). The Cronbach's α coefficients for the 4 factors were .852, .900, .820, and .571, respectively. The overall scale was 0.797, indicating good internal consistency. Spearman's correlation coefficients for each of the 4 factors with the scale's total score showed good stability; all correlations were significant. In Japan's super-aged society, it is important to focus on foot care practices among older adults and to promote good foot care practices among early older adults so that they can practice self-care at home. Therefore, a scale for comprehensively evaluating foot care in elderly patients with diabetes is needed. The Foot Care Scale for Older Diabetics could be useful as a tool for assessing the ability to self-manage foot care in older Japanese patients with diabetes.

The foot in diabetes - a reminder of an ever-present risk

The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management.

A Scoping Review of Footwear Worn by People With Diabetes in Low- and Middle-Income Countries: Implications for Ulcer Prevention Programs

International guidelines advise people with diabetes to wear close-toed, thick-soled footwear to protect against foot ulceration. However, this type of footwear is incompatible with some of the cultures, climates, and socioeconomic conditions in many low- and middle-income countries (LMICs). This scoping review aims to summarize what is known about footwear used by people with diabetes in LMICs and consider whether international diabetic foot guidelines are practical and actionable in these contexts, given current practices. PubMed, CINAHL, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature, and African Journals Online were searched for articles that documented the footwear used by people with diabetes in LMICs. Twenty-five studies from 13 countries were eligible for inclusion and indicated that a large proportion of people with diabetes wear footwear that is considered inappropriate by current guidance, with sandals and flip-flops being popular choices in a majority of the studies. Reasons given for these choices include poverty, lack of awareness of and provider communication about the importance of footwear selection, comfort, and cultural norms. We recommend that LMIC health care systems relying on international guidelines critically consider whether their recommendations are sensible in their settings. Diabetic foot experts and LMIC-based health care stakeholders should collaborate to design alternative guidelines, strategies, and interventions specifically for LMIC contexts to increase preventative practice feasibility and uptake.

The Weakness of the Strong Sex: Differences Between Men and Women Affected by Diabetic Foot Disease

We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m²; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P = .02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.

Sex differences in diabetic foot ulcer severity and outcome in Belgium

BACKGROUND

Sex differences are increasingly recognized to play an important role in the epidemiology, treatment and outcomes of many diseases. This study aims to describe differences between sexes in patient characteristics, ulcer severity and outcome after 6 months in individuals with a diabetic foot ulcer (DFU).

METHODS

A total of 1,771 patients with moderate to severe DFU participated in a national prospective, multicenter cohort study. Data were collected on demographics, medical history, current DFU and outcome. For data analysis, a Generalized Estimating Equation model and an adjusted Cox proportional hazards regression were used.

RESULTS

The vast majority of patients included were male (72%). Ulcers in men were deeper, more frequently displaying probe to bone, and more frequently deeply infected. Twice as many men presented with systemic infection as women. Men demonstrated a higher prevalence of previous lower limb revascularization, while women presented more frequently with renal insufficiency. Smoking was more common in men than in women. No differences in presentation delay were observed. In the Cox regression analysis, women had a 26% higher chance of healing without major amputation as a first event (hazard ratio 1.258 (95% confidence interval 1.048-1.509)).

CONCLUSIONS

Men presented with more severe DFU than women, although no increase in presentation delay was observed. Moreover, female sex was significantly associated with a higher probability of ulcer healing as a first event. Among many possible contributing factors, a worse vascular state associated with a higher rate of (previous) smoking in men stands out.

Prediction of Foot Ulcers Using Artificial Intelligence for Diabetic Patients at Cairo University Hospital, Egypt

Introduction

In Egypt, diabetic foot ulcers markedly contribute to the morbidity and mortality of diabetic patients. Accurately predicting the risk of diabetic foot ulcers could dramatically reduce the enormous burden of amputation.

Objective

The aim of this study is to design an artificial intelligence-based artificial neural network and decision tree algorithms for the prediction of diabetic foot ulcers.

Methods

A case-control study design was utilized to fulfill the aim of this study. The study was conducted at the National Institute of Diabetes and Endocrine Glands, Cairo University Hospital, Egypt. A purposive sample of 200 patients was included. The tool developed and used by the researchers was a structured interview questionnaire including three parts: Part I: demographic characteristics; Part II: medical data; and Part III: in vivo measurements. Artificial intelligence methods were used to achieve the aim of this study.

Results

The researchers used 19 significant attributes based on medical history and foot images that affect diabetic foot ulcers and then proposed two classifiers to predict the foot ulcer: a feedforward neural network and a decision tree. Finally, the researchers compared the results between the two classifiers, and the experimental results showed that the proposed artificial neural network outperformed a decision tree, achieving an accuracy of 97% in the automated prediction of diabetic foot ulcers.

Conclusion

Artificial intelligence methods can be used to predict diabetic foot ulcers with high accuracy. The proposed technique utilizes two methods to predict the foot ulcer; after evaluating the two methods, the artificial neural network showed a higher improvement in performance than the decision tree algorithm. It is recommended that diabetic outpatient clinics develop health education and follow-up programs to prevent complications from diabetes.

Differences in adherence to using removable cast walker treatment during daytime and nighttime weight-bearing activities in people with diabetes-related foot ulcers

AIMS

Patients' adherence to using knee-high offloading treatment is critical to effective healing of diabetes-related foot ulcers (DFUs). Previous studies have found that patients generally have low adherence to using removable knee-high offloading treatments, yet no study has investigated whether their adherence differs during daytime and nighttime. This study aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment during daytime and nighttime weight-bearing activities in people with DFUs.

