Diabetes foot care knowledge questionnaire example,type 2 diabetes diet made easy 5th,what vegetables are bad for type 2 diabetes - Good Point


5.Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Sonali Kar,Shalini Ray,Dayanidhi Meher Advances in Public Health.
Samira Beiranvand,Sedigheh Fayazi,Marzieh Asadizaker Jundishapur Journal of Chronic Disease Care. Objective: To assess the knowledge and practices among the diabetic patients regarding foot care.
Methods: In this cross sectional study, by using non-probability convenience sampling, 150 diabetic respondents fulfilling the inclusion criteria were included in the study.
Conclusion: About one third of diabetic patients had poor knowledge about foot care and only very few patients had good practices for foot care. Diabetes Mellitus is a syndrome of chronic hyperglycaemia due to relative insulin deficiency, resistance or both.
Diabetes currently affects about 200 million people worldwide and is expected to reach 333 million by 2025, with most of the massive burden falling in developing countries. According to the International Diabetes Federation (IDF) Pakistan had 6.2 million people of age group 20-79 years with diabetes in 2003. Diabetologists started recognizing diabetic foot problems in UK in 1980 and in other European countries in1990. According to the American Diabetes Association, there are certain guidelines to be followed by diabetic persons.9 This study was carried out to assess the knowledge and practices among the diabetic patients regarding foot care. A cross-sectional study was conducted in the diabetic clinic situated in outpatient department of Jinnah Hospital Lahore. A total of 117 respondents (78%) knew the importance of keeping the blood glucose level within normal limits to prevent themselves from its complications and 119 (79%) were taking the antidiabetic treatment regularly. This study was conducted to assess the knowledge and practices of the diabetic patients on foot care. The role of physicians is very important in improving the knowledge and practices regarding foot care.
This recent study reveals that only 14% of the respondents had good practices for foot care and 32% had poor foot care practices which indicates an alarming situation and one should take appropriate action for it.
This study has shown a marked gap in the knowledge and practices of the diabetic patients regarding foot care in a diabetic clinic of a tertiary level hospital. 2.International Diabetes Federation Press release Karachi, Pakistan-26 February 2006 - Diabetes kills without distinction. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. Introduction: The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods: Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. Results: Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Conclusion: Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Competing interests and funding: The authors declare that they have no conflicts of interest nor was any funding made available for this study.
With an impact of over 300 million people worldwide, diabetes has become the fastest developing chronic disease (1). Uncontrolled T2DM has serious health implications other than chronic hyperglycemia, such as heart disease, stroke, retinopathy, neuropathy, and nephropathy (2). T2DM foot complications, which more often affect older adults, have the capacity to diminish a person’s quality of life (1). This systematic review contains research studies of foot care knowledge and foot care practices interventions.
Two investigators (TJB and ESL), independently reviewed publications by title and abstract according to the above mentioned criteria by rating the studies with a yes or no. Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection.
Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. For each variable of interest, give sources of data and details of methods of assessment (measurement). Discuss limitations of the study, taking into account sources of potential bias or imprecision.Discuss both direction and magnitude of any potential bias. Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence. An explanation and elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. Data abstraction was conducted by one investigator (TJB) using the procedures in Garrard’s method of literature review (17). Systematic review flow diagram on diabetes-related foot care knowledge and foot care skills interventions in US studies.
The journals that have reported studies are from foot and ankle journals (n=2), diabetes journals (n=12), nursing journals (n=7), rehabilitation journals (n=4), and medical journals (n=6). This systematic review is composed of studies ranging from randomized controlled trials (n=9), surveys (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1) (Supplementary Table 1).
The learning outcomes of the studies were measured by general T2DM knowledge scores (36), self-care scores (30, 37–40), foot care knowledge scores (8, 29, 33, 41, 42, 43), self-efficacy scores (30, 31, 37), and physician prevention survey scores (44).
