The effect of operative groups on diabetic foot self-care education: a randomized clinical trial

Effect of group-based nutritional education combined with individual standard care for outpatients with type 2 diabetes: study protocol for a randomized clinical trial {1}

BACKGROUND

Diabetes remains a significant contributor to global morbidity and mortality in the twenty-first century. Lifestyle modification strategies are widely recommended for effective diabetes management. Research suggests that a person-centered approach, implemented in either group or individual settings, offers considerable potential for improving long-term disease outcomes. Nutritional counseling using the operative group model has been tested and shown to yield positive health outcomes across diverse populations affected by diabetes. This study aims to evaluate the impact of group-based nutritional education, combined with individual standard care, compared to individual standard care alone, on health outcomes among patients diagnosed with type 2 diabetes.

METHODS

This study is a 12-month, parallel-group, randomized superiority controlled trial. Individuals diagnosed with type 2 diabetes will be randomized in a 1:1 ratio into one of two treatment arms: (1) individual usual care alone or (2) usual care supplemented with group-based nutritional education. The group nutritional education will consist of three sessions addressing the following themes: "Let's Go Shopping," "Healthy Plate," and "Hunger and Satiety." The primary outcome will be the change in HbA1c levels. Secondary outcomes will include fasting glucose, lipid profile, body mass, dinapenic abdominal obesity, blood pressure, eating behavior, adherence to nutritional counseling, and diabetes-related complications. All outcomes will be assessed at baseline and at 4, 8, and 12 months, except diabetes-related complications that will be assessed at baseline and 12 months. Sample size calculations were based on an estimated mean difference of 0.59 ± 1.39% in HbA1c with the intervention (patient-centered group), using a type I error rate of 5% and a type II error rate of 20%. It was determined that 88 participants per group (1:1 randomization; n = 176) would provide sufficient statistical power. Accounting for an anticipated dropout rate of 30%, a total of 252 participants will be recruited to ensure the necessary sample size is maintained throughout the study period.

DISCUSSION

The American Diabetes Association recommends interventions for patients with diabetes lasting more than 10 h over a period of 6 to 12 months to optimize health outcomes. Therefore, this study hypothesizes that integrating group-based nutritional education into standard treatment within a nutrition-specialized outpatient clinic may lead to further improvements in health parameters among individuals diagnosed with type 2 diabetes mellitus. TRIAL REGISTRATION {2A AND 2B}: Clinicaltrials.gov identifier, NCT05598203. Registered on 13 October 2022.

Research hotspots and trends in nursing for diabetic foot ulcers: A bibliometric analysis from 2013 to 2023

Background

Nursing can effectively prevent and ameliorate diabetic foot ulcers (DFU). However, there is a lack of literature on the bibliometric analysis of DFU nursing. This study aimed to analyze the research hotspots and development trends in DFU nursing over the past 10 years to provide references for future related research.

Methods

The Web of Science Core Collection was used to retrieve literature related to DFU nursing from 2013 to 2023. Analyses included the annual publication trends; author, institution, and country collaborations; journal and literature co-citation; and keyword co-occurrence, clustering, and bursting, performed using CiteSpace 5.8 R3.

Results

A total of 229 papers were included, showing an upward trend in annual publications. American scholar David G Armstrong (n = 3) and King's College Hospital London (n = 4) were the most productive authors and institutions, respectively. The United States ranked first (n = 45) in national contributions, followed by China and Brazil. The overall research strength between authors and institutions was relatively scattered, and intensive cooperation has not yet been formed. National collaborations resulted in a core team dominated by Europe and North America with concentrated research strengths. The most frequently co-cited journal and co-cited reference were Diabetes Care (111 citations) and Armstrong DG (2017) (131 citations), separately. Research hotspots mainly focused on risk assessment, classification systems, protective measures, and clinical management of DFU. "Primary care" and "intervention efficacy" were identified as the research trends in the coming years.

Conclusion

The field of DFU nursing requires more attention. Academic exchange and cooperation between authors, institutions, and countries should be strengthened. Our future research will focus on the latest hotspots and trends, conducting more in-depth and comprehensive studies on DFU management.

Mobile Application for Adhering to Diabetic Foot Self-care: Randomized Controlled Clinical Trial

This study aimed to analyze the effectiveness of a mobile application for adherence to foot self-care in people with type 2 diabetes at risk for diabetic foot ulcer. A double-blind randomized controlled clinical trial was conducted with people with type 2 diabetes in a secondary healthcare unit. A total of 42 patients were recruited, matched, and allocated into two groups: one (intervention group) undergoing standard nursing consultations and application use and the other (control group) receiving only standard nursing consultations. The outcome variable was the adherence to foot self-care, measured by completing questionnaires on diabetes self-care activities and adherence to foot self-care. Measures of central tendency and dispersion were calculated, in addition to bivariate associations, considering a significance level of P ≤ .05. The intragroup and intergroup analyses regarding diabetes self-care did not show statistical significance; however, the intervention group showed a considerable increase in the frequency of daily assessments ( P = .048) and adherence to foot self-care ( P = .046). The use of the app, combined with the nursing consultation, increased adherence to foot self-care of people with type 2 diabetes. Brazilian Registry of Clinical Trials: U1111-1202-6318.

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.