METHODS

This was a secondary analysis of data collected from a multi-centre cross-sectional study investigating adherence to using knee-high RCWs among 57 participants with DFUs. All participants had multiple socio-demographic, physiological and psychosocial factors collected, before having their adherence to using RCWs during weight-bearing activity monitored over a 1-week period using the dual activity monitor method. Adherence data were categorised into daytime (06:00-18:00) and nighttime (18:00-06:00) periods and calculated separately. Multiple linear regression was used to identify factors associated with daytime and nighttime adherence.

RESULTS

Mean adherence to using RCW during weight-bearing activities in people with DFUs was higher during daytime compared with nighttime [39.9% (SD = 18.9) versus 20.4% (SD = 16.7), p < 0.001]. Factors independently associated with lower adherence during daytime were being male, longer diabetes duration, not having peripheral artery disease (PAD), and higher perceived RCW heaviness. Factors associated with lower adherence during nighttime were higher mean daytime steps, not having retinopathy and having dyslipidaemia.

CONCLUSIONS

Adherence to using RCWs during weight-bearing activities reduced significantly at nighttime compared with daytime among people with DFUs, and this was associated with different factors. Interventions to improve adherence, in research and clinical practice, should incorporate methods to target daytime or nighttime adherence specifically.

Complications related to diabetic foot ulcer and associated social vulnerability factors at a referral centre in Brazil

Objective:

To analyse the prevalence and associated social vulnerability factors of complications related to diabetic foot ulcer (DFU) among individuals followed up in a public care centre in Brazil.

Method:

This is a cross-sectional study carried out with individuals followed up at the diabetic foot service of the State Referral Center for Diabetes and Endocrinology Assistance (CEDEBA) between December 2019 and October 2020, during the COVID-19 pandemic. Descriptive analysis and comparison of the prevalence of complications related to DFU were carried out. The factors associated with the outcome variables were verified by hierarchical logistic regression analysis.

Results:

Among the 253 participants in this study, 30.4% had an active ulcer, 57.1% had a previous ulcer and 45.1% had an amputation. Lower limb ulcers were positively associated with male sex (prevalence ratio (PR): 1.22 (1.04–1.43)) and negatively associated with age >60 years (PR: 0.71 (0.61–0.83)), screening for diabetic foot (PR: 0.79 (0.67–0.92)) and the use of public transport to access CEDEBA (PR: 0.82 (0.71–0.96)). On the other hand, amputations were positively associated with male sex (PR: 1.61 (1.23–2.11)) and not working (PR: 3.83 (1.48–9.95)) and negatively associated with age >60 years (PR: 0.57 (0.45–0.74)) and the use of public transport to access CEDEBA (PR: 0.63 (0.49–0.81)).

Conclusion:

The prevalence of complications was higher than in previous studies, and associated with sociodemographic and clinical characteristics. Further research should be encouraged to investigate the role that determinants of health play in the course of the disease, contributing to the construction of strategies that incorporate formulations developed in the social and economic spheres to broaden the impact of health actions on the prevention of major diabetic foot complications.

Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia

OBJECTIVE

We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia.

METHODS

We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice.

RESULTS

The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice.

CONCLUSION

The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.

Intervención educativa de autocuidado en la prevención del pie diabético

Objetivo: evaluar los cambios de una intervención educativa en la prevención del pie diabético en el nivel de autocuidado de personas con diabetes mellitus tipo 2. Materiales y métodos: estudio cuantitativo, tipo antes y después, con una muestra de 79 participantes. La medición pretest incluyó la caracterización sociodemográfica y clínica de los participantes, así como su clasificación en categoría de riesgo y nivel de autocuidado. Se implementó una intervención educativa, tras lo cual se llevó a cabo la medición postest del nivel de autocuidado. Resultados: la mediana de edad de los participantes fue de 62 años y el 62 % (n = 49) de estos corresponden a personas de sexo femenino. Los participantes presentaban antecedentes como hormigueo (n = 58; 73,4 %), claudicación (n = 14; 17,7 %), falta de educación previa (n = 25; 31,6 %) y uso de calzado/medias inadecuadas (n = 21; 26,6 %). La mitad de ellos se ubicaron en categorías altas de riesgo de pie diabético. Se identificaron cambios significativos en el nivel de autocuidado en la prevención del pie diabético posterior a la intervención educativa (p = 0,0000). Conclusiones: la intervención educativa implementada mostró mejoras en el nivel de autocuidado en la prevención del pie diabético. Esta intervención abordó dimensiones emocionales, sociales, automanejo de la diabetes y cuidado pedio. Se recomienda su aplicación en poblaciones similares.

Knowledge, Attitudes, and Practices Associated With Diabetic Foot Prevention Among Rural Adults With Diabetes in North China

Background

The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China.

Method

This cross-sectional survey included 1,080 rural adults from North China, cluster sampled 12 villages and surveyed diabetic patients without diabetic foot who participated in community diabetes management. The self-administered knowledge and attitude questionnaire and the Chinese version of the Nottingham Assessment of Functional Foot-care Questionnaire were used.