The clinical outcomes that were assessed in the studies included hospitalizations (23), ulcerations (23, 32, 42), ER visits (23), antibiotic treatments (23), foot operations (23), lower extremity amputations (23, 26), missed work days (23), presence of vascular disease (32), foot trauma (32), comorbid complications (32), foot lesions (25, 36), calluses (9), peripheral vascular disease (9), bunions (9), hammertoes (9), glucose levels (9), dorsalis pedis pulses (25), posterior tibial pulses (25), femoral pulses (25), peripheral neuropathy (25), dry or cracked skin (25), ingrown nails (25), fungal nail infections (25), fungal skin infections (25), and interdigital macerations (25). Proper foot self-care behaviors can reduce the risk of injury, infection, and amputation in someone with an at-risk foot (37). Foot injuries and ulceration have been associated with poor T2DM-related foot care knowledge and foot self-care skills (29). Diabetes Self Management Education (DSME) has been shown to be the foundation of care for anyone with T2DM wanting to improve disease-related health outcomes (49). This systematic literature review is a comprehensive examination of foot self-care knowledge and practice interventions conducted within the United States, solely on individuals with T2DM. The literature has shown that T2DM self-care management programs have a positive impact on self-care behaviors, as well as health outcomes, even with a lack of consensus on the best approach. The primary author has full control of all primary data, which may be assessed by contacting the corresponding author. Associations between coping, diabetes knowledge, medication adherence and self-care behaviors in adults with type 2 diabetes.
Theory-guided intervention for preventing diabetes-related amputations in African Americans.
GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, p. Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Management of patients with type II diabetes residing at a homeless shelter: a series of case reports.
Foot care assessment in patients with diabetes: a screening algorithm for patient education and referral. Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.
Foot education improves knowledge and satisfaction among patients at high risk for diabetic foot ulcer. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus.
Development and formative evaluation of a foot self-care program for African Americans with diabetes. Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement.
Use of folk treatments for diabetic plantar ulcers among African Americans with type II diabetes. Comparison of three types of diabetic foot ulcer education plans to determine patient recall of education.
Behaviors predicting foot lesions in patients with non-insulin-dependent diabetes mellitus. Perceived risk of amputation, emotions, and foot self-care among adults with type 2 diabetes.
Foot care practices, services and perceptions of risk among Medicare beneficiaries with diabetes at high and low risk for future foot complications. Personal and treatment factors associated with foot self-care among veterans with diabetes. Patient interpretation of neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care.
A CNS-managed diabetes foot-care clinic: a descriptive survey of characteristics and foot-care behaviors of the patient population. Diabetes self-management education for older adults: general principles and practical application. Potential economic benefits of lower-extremity amputation prevention strategies in diabetes.
As we have already discussed an ulcer is an open sore or break in the skin caused by neuropathy, poor circulation, foot deformities, poor wound healing etc.
Although overall a diabetic has an increased risk of developing foot ulcers than a non-diabetic, there are some other factors that further increase this risk in diabetics. Neuropathy – the risk of developing neuropathy increases with longer duration of diabetes, older age and poor glucose control. Peripheral arterial disease – the risk increases with longer duration of diabetes, older age, male gender, high cholesterol, high blood pressure, smoking and being overweight. Structural foot deformities – such as bunions, hammertoes, tiptop toe deformity, loss of arches.
Your doctor will perform a comprehensive foot exam (mentioned in previous article) and place you in a risk category. By following the foot care routine, the do’s and don’ts of diabetic foot and daily foot self-exams is the cornerstone for preventing diabetic foot ulcerations. The goal of your healthcare team is to help your ulcer heal as quickly as possible to minimize further complications such as infection or amputation. It’s a process by which dead skin, tissue and callus surrounding the ulcer is removed until a healthy bleeding edge is revealed. Most common is by using a scalpel and scissors to remove the dead tissue and then washing out the ulcer. Wet-to-dry dressing is applied to the wound where it sticks to the dead tissue, pulling it away when removed. After debridement, probing of the ulcer is done using a blunt instrument to determine the extent of underlying soft tissue and bone involvement.
Wound coverage with an appropriate dressing is absolutely essential in management of diabetic ulcers. Make sure you keep the surrounding skin as dry as possible and not too wet from the dressing. Your healthcare provider will work with you to select the device best suited to your lifestyle. Once you have had one ulcer, you are at a higher risk of another one, so treat your feet very carefully. Fragile, newly healed skin will break down easily if feet are not protected from high pressure.
After the initial evaluation phase and debridement, diabetic foot ulcers are mostly managed in an outpatient setting.
Good wound care- Keeping the dressing dry and clean, changing it regularly as advised by your doctor. Wear your off-loading device AT ALL TIMES- The ulcer will not heal if the pressure is not relieved.