Result

Of the 1,080 subjects, 51.6% received moderate knowledge scores, 63.9% had a positive attitude and 71.4% received poor practice scores. In terms of knowledge, parameters of knowledge about foot examinations and treatment of foot problems showed the lowest scores. In terms of practice, in line with the results of the low knowledge score, parameters of the pursuit of medical treatment for foot problems and routine foot examinations were associated with the lowest scores. Multiple regression analysis revealed that participants who were current smokers (β: -0.049, 95% CI: -0.088 to -0.011) had lower knowledge scores than those who never smoke; participants who were current smokers (β: -0.818, 95% CI: -1.067 to -0.569) and past smokers (β: -0.299, 95% CI: -0.485 to -0.112) had lower attitude scores than those who had never smoked; participants who had higher knowledge scores (β: 1.964, 95% CI: 1.572-2.356) achieved higher scores on attitudes; women had better practice scores than men (β: 0.180, 95% CI: 0.122-0.239); patients with a long diabetes duration (6-10 years) had better practice scores than those who had a short diabetes duration (<2 years; β: 0.072, 95% CI: 0.012-0.131). Knowledge (β: 0.130, 95% CI: 0.001-0.258) and attitudes (β: 0.268, 95% CI: 0.249-0.287) were significantly associated with good practices.

Conclusions

Increasing knowledge regarding diabetic foot would help instill positive attitudes and cultivate better practices toward diabetic foot prevention. The results of this study may help guide future promotional resources to those groups most in need, which may help lower the incidence of diabetic foot among adults in North China.

Preventive foot self-care practice and associated factors among diabetic patients attending the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia, 2021

BACKGROUND

Diabetes mellitus is emerging as a major worldwide health problem that has a social, financial, and developmental impact on developing countries. Foot complications are among the most serious and costly complications of diabetes which lead to lower extremity amputation due to diabetic foot ulcers. Poor diabetic foot self-care practice is identified by different studies as a major contributing factor to diabetic foot ulcers. Therefore, this study was intended to assess foot self-care practice and associated factors among diabetic patients attending the University of Gondar comprehensive specialized referral hospital.

METHODS

A hospital-based cross-sectional study was conducted from July 1 to August 30, 2021, at the University of Gondar comprehensive specialized referral hospital. A systematic random sampling technique was employed to select 384 diabetic patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data was entered in epi-info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model. P-value < 0.05 and an odds ratio with a 95% confidence interval were used to determine the significance and strength of the association.

RESULTS

Of the 384 diabetic patients, 46.4% (95% CI (41.1%-51.6%)) of them had poor foot self-care practice. Being male [AOR = 0.54, 95% CI (0.32, 0.89)], couldn't read and write and completed primary education [AOR = 2.35, 95% CI (1.01, 5.43)] & [AOR = 2.92, 95% CI (1.39, 6.12)], living in rural area [AOR = 3.84, 95% CI (1.91, 7.75)], having diabetic complications [AOR = 2.19, 95% CI (1.07, 4.46)], taking both injection and pills [AOR = 0.33, 95% CI (0.12, 0.88)], having previous information about foot care [AOR = 0.12, 95% CI (0.06, 0.24)], and family support [AOR = 0.57, 95% CI (0.34, 0.94)] were determinants of poor foot self-care practice.

CONCLUSION

The adherence of diabetic patients toward foot self-care practice was poor. Being male, having low educational status, living in a rural area, having diabetic-related complications, taking both injections and pills, not having previous information about foot care, and having poor family support increases the odds of having poor foot self-care practice. Giving health education to patients and their caregivers about the basic principles of diabetes foot care, like regular inspection of feet and appropriate footwear at their regular follow-up time, should be emphasized.

[Use of information and communication technologies to promote self-management of diabetic foot ulcersUso de tecnologías de informado e comunicado para promover o autogerenciamento das úlceras do pé diabético]

Introduction

Using information and communication technologies in nursing educational interventions facilitates self-management processes to adapt to chronic health conditions.

Objective

To evaluate the effect of a nursing educational intervention to promote self-management and prevent diabetic foot ulcers in Colombian adults with type 2 diabetes mellitus through information and communication technologies.

Materials and Methods

A quasi-experimental, pre- and post-intervention study was conducted with 82 adults attending the chronic patient consultation of a second-level hospital in the department of Boyacá, Colombia. Participants were randomly allocated to the experimental and comparison groups.

Results

There were no significant differences between the experimental and the comparison groups in terms of preintervention self-management scores. However, the experimental group's mean self-management score was significantly higher than the control group's six weeks after the intervention (p<0.005); the primary outcome was self-management behaviors from foot care. Nonparametric Wilcoxon and Mann Whitney tests were used.

Discussion

nursing interventions should be supported by theoretical approaches specific to the discipline, which allow visualizing specific results, in this case self-management, which requires strategies such as knowledge, skills and social support that will support adaptation to situations of chronic illness.

Conclusions

The educational intervention based on the use of information and communication technologies improved self-management for preventing diabetic foot injuries, achieving a change in people's behavior.

Factors associated with adherence to using removable cast walker treatment among patients with diabetes-related foot ulcers

INTRODUCTION

Adherence to using knee-high offloading treatment is critical for healing diabetes-related foot ulcers (DFUs). However, few studies have investigated patients' adherence to using knee-high offloading treatment. We aimed to investigate the levels and factors associated with adherence to using knee-high removable cast walker (RCW) treatment among patients with DFUs.

RESEARCH DESIGN AND METHODS

In this multicenter cross-sectional study, we investigated adherence to using knee-high RCWs in 57 participants with DFUs. All participants were clinically examined for multiple sociodemographic, physiological, and psychosocial factors. Each participant's adherence level to using RCWs was then objectively measured using dual activity monitors (attached to the wrist and RCW) over a 1-week period. Multiple linear regression was undertaken to determine those factors independently associated with adherence levels.

RESULTS

The mean adherence level to using RCWs was 33.6% (SD 16.5) of weight-bearing activity. Factors independently associated with lower adherence levels were being male, longer diabetes duration, not having peripheral artery disease (PAD), and having higher perceived RCW heaviness (p≤0.05). No associations were found with psychosocial factors.

CONCLUSIONS

Patients with DFUs adhered to using their RCWs on average for only a third of their prescribed weight-bearing treatment duration. Factors linked to lower RCW adherence levels were being male, longer diabetes duration, not having PAD, and perceived heavier RCWs. These findings highlight the importance of using gold standard non-removable knee-high offloading device treatment. Furthermore, these findings suggest, when gold standard devices are containdicated, that these factors be considered when prescribing the second choice RCW offloading treatment to optimise adherence. Regardless, further longitudinal studies are needed to confirm these factors.

Production and validation of the short film Pés que te quero®: educational technology for people with diabetes

ABSTRACT Objective: To describe the production and validation of short film type educational technology for the prevention of diabetic foot ulcers. Methods: A methodological study focused on the validation of a short film. The construction of the film was carried out in three stages: pre-production, production, and post-production. Thirty-seven evaluators undertook the internal validation, divided into two groups of 31 proficient nurses and six from the communication area. Fifteen people with diabetes mellitus performed the external validation. Result: The nursing proficient validated the script with a total content validity index of 0.95, with internal reliability of 0.849 conferred by Cronbach’s Alpha. Communication specialists validated with a content validity index of 0.97; and target audience with 0.95 (clarity) and 0.97 (relevance). Conclusion: The study showed that the short film is a valid and reliable educational technology to promote foot care to people with diabetes mellitus.

Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito

Background

The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation.

Objectives

To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia.

Methods

This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected).

Results

58% of the sample did not know the term “diabetic foot”, but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex.

Conclusions

Interviewed patients with DM did not perform all foot self-care activities and did not know what the term “diabetic foot” means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Production and validation of the short film Pés que te quero®: educational technology for people with diabetes

ABSTRACT Objective: To describe the production and validation of short film type educational technology for the prevention of diabetic foot ulcers. Methods: A methodological study focused on the validation of a short film. The construction of the film was carried out in three stages: pre-production, production, and post-production. Thirty-seven evaluators undertook the internal validation, divided into two groups of 31 proficient nurses and six from the communication area. Fifteen people with diabetes mellitus performed the external validation. Result: The nursing proficient validated the script with a total content validity index of 0.95, with internal reliability of 0.849 conferred by Cronbach’s Alpha. Communication specialists validated with a content validity index of 0.97; and target audience with 0.95 (clarity) and 0.97 (relevance). Conclusion: The study showed that the short film is a valid and reliable educational technology to promote foot care to people with diabetes mellitus.

Predictors of Foot Ulcers Among Diabetic Patients at a Tertiary Care Center, Egypt

BACKGROUND AND PURPOSE

Diabetic foot ulcers (DFUs) markedly contribute to morbidity and mortality of diabetic patients. Hence, this study was conducted to investigate the predictors of foot ulcers among Egyptian diabetic patients.

METHODS

A case-control study was conducted among 488 diabetic patients attending the inpatient departments and outpatient clinics at the National Diabetes Institute in Egypt. A pretested data collection sheet was designed to collect and record the following: socio-demographic data, diabetic history and lifestyle characteristics, recorded comorbidities, and the results of foot examination.

RESULTS

Significant positive predictors of DFUs on multivariate logistic regression analysis included presence of three or more comorbidities; two or more diabetic complications; callus; and flatfoot. Significant protective (negative) predictors were management of diabetes by diet, oral hypoglycemic drugs (OHGs), and insulin; and intact vibration sense.

CONCLUSION

Significant positive predictors of DFUs on multivariate analysis were presence of three or more comorbidities, two or more diabetic complications, callus and flatfoot, while protective predictors were management of diabetes by diet, OHGs, and insulin; and intact vibration sense. Hence, close monitoring should be provided to diabetic patients with comorbidities and complications to reduce the risk of DFUs.

Dietary habits among men and women in West Greenland: follow-up on the ACCEPT birth cohort

BACKGROUND

In the past decades, the diet in Greenland has been in transition resulting in a lower intake of traditional food and a higher intake of imported western food. This diet transition can affect public health negatively, and thus, continued monitoring of dietary habits is important. The present study aimed to follow up on the dietary habits of pregnant women included in the Greenlandic ACCEPT birth cohort (2013-2015) and the children's father.

METHODS

The follow-up food intake was assessed in 2019-2020 using food frequency questionnaires for 101 mothers and 76 fathers aged 24-55 years living in Nuuk, Sisimiut, and Ilulissat. Non-parametric statistical methods were used (Mann-Whitney U test/Spearman correlation) to assess the dietary pattern and influencing factors.

RESULTS

The proportion of traditional and imported food was 14 and 86%, respectively. Intake frequency differed by gender (vegetables, fruits, fast food), the living town (terrestrial animals, vegetables, fruits), and age (fish, meat products, fruits, fast food). Socioeconomic and lifestyle factors significantly correlated with the intake frequency of several traditional and imported foods. Few changes in the mother's dietary habits from inclusion (during pregnancy) to follow-up (3-5 years later) were found, showing less frequent intake of seabirds and fruits and more frequent meat intake.