In conclusion, as a diabetic it is very important for you to learn as much as possible about routine diabetic foot care as it plays the biggest role in preventing foot ulcers. You must have JavaScript enabled in your browser to utilize the functionality of this website. Knowing how to properly manage your diabetes is the best way to keep yourself (and your numbers) on track for long-term success. This is an-depth list of things that all people with diabetes should, at minimum, be familiar with and perhaps are already doing. If any of these things send you into panic mode - don't worry - just ask your doctor for help. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Reducing lower leg amputations in diabetes: A challenge for patients, healthcare providers and the healthcare system. Diabetic foot care: Self-reported knowledge and practice among patients attending three tertiary hospital in Nigeria.


Feet Can Last a Lifetime: A Health Care Provider's Guide to Preventing Diabetes Foot Problems. Knowledge and practices regarding foot care in diabetic patients visiting diabetic clinic in Jinnah Hospital, Lahore. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Frequency of patients with diabetes taking proper foot care according to international guidelines and its impact on their foot health.
Profile of diabetic foot complications and its associated complications - A multicentric study from India. Education for secondary prevention of foot ulcers in people with diabetes: A randomised controlled trial. Immediate impact of a diabetes training programme for primary care physicians - An endeavour for national capacity building for diabetes management in India.
The rising burden of diabetes and hypertension in Southeast Asian and African regions: Need for effective strategies for prevention and control in primary health care settings. For a faster, more beautiful, safer and reliable browsing experience, upgrade for free today. Their knowledge and practices regarding foot care were assessed by a pre-tested questionnaire and classified as good, satisfactory and poor depending upon the score. Every year 3.2 million deaths are attributable to the disease, no matter where people are from and where they live.
They become infected frequently, can be expensive to treat and usually are the first step towards amputation of a lower extremity.5 It has been shown that 49-85% of all diabetic foot related problems are preventable if appropriate measures are taken.
Simple frequency distribution tables were generated for dependent and independent variables. The knowledge and practices regarding foot care is approximately the same for most of the questions asked.
Regarding knowledge, only 29% respondents had good information (>70%) about foot care and formal education had a role in better knowledge about foot care. In a study from Italy, more than 50% of the patients reported that they did not have their feet examined by their physician and 28% referred that they had not received foot education. It does not require costly  measures but simple preventive measures to prevent the persons to suffer from disability. This also reflects indirectly a grim situation in the primary and secondary health care facilities.
Pakistan national diabetes survey: prevalence of glucose intolerance and associated factors in Shikarpur, Sindh Province. Multidisciplinary team managing diabetic foot has amputations by 34% which is quite impressive (Interview). References from the included studies were reviewed to identify any missing studies that could be included. Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Interventions and research studies that aim to reduce lower extremity complications are still lacking. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Despite cases of unreported causes of death in the United States, diabetes (T2DM) was still noted as the seventh leading cause of death in 2006 (2). The complications do not end there; lower extremity amputations comprise over 60% of non-traumatic amputations in the United States (8).
Foot self-care behaviors, including daily inspection of feet, professional treatment, hygiene, and proper shoe gear help minimize the risk of foot complications (1).
The inclusion criteria were limited to studies that evaluated T2DM-related foot care knowledge and foot self-care interventions. The number of articles that were excluded at each stage of the selection process is presented in Fig.
The Strength of Recommendation Classification Scheme (15) was used to rank all the studies based on strength and validity of the studies (18). All of the studies that measured foot care knowledge saw an improvement in health outcomes based on receipt of foot care education. Many of the behaviors demonstrating significant improvements were those surrounding daily foot checks (20, 22, 45) and proper foot self-exams (24). Many of the clinical outcomes that showed significant improvement in the studies included foot-related ulcer days (23), hospitalizations (23), hospital days (23), ER visits (23), antibiotic prescriptions (23), foot surgery (23), lower extremity amputations (23, 26), missed work days (23), ulcerations (26), foot lesions (25, 36), cracked skin (25), ingrown nails (25), fungal nails (25), macerated web spaces (25), and incidence of neuropathy (35). Thirty-one studies investigated various foot care interventions that mostly utilized foot care education, professional foot assessments, and foot care skills, although the interventions varied between studies.
Ideal foot self-care behaviors include daily foot and shoe gear checks, proper daily foot hygiene, not walking barefoot, wearing appropriate shoe gear, trimming toenails, avoiding using anything abrasive on the feet, early professional care for open wounds and lesions on the foot, and routine foot exams by a professional trained to identify diabetic foot complications (29).