CONCLUSION

We identified several factors that could affect dietary habits, and the results may be used to target future food recommendation for relevant population groups.

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006-2019

BACKGROUND

There is conflicting evidence whether limb amputation (LA) disproportionately affects indigenous populations. To better understand this disparity, we compared the LA incidence rate between First Nations persons registered under the Indian Act of Canada (RI) and the general population (GP) in Saskatchewan.

METHODS

We used Saskatchewan's retrospective administrative data containing hospital discharge LA cases, demographic characteristics (age and sex), and residents population reported in the database stratified by RI and GP from 2006-2019. The LA cases for each stratified group were first disaggregated into three broad categories: overall LA (all reported LA), primary LA (first reported LA), and subsequent LA (revision or contralateral LA), with each category further split into the level of amputation defined as major amputation (through/above the ankle/wrist joint) and minor amputation (below the ankle/wrist joint). LA rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial regressions were performed to explore the trends further.

RESULTS

Overall, there were 1347 RI and 4520 GP LA cases reported in Saskatchewan from 2006-2019. Primary LA made up approximately 64.5% (869) of RI and 74.5% (3369) of GP cases, while subsequent LA constituted 35.5% (478) of RI and 25.5% (1151) of GP cases. The average age-adjusted LA rate was 153.9 ± 17.3 per 100,000 in the RI cohort and 31.1 ± 2.3 per 100,000 in the GP cohort. Overall and primary LA rates for the GP Group declined 0.7% and 1.0%, while subsequent LA increased 0.1%. An increased LA rate for all categories (overall 4.9%, primary 5.1%, and subsequent 4.6%) was identified in the RI group. Overall, minor and major LA increased by 6.2% and 3.3%, respectively, in the RI group compared to a 0.8% rise in minor LA and a 6.3% decline in major LA in the GP group. RI females and males were 1.98-1.66 times higher risk of LA than their GP counterparts likewise, RI aged 0-49 years and 50+ years were 2.04-5.33 times higher risk of LA than their GP cohort. Diabetes mellitus (DM) was the most prevalent amputation predisposing factor in both groups with 81.5% of RI and 54.1% of GP diagnosed with DM. Also, the highest proportion of LA was found in the lowest income quintile for both groups (68.7% for RI and 45.3% for GP).

CONCLUSION

Saskatchewan's indigenous individuals, specifically First Nations persons registered under the Indian Act of Canada, experience LA at a higher rate than the general population. This disparity exists for all variables examined, including overall, primary, and subsequent LA rates, level of amputation, sex, and age. Amplification of the disparities will continue if the rates of change maintain their current trajectories. These results underscore the need for a better understanding of underlying causes to develop a targeted intervention in these groups.

Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review

Background

Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.

Methods

PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.

Results

Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.

Conclusion

Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

Aim: Diabetic foot syndrome (DFS) is a complication of diabetes in which the presence of infections, ulceration and/or destruction of deep tissue associated with neuropathy, peripheral atherosclerosis and comorbidity affect the prognosis, the need for limb amputation and quality of life. Purpose of the present study is to report the features of patients with acute DFS admitted to our Diabetic Foot Unit tertiary Center in 2019. Methods: In all patients admitted, the approach was performed through a multidisciplinary team (Diabetic Foot Care Team) and described in a specific diagnostic-therapeutic-assistance program. Criteria of inclusion were presence of sepsis and/or suspected osteomyelitis and/or critical limb ischemia. Clinical features and interventions performed were registered. Primary endpoints were mortality and amputation (major, minor). Secondary endpoints were length of hospitalization, type of revascularization and duration of antibiotic therapy. Results: Among 75 consecutive patients (mean age 70.9 years) enrolled, prevalence of acute DFS was higher among men (M/F 3:1). Poor glycemic control [mean hemoglobin A1c (HbA1c) 67.9 ± 22.3 mmol/mol], long duration of diabetes (mean 19 ± 16.3 years), high low-density lipoprotein-cholesterol (mean 89.5 ± 45.1 mg/ dL) and obesity (mean Body Mass Index 30.2 ± 7.6 kg/m2) were common. Diabetes-related complications as peripheral arterial disease (PAD) (76%), ischemic heart disease (48%), retinopathy (40.5%), hepatic steatosis (50%), heart failure (17.8%) were present. During hospitalization, 21 subjects (28.4%) underwent lower limb amputations (overall rate of major amputation 4%), and 41.3% underwent percutaneous angioplasty. Long period of hospitalization (18.4 ± 7.9 days) and prolonged antibiotic therapy (23.9 ± 15.9 days) were observed. Major amputation was associated with C-reactive protein > 6.5 mg/dL (P = 0.03), osteomyelitis (P = 0.001), prior insulin therapy (P = 0.015). Conclusions: Male sex, co-morbidity, PAD, systemic inflammation and poor glycemic control are major features of acute hospitalized DFS. An approach through a multidisciplinary team is recommended in order to treat vascular and extra-vascular complications aimed at reducing mortality and at improving quality of life.

Association between the handgrip strength and the isokinetic muscle function of the elbow and the knee in asymptomatic adults

Background:

The handgrip strength is a practical, valid, reliable, low-cost tool that presents strong correlations with several health conditions. However, handgrip strength may be inaccurate to prospectively predict the variability of muscular function since the decrease in muscular strength over the years varies according to a muscular group or between upper and lower limbs. Our hypothesis is that the handgrip strength cannot explain the variance of muscle function prospectively.

Purpose:

The aim of this study was to evaluate the cross-sectional and prospective association between handgrip strength and isokinetic muscle function of the knee and elbow in 780 asymptomatic adults.

Methods:

In a sample of 780 adults, we obtained handgrip strength and elbow and knee muscle function (for both flexion and extension at 60°/s and 300°/s) using, respectively, a hydraulic dynamometer and an isokinetic dynamometer. In a cross-sectional analysis, we analyzed the data obtained from baseline assessment. Then, we calculated the absolute change as a result of the variation data between the baseline and the 1-year follow-up assessment of each participant. The correlations were analyzed using Pearson or Spearman coefficients. We used multivariate models to investigate the association between handgrip strength and isokinetic muscle function.

Results and Discussion:

The cross-sectional correlations were significantly moderate-to-strong (r = 0.41–0.71, p < 0.01), but became weak-to-moderate (r = 0.26–0.34, p < 0.01) prospectively. In the cross-sectional analysis, the handgrip strength was selected as a strong predictor for isokinetic variables (∆R² = 0.171–0.583, p < 0.05) as expected. Although handgrip strength was also selected as a significant predictor in prospective analysis, it explained only a little variance in isokinetic muscle function of the knee (∆R² = 0.7–0.117, p < 0.05). Regarding the predictive models for the elbow, handgrip strength was not selected prospectively.

Conclusion:

The 1-year absolute change of the handgrip strength cannot explain the variance of the isokinetic muscle function. Thus, specific measures are required for assessing muscle function in epidemiological studies.

Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams

Diabetic foot ulcers (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. As the global incidence of diabetes has increased, along with the lifespan of the diabetic patient, the worldwide burden of DFUs has grown steadily. Outcomes in diabetes and DFUs are known to depend strongly on social determinants of health, with worse outcomes noted in minority and socioeconomically disadvantaged populations. Effective treatment of DFUs is complex, requiring considerable expenditure of resources and significant cost to the health care system. Comprehensive care models with multidisciplinary teams have proven effective in the treatment of DFUs by decreasing barriers to care and increasing access to the multiple specialists required to provide timely and effective DFU procedural intervention, surveillance, and preventative care. Vascular surgeons are an integral part throughout the cycle of care for DFUs and should be involved early in the course of such patients to maximize their contributions to a multidisciplinary care model.

Knowledge and Practice on Diabetic Foot Self-Care and Associated Factors Among Diabetic Patients at Dessie Referral Hospital, Northeast Ethiopia: Mixed Method

INTRODUCTION

Diabetic foot ulcer is a serious and disabling complication of diabetes mellitus that consists of lesions in the deep tissues resulting in lower extremity amputations. The incidence of diabetic foot ulcers has increased due to an increased prevalence of diabetes mellitus. This study assessed the knowledge and practice of diabetic foot self-care among diabetic patients attending Dessie referral hospital.

METHODS

A facility-based explanatory sequential mixed method was used from April 03/2019 to May 09/2019. The quantitative method employed an institutional-based cross-sectional study design using a structured questionnaire. A simple random sampling technique was employed to select the study participants. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Then, a phenomenological study was employed among key informants and content analysis was performed.

RESULTS

Sixty-eight (19.8%) of patients with diabetes developed complication, among them 97 (28%) had foot ulcer. Nearly two-third (217 (61.3%): 95% CI (57.6-68.3%)) and 134 (39%; 95% CI:34.3-45.1%) of patients with diabetes had good knowledge and practice on diabetic foot self-care, respectively. Diabetic nephropathy ((AOR): 0.03, 95% CI (0.00-0.27)) was associated with knowledge on foot self-care. Practice of foot self-care was associated with female ((AOR: 2.07, 95% CI (1.04-4.12)), age 21-30 ((AOR: 6.42, 95% CI (1.54-26.8)), 31-40 years ((AOR: 7.4, 95% CI (1.42-39.05)), 41-50 years ((AOR: 8.4, 95% CI (1.4-50.6)), single ((AOR: 0.35, 95% CI (0.150-0.81)), living in rural ((AOR: 0.31, 95% CI (0.18-0.545)) and no comorbidity ((AOR: 0.406, 95% CI (0.18-0.88)). Key informants were not compliant, confused and negligent to foot self-care.

CONCLUSION

Nearly two-third and more than one-third of patients with diabetes had good knowledge and practice on diabetic foot self-care, respectively. Patients lack proper knowledge regarding self-care and how it is practiced. Patient education and proper management of diabetic foot ulcers are recommended to reduce, delay, or prevent complications.

Age- and sex-specific incidence of non-traumatic lower limb amputation in patients with type 2 diabetes mellitus in a U.S. claims database

AIM

To estimate age- and sex-specific incidence rates (IRs) of non-traumatic lower limb amputations (LLA) in patients with type 2 diabetes mellitus (T2DM) using a claims database from the United States (US).

METHODS

Patients with T2DM 18 years and older were identified using the Truven Health MarketScan database from January 1, 2007 to September 30, 2018. The overall and age- and sex-specific IRs of all non-traumatic LLA, minor LLA (amputation at or below the ankle), and major LLA (amputation above ankle) were calculated.

RESULTS

Among the 6,117,981 patients with T2DM, 14,627 LLA events occurred (minor LLA; 72.8%; major LLA: 27.2%). The IRs (95% CI) of all LLA, minor LLA, and major LLA per 1000 person-years or PY were 0.86 (0.85, 0.88), 0.63 (0.62, 0.64), and 0.23 (0.23, 0.24), respectively. The IR (95% CI) of all LLA per 1000 PY in males was higher compared to females [1.24 (1.22, 1.26) vs. 0.46 (0.45, 0.48)]. The incidence of all LLA increased with an increasing age (highest IR in age-group of ≥80 years).