This lack of knowledge has been recognized as a contributing factor to why people with T2DM do not undertake foot self-care practices (46). DSME is an essential component in the prevention of T2DM-related complications, but it also provides disease prevention for those with pre-T2DM (50). This review provides an important insight into an area of T2DM management and care that has been ignored by research studies and interventions. Standardization of these programs is needed in T2DM, but the inclusion of self-care for associated comorbidities and complications also needs deeper examination by program developers.
The authors would like to thank the Transdisciplinary Center for Health Equity Research at Texas A&M University for research support. Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: an integrative review.
National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Therefore, it is crucial to identify these factors and follow the preventive measures accordingly to avoid developing a foot ulcer.
Sometimes despite preventive measures and regular foot care routine, diabetics still develop foot ulcers. Adequate wound debridement is an essential step as it helps the ulcer heal faster by removal of dead tissue.
Your health care provider may use local or general anesthesia for the procedure depending on the extent of debridement. The old school of thought of letting air get at the wound is now obsolete as it causes more harm to healing. You healthcare provide will advise you how often it needs to be changed and will also teach you how to change it.
Dressings that are soiled with drainage act as a breeding ground for bacteria, increasing your chance of developing an infection. Your doctor may prescribe specially fitted shoes or inserts to continue to off-load your foot and protect it. However, it’s important for you to recognize the signs of infection in a diabetic foot ulcer (See previous article).
Your healthcare provider will assess circulation in your feet using non-invasive tests, and may refer you to a vascular surgeon if the circulation is poor. Wearing your off-loading device for every step will give you the best chance to heal your ulcer quickly. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients. Whereas only 14% respondents had good practices for foot care, 54% had satisfactory practices and 32% had poor practices. However, many people are more vulnerable because they do not have access to appropriate health care and education. This can be achieved through a combination of good foot care — provided by a multidisciplinary diabetes care team and appropriate education for both people with diabetes and health care professionals.6 All patients with diabetes are potentially at risk from diabetic foot which can only be avoided by creating awareness about the importance of appropriate self care. It is affiliated with International Diabetes Federation (IDF) and has been quite active for the last ten years.7 Pakistan was included in this group in 2006 during an international diabetic conference in Karachi. The inclusion criteria for the cases included diagnosed cases of type I and II diabetes since at least six months, who had never developed foot ulcers. Chi-square test was applied to find out whether there is any statistical significant effect of socioeconomic factors on knowledge and practices regarding foot care in diabetics.
Seventy two female respondents out of 94 (77%) were housewives while out of 56 males, 18 (32%) were manual workers.
However there was a marked difference for about use of talcum powder to keep the interdigital spaces dry, lotion application on the feet interdigital spaces, change of socks, wearing of comfortable coat shoes and walking bare foot (Table-1).
Thus patients' knowledge and practices are strongly related to physicians' attitudes.11 In USA, a prospective, randomized, single center, two group design was used to test the effectiveness of an educational intervention to improve patient's foot care knowledge, self-efficacy, and self care practices. Another striking feature which is revealed in this study is that 40% of the respondents had satisfactory knowledge (50-70%) whereas 54% of the respondents had satisfactory practices (50-70%) regarding foot care. Diabetic foot is one of the main complications of Diabetes Mellitus of high socioeconomic impact, characterized by foot lesions and finally leg amputation in most of the cases. We are also grateful to the College and Jinnah Hospital administration for utilizing the resources for this study. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Further research is needed to test foot care interventions across multiple populations and geographic locations.
Lifestyle behavior changes are required for management of this condition, including physical activity, dietary changes, monitoring blood glucose levels, and adherence to medication (3).
These T2DM-related lower extremity amputations cause critical implications for individuals, family members, and caretakers in terms of psychosocial, physical, functional, and financial implications (9).
T2DM is multifaceted and requires a multidisciplinary approach to the treatment of the condition and prevention of associated complications (11).
We excluded studies that were not peer reviewed, did not discuss T2DM, contained no element of T2DM-related lower extremity complication, were not in English, and were not conducted within the United States. The reference lists of the studies included in the evaluation were also searched systematically for any eligible studies that may have been overlooked, but were not included. The methodologies and findings of the included articles were then reviewed by one investigator (TJB) for validity assessment, which included determining whether the studies were described in sufficient enough detail to include in the current review. The post-test scores of the control groups were also poorer than the post-test scores of the intervention groups, revealing the need for foot care–specific education. The learning outcomes assessed in the studies utilized self-care scores, foot care knowledge scores, and self-efficacy scores as they related to foot care. T2DM health care providers strongly encourage patients to implement these foot self-care practices (1).
It is widely accepted that additional education will lead to improved knowledge, self-care behaviors, and reduction of foot complications (1). Patients that are not offered DSME have a fourfold risk of developing T2DM-related complications compared with those that have had some form of DSME (51). The studies included within this systematic literature review provide evidence of improved health outcomes, learning outcomes, and behavioral outcomes and how those outcomes ultimately improve the quality of life for those with T2DM.
Future research should examine the effects of a standardized foot self-care program across multiple populations and intervention sites that focuses on the reduction of complications associated with a T2DM diagnosis.
Therefore, it is important for you to get it removed by your healthcare provider and wear an appropriate orthotic device to decrease its formation. It is important for you to ask your doctor about your risk category and devise a preventive and screening plan accordingly. A multidisciplinary approach, usually by podiatrists, medical specialists, vascular surgeons, dietitians, physiotherapists and diabetes educator in the management of diabetic foot ulcers significantly increases the chance of successful healing and preventing recurrence. Your healthcare provider may also take X-rays of your foot to evaluate for bone involvement. Later on when the dressing is removed, some of the tissue comes off with it promoting healing.
In the comfort of their homes, diabetics sometimes choose not to wear them for a few quick steps around the house. If you have signs of infection, your doctor will take cultures from your wound to see what type of infection you have and which antibiotics will work. Materials and Methods: A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes.
Diabetes along with its complications is expected to result in increasing morbidity, mortality and health expenditure due to the requirement of specialized care. This makes the diabetes population of 20-79 years age group in Pakistan the seventh largest in the world and if the predictions are accurate, it will take fifth place by 2025.
The income per capita of 54 (36%) respondents was between Rs.601-1000, followed by less than Rs. This educational intervention improved patient's knowledge, confidence and reported foot care behaviours. This 14% increase in practices with less knowledge indicates that people are doing good practices without knowing that they are good for health.
No financial resources were utilized directly because participation of researchers and data collectors was on voluntarily basis. The quality of life of someone living with T2DM can be greatly improved with the implementation of self-management education to help them manage the condition (2). T2DM-related complications account for a death risk that is two times higher than that of someone that does not have T2DM (10).
The Strength of Recommendation Classification Scheme (15) was one of the quality assessment tools utilized for this review (Table 1). The second investigator (ESL) independently reviewed and extracted data from 18 of the 31 articles that were selected for the review.
Articles were excluded after not meeting the following inclusion criteria: 1) peer reviewed, 2) T2DM-related, 3) lower extremity disease component as the basis of the study, 4) study conducted in the United States, and 5) foot care education or foot care practices intervention only in participants that were living with T2DM.


There were 18 studies that included female participants, 21 studies that included male participants, and nine studies that did not report the gender of the participants.
The randomized controlled trials that did not receive a 1B received a 1C due to not describing the control group, not providing analysis for the intervention group, and not providing between-group analysis. All the studies that assessed foot care practices noticed an improvement in foot care practices, but not in lower extremity complications.
The major behavioral outcomes assessed in the studies were daily foot checks and foot self-exams. Previous studies have found an increase in foot ulcers and amputations in those patients that do not adopt these practices (45). Studies have shown that these educational interventions have the ability to lower rates of lower extremity amputations by up to 85% (52). The limitations of this review are that it only analyzed studies within the United States and only those studies that examined foot care knowledge and foot care practices in the actual population that lives with T2DM. This potential intervention has the ability to expand the scope of DSME to not only include foot care, but also other complications associated with this condition.
It is extremely important that you seek medical help and avoid treating your ulcer at home.
Three-phase bone scans and Radiolabelled Leukocyte Scans (See previous article) are expensive but more accurate in establishing a diagnosis. Off-loading device decreases pressure and reduces irritation to the wound area, speeding up the healing process. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. In Pakistan, deaths from diabetes alone are projected to increase by 51% over the next 10 years.3 These figures make diabetes an epidemic - one which places an enormous burden on our healthcare systems and societies. In the present study, 54% of the respondents had satisfactory practices regarding foot care, 32% had poor practices and only 14% had good practices. Thus incorporating such interventions into routine home care services may enhance the quality of care and decrease the incidence of lower-extremity complications.13 Similarly a study was conducted in UK to assess the knowledge and practices of foot care in people with diabetes.