CONCLUSIONS

This study identified males and older patients with T2DM at higher risk of developing LLA in the US, warranting further exploration of risk factors of LLA in these subgroups.

Cómo perciben los hombres tener diabetes mellitus tipo 2: casos en Bogotá

Introducción: La diabetes mellitus es una enfermedad crónica que se percibe y se maneja de distintas maneras según las concepciones que cada persona tiene y que pueden ser diferentes según el género. Objetivo: Describir la percepción de estar enfermo de los hombres con diabetes mellitus tipo 2 en población colombiana. Método: Estudio cualitativo-descriptivo con análisis de contenido basado en una categorización de tipo inductivo. Se incluyeron 6 participantes que cumplieron con los criterios de inclusión de ser hombres mayores de 30 años con diagnóstico de diabetes mellitus tipo 2 y con una duración de la enfermedad de al menos un año, durante 2016. Se realizaron entrevistas semiestructuradas sobre su proceso y percepción de la enfermedad en su vida, las cuales se analizaron y codificaron por medio del programa Atlas.ti. Resultados: Las 7 categorías obtenidas dan cuenta de la percepción de los hombres respecto a la enfermedad en la que asocian la salud con ausencia de síntomas y dolor, poder entender lo que era tener diabetes implicó un proceso de afrontamiento y adaptación en el que buscaron darle sentido a la diabetes a través conocer qué es la enfermedad y cómo incorporarla a la vida cotidiana Conclusión: La vivencia de la diabetes en los hombres adultos mayores colombianos representa las dificultades para aceptar el diagnóstico, comprometerse con comportamientos de autocuidado adecuados para el control de la diabetes y reconocer y buscar ayuda asistencial cuando la requieren por complicaciones de la enfermedad.

Diabetic foot care: knowledge and practice

BACKGROUND

Diabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs.

METHODS

The current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18.

RESULTS

The mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score.

CONCLUSIONS

According to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes.

Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study

OBJECTIVE

To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.

PRIMARY AND SECONDARY OUTCOME MEASURES

Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.

RESULTS

Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.

CONCLUSION

A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Hombres con diabetes mellitus tipo 2: autoeficacia y factores psicológicos que influyen en el autocuidado

Introducción: La prevalencia global de diabetes mellitus tipo 2 (DMT2) en los hombres es alta. Para el tratamiento de la enfermedad el hombre debe realizar acciones de autocuidado, por lo que es importante conocer factores relacionados con su cumplimiento. Objetivo: Identificar la relación entre variables demográficas, clínicas, la angustia, la depresión, la autoeficacia y su influencia sobre el autocuidado en hombres con DMT2. Métodos: Estudio transversal y correlacional, en una muestra de 96 hombres con DMT2, usuarios de 13 centros de salud. Los instrumentos utilizados fueron el cuestionario de acciones de cuidado en diabetes, la escala Self-Efficacy for Diabetes, la escala depresión (CES-D) y la escala angustia por diabetes (DDS). Resultados: El autocuidado se correlacionó de manera positiva con la autoeficacia y negativamente con la angustia por diabetes. Las variables que explicaron el autocuidado con el 47.7% de varianza fueron: la autoeficacia (β = .39), el consumo de alcohol (β = -.29), las horas sentado/parado (β= -.27), el tiempo de diagnóstico (β= -.22) y la edad (β =.18). Discusión: Los hombres tuvieron un bajo autocuidado y mantienen conductas de riesgo, lo cual puede atribuirse a sus creencias, estilo de vida o al tipo de trabajo que desempeñan. Conclusiones: Los resultados ofrecen evidencia sobre factores que influyen en el autocuidado de hombres con DMT2, que pueden orientar a los profesionales de enfermería en la atención del paciente. Se sugiere realizar investigaciones de enfermería en hombres, que contribuyan a mejorar la autoeficacia y el autocuidado.

Association between knowledge and adherence to foot self-care practices performed by diabetics

ABSTRACT Objectives: to verify the association between knowledge and adherence to foot self-care practices performed by patients with diabetes mellitus type 2. Methods: cross-sectional, descriptive study carried out with 197 patients in basic health units located in the Northeast region of Brazil. For data collection, we used a semi-structured questionnaire that addressed issues inherent to knowledge and Diabetes Self-Care Activities. Results: we observed that patients with moderate knowledge about self-care practices were more likely to perform foot self-examination, dry the interdigital spaces, moisturize their feet with creams and oils, observe the presence of mycosis and ingrown toenail when compared to patients with insufficient knowledge. Conclusions: the patients' level of knowledge was closely related to the self-care activities carried out, which reinforces the importance of nurses working on training those on essential health care.

Altered touch perception and associated risk factors in individuals with diabetes mellitus

ABSTRACT Objective: To evaluate the prevalence of altered touch perception in the feet of individuals with diabetes mellitus and the associated risk factors. Method: Cross-sectional study with 224 individuals with diabetes mellitus conducted in an endocrinology clinic at a public hospital in Campina Grande, Paraíba. The evaluation used touch sensitivity and perception, and a descriptive and multivariate analysis with Poisson regression was performed. Results: We found the prevalence of altered touch perception to be 53.1%. The risk factors that had a significant and joint impact on its occurrence were: female gender; previous ulcer; diabetes mellitus type 2; burning sensation, cracks, fissures, calluses, and Charcot foot. Conclusions: This study found a high prevalence of altered perception of touch, and this should support the planning of actions aimed at preventing the problem. The study showed the relevance of the phenomenon as a nursing diagnosis that could be included in NANDA-International.