This may be explained on the basis of Islamic rituals which they are performing religiously without knowing that some of these activities are a part of good foot care practices e.g.
Thus low cost, low technology evaluation and preventive processes are enough to substantially reduce the rates of risk.
We are also thankful to the patients of Diabetes clinic for their cooperation during data collection. Similar to how continuing education is essential for healthcare providers, there must also be continuous education for the person that is battling T2DM (4). However the development of such complications can be prevented and reduced through the implementation of comprehensive programs focused on foot care, which have been shown to greatly reduce amputation rates (8).
This classification scheme uses a hierarchy to rank the strength and validity of evidence from each study included in this systematic review. Any discrepancies between the two investigators’ scores were then resolved through a second review of the abstracts, discussion of discrepancies, and a finalized consensus. One study included Filipino participants, 17 included African-American participants, five studies included Hispanic participants, two studies included Native Americans, and 10 studies did not include participants’ racial or ethnic information.
There was one study (22) that noted that improvement of practices coupled with foot care education did not reduce the incidence of lower extremity complications in the study participants. The clinical outcomes assessed in the studies varied greatly across the studies, but the most common outcome assessed was presence of ulceration, risk of amputation, or presence of a foot lesion.
DSME is effective at controlling illness and improving health, and it is accepted as a cost-effective strategy (53). The systematic review also did not include studies that examined the foot care knowledge and foot care practices of caregivers or health care providers.
This article will help you understand YOUR role in improving your health and helping your ulcer heal. Your health care provider may use different kinds of dressing during the healing process of your ulcer.
Prevalence of diabetes is 10% and at 95% confidence interval with margin of error of 5%, the minimum representative sample was 137 but we took 150 respondents. An individualized educational intervention can lead to improved foot care knowledge; self care practices and confidence in performing foot related self care.
Batches 'A' and 'B' of 4th year MBBS class (Session 2006-2007) of Allama Iqbal Medical College had actively participated in this research work. According to the American Association of Diabetes Educators 7 Self-Care Behaviors framework, people with T2DM should be skilled in self-care behaviors that improve their quality of life while reducing associated complications of this condition (5). This scheme allowed the investigators to rank the strength of not only randomized controlled trials, but also the strength of observational studies, cohorts, case-control studies, case series, and case reports, many of which have also been included in this systematic review. The cohort studies, case series, cross-sectional studies, and qualitative inquiries were assigned a rank of III. In the randomized controlled trials, there were no studies that reported improved outcomes in the control group as opposed to the intervention group. There are studies that have shown a clear reduction in amputation rates following a foot care intervention (48).
Fifty nine out of 150 respondents (39%) were suffering from diabetes since 6 months — 4 years and 121 (80.7%) respondents had type-2 Diabetes Mellitus. However this can be explained on the basis that in that particular study, there were more women with low educational status.10 It can be deduced that the results are consistent with our study. Similarly 73.3% of the respondents answered that they had the knowledge to always check the shoes before wearing that it may not have any insect or tiny gravels and regarding practice 76% of the respondents always checked their shoes before wearing. There is a need to reorient and motivate health personnel in educating diabetics about self care and also practicing by themselves proper foot examination when and where required.
The included studies were also appraised using the Strength of Reporting Observational Studies in Epidemiology (STROBE) tool (Table 2) (16). Although there were many interventions and health outcomes assessed in the included articles, consistency in the type of intervention was lacking collectively throughout the studies.
Results: Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Studies such as the United Kingdom Prospective Diabetes Study have shown that proper control of blood glucose through diet, exercise and medications prevents the development of microvascular complications. The respondents were interviewed on a pre-tested structured questionnaire after their verbal consent.
Print and electronic media must be engaged in order to enhance the public awareness of diabetes and its complications. Self-care management has the capacity to reduce the gap between patient needs and available health care services to meet those needs (6). Despite evidence of the success of multidisciplinary approaches to T2DM care, this approach to care has yet to be fully implemented as part of the standard of care (14).
This tool was also used because it addresses cohort, case-control, and cross-sectional studies, which have been included in this review (16).
Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. The dependent variables of the study were knowledge and practices regarding foot care in diabetics and the independent variables were education, occupation and income per capita. Strategies must be worked out to develop a countrywide network of diabetes centers with implementation of primary prevention programs regarding foot care. Health care providers must equip patients with the tools needed to effectively monitor their blood glucose levels, maintain any dietary restrictions, and be active participants in their individual self-care to control their disease (7). The purpose of this systematic literature review was to compile and evaluate published evidence for increasing foot care knowledge and self-care practices as part of a targeted T2DM foot care intervention.
The tool consists of 22 items, but the last item, funding, was omitted from the checklist, which brings the tool to 21 items (1). The majority of the included studies failed to report how the study size was calculated or any source of bias. People with poor knowledge and practice regarding diabetic foot care are known to have a higher incidence of diabetic foot ulcers. There were six teams comprising of two female students and one male student of 4th year MBBS class. Most of the studies also acknowledged that there were limitations to the generalizability of the results. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. The responses were read out by the data collectors from the pre-tested close ended questionnaire. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally. Thus, the objective of our study was to assess the risk factors for poor diabetic foot care and to determine the effectiveness of health education in improving diabetic foot care practice in a rural outpatient setting.
We surveyed all the diabetic patients attending the weekly afternoon chronic disease clinic at our Institute Rural Health Center during March 2013. A total of 103 diabetes patients were taking treatment at the health center at the time of the study. The diabetic foot care was reassessed after 2 weeks of health education.Study instrumentThe questionnaire consisted of four sections pertaining to awareness regarding diabetes, practice of diabetes care, practice of self-care of feet and feet examination details. The survey instrument on diabetic feet care was modified from a questionnaire prepared from the recommendation of the diabetes UK and used in previous studies. Group education by flipchart display and demonstration regarding foot cleaning, drying and foot examination was also done by nursing students for all patients. Diabetes awareness score and diabetes care score were divided into poor (0-3) and good (4-5) categories. Similarly, we divided the diabetic foot care score into poor (0-5), satisfactory (6-7) and good (8-10) categories. Mann-Whitney U test was used to compare the baseline foot care scores across two categories.
We used McNemar test to assess improvement in individual items of foot care practice following health education. We used Wilcoxon test to assess change in diabetic foot care practice score after health education.
Mann-Whitney U test and Wilcoxon test were used, as the scores were not following a normal distribution. Only around half (54.4%) were aware that diabetes could cause reduced foot sensation leading to ulcers. Around two-thirds (63%) of the patients were aware that diabetes could affect the various organs of the body. Only around one-third (33.0%) were especially aware that diabetes could lead to damage of the nerves. Around three-fourth (75.7%) were having their blood glucose checked at least once in 3 months.
Three patients had foot ulcers with peripheral neuropathy while another three had only neuropathy.
Diabetes awareness score was found significantly higher among high-risk patients compared with low-risk patients (4.83 vs. However, illiterates were higher among returning patients compared to those who dropped out (55.0% vs.
However, around half the patients had a poor overall knowledge regarding diabetes, which was similar to the findings of earlier studies mostly in tertiary care settings. Regular blood glucose monitoring and compliance to diet and life-style advice were found to be comparatively better. This is in line with an earlier finding that foot care and health education were least suggested by doctors. However, footwear use was heavily skewed in favor of slippers (chappals) rather than sandals with strap, floaters or shoes which provide better support to the feet.
However, absence of use of therapeutic footwear points to a deficiency in care by the health-care providers.
Regular footwear inspection being done in only half of our patients was similar to the findings of the Nigerian and Saudi studies.
Outdoor footwear use didn't improve as it was already high, whereas indoor footwear use didn't improve probably due to cultural reasons. Also there was no improvement in healthy nail trimming probably because a single education session was not sufficient to introduce this habit. Thus, diabetic foot care education should be regularly reinforced at outpatient clinic visits to be effective in the long run.We had a limitation that turnout for post-test of foot care practice was not adequate. Furthermore, the improvement in clinical outcomes could not be studied due to the cross-sectional nature of the study.
When consistently reinforced, this education is likely to result in healthy habit formation, which may prevent disability and reduce medical expenditure in the long run.
Furthermore, a training program of more than 3,000 primary care physicians in India showed that information on diabetic foot care was found highly educative by participants. Thus integration of sustainable patient education at primary care level will be the most cost-effective way of reducing the burden of its complications. We would like to acknowledge the help of doctors Aditya Gautam, Aishwarya PK, Deepak MJ, Krishin K, Surya Raj M, Tapan Gohain and Rajesh Raman for their help in data collection.



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