Perspectiva de jovens com diabetes sobre intervenção educativa na rede social Facebook®

Resumo Objetivo Apreender a perspectiva de jovens com diabetes mellitus sobre a participação em um grupo de estimulo ao autocuidado na rede social Facebook®. Métodos Estudo descritivo e exploratório, junto a 35 jovens com diabetes mellitus tipo 1 que participaram de um grupo no Facebook®. Os dados foram coletados por meio de entrevista semi-esturuada e após submetidos à análise de conteúdo, modalidade temática. Resultados Foram identificadas três categorias: assistência convencional oferecida aos jovens com diabetes mellitus; vantagens da utilização do Facebook® para inovação da assistência à saúde, e espírito de comunidade e fortalecimento a partir do Facebook®, as quais mostram que, na perspectiva de jovens com diabetes, a participação no grupo favoreceu o desenvolvimento do espírito de comunidade e o fortalecimento de vínculo entre os pares, além de auxiliar no processo de aceitação da doença e na formação de uma rede de suporte. Além disso, observou-se avaliação positiva sobre a participação, uma vez que os jovens manifestaram o desejo de que outros grupos com características semelhantes fossem implementados. Conclusão Ações educativas na rede social Facebook® são bem aceitas por jovens e pode constituir uma estratégia importante para aproximá-los dos serviços de saúde e auxiliá-los nas ações de autocuidado.

Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes

AIMS

To develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy.

METHODS

The development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI).

RESULTS

Among specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%.

CONCLUSION

This free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.

Intervención educativa de enfermería para el autocuidado de los pies en personas que viven con diabetes tipo 2

Objetivo: probar una intervención educativa con fundamento en la teoría de autocuidado, con aplicación pedagógica de la educación dialógica para el autocuidado de los pies. Materiales y métodos: estudio cuantitativo de diseño cuasiexperimental de preprueba y posprueba. El grupo experimental estuvo conformado por 40 personas y el grupo de comparación por 32. La variable de autocuidado de los pies se midió a través de dos instrumentos, “Autocuidados para prevenir el pie diabético” y “Autocuidados del pie diabético”, este último elaborado por investigadores de la Universidad de Málaga. Resultados: en la preprueba, el 35 % de las personas del grupo experimental presentó un nivel bajo de autocuidado, el 28 % medio y el 37 % alto. Después de la intervención se observó un incremento estadísticamente significativo (p = 0,000) en el autocuidado; en cambio, el grupo de comparación mantuvo casi los mismos porcentajes, sin encontrarse diferencias significativas. Conclusiones: los resultados sugieren que una intervención educativa con fundamento teórico influye en la mejora del autocuidado de los pies de las personas que viven con diabetes, donde enfermería cumple un papel fundamental para su desarrollo.

Factors related to self-care activities of patients with type 2 diabetes mellitus

Abstract Objective: To verify self-care activities of patients with type 2 diabetes mellitus and to analyze the relationship with sociodemographic and clinical variables. Method: A cross-sectional study was performed of 149 people using the Diabetes Self-Care Activities Questionnaire. Results: Of the 15 self-care activities analyzed, appropriate behavior was observed for aspects related to medication use and inadequate for fruit/vegetable consumption, blood sugar testing and physical exercise. The correct use of medications was correlated to marital status. Regarding inadequate behaviors, there were associations of fruit/vegetable consumption with skin color and place of residence and blood sugar testing with marital status and inverse correlations of physical exercise with systolic blood pressure, pulse pressure, waist circumference and postprandial glycemia. Conclusion: The results of this research contribute by strengthening the line of care in chronic diseases and assist in divulging the importance of supported self-care. Implications for practice: The findings of this research provided information relevant to the planning of care.

Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study

OBJECTIVES

The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics.

DESIGN

Descriptive multicentre prevalence study.

SETTING AND PARTICIPANTS

The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included.

RESULTS

In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics.

CONCLUSION

Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector.

TRIAL REGISTRATION NUMBER

This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons: A cross-sectional trial

AIMS

This trial aims to identify differences between genders in relation to factors associated with the risk of diabetic foot in elderly persons.

METHODS

We evaluated 187 older adults diagnosed with diabetes type 2. The variables investigated were sociodemographic data, clinical history of diabetes mellitus and complaints about the feet. The plantar sensitivity was evaluated on both feet, with the use of Semmes-Weinstein monofilaments. For data analysis we used chi-square test and binary logistic regression (p < 0.05; 95% CI).

RESULTS

We included 174 elderly people who had no history of stroke and peripheral vascular disease. Most (58.6%) were female and among them the risk factors for diabetic foot were older age (p < 0.021; OR 6.0), presence of calluses (p < 0.046; OR 2.83) and claw toes (p < 0.041; OR 3.18). And among men, the risk factors for diabetic foot were insulin use (p < 0.008; OR 5.22), presence of sensory comorbidities (p < 0.007; OR 5.0), ulcers (p < 0.001), numbness (p < 0.002; OR 6.6) and stiffness in the feet (p < 0.009; OR 5.44).

CONCLUSION

The factors associated with the development of diabetic foot were presented differently in women and men, so a targeted and more specific preventive approach is required.