Diabetic Foot Prevention

Lavery, Lawrence A.; Hunt, Nathan A.; LaFontaine, Javier; Baxter, Cory L.; Ndip, Agbor; Boulton, Andrew J.M.

doi:10.2337/dc10-0310

Cited by 62 publications

(38 citation statements)

References 12 publications

(15 reference statements)

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“…A close temporal relationship has also been demonstrated between foot ulceration and the onset of dialysis for endstage renal disease (44)(45)(46). While it may be assumed that the ulceration in such cases is the result of worsening renal function, it is equallydand possibly mored likely that it is the inflammation associated with the ulceration that triggers the final decline in renal function (47).…”

Section: The Link Between Dfus and Established Renal Failurementioning

confidence: 94%

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

et al. 2018

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Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.Despite considerable advances made over the last 25 years, diabetic foot ulcers (DFUs) continue to present a very considerable health care burdendone that is widely unappreciated. DFUs are common, the median time to healing without surgery is of the order of 12 weeks, and they are associated with a high risk of limb loss through amputation (1-4). The 5-year survival following presentation with a new DFU is of the order of only 50-60% and hence worse than that of many common cancers (4,5). While there is evidence that mortality is improving with more widespread use of cardiovascular risk reduction (6), the most recent datadderived from a Veterans Health Adminstration populationdreported that 1-, 2-, and 5-year survival was only 81, 69, and 29%, respectively, and the association between mortality and DFU was stronger than that of any macrovascular disease (7). Iversen et al. (8) have also shown that the occurrence of a DFU was an independent predictor of mortality even at 10 years.The cost to health care services is also enormous. The estimated global cost of diabetes in 2015 was $1.3 trillion (9), and it has been reported that up to one-third of diabetes expenditure is on lower-limb-related problems in the U.S. (10). The latest data from the U.K. estimate that the total annual cost of management of DFUs exceeds £1 billion ($1.32 billion) and represents almost 1% of the total National Health Service budget (11). The equivalent figure from the U.S. has been estimated to be $9-13 billion (12). GEOGRAPHIC DIFFERENCES IN CLINICAL OUTCOMEThere is also wide variation in clinical outcome within the same country (13-15), suggesting that some people are being managed considerably less well than others.

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Section: The Link Between Dfus and Established Renal Failurementioning

confidence: 94%

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

et al. 2018

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“…The patient's active engagement in foot care is a cornerstone of successful prevention . Key behaviours that reduce the risk of developing DFU include daily inspection of feet and immediate reporting of irregularities to a health professional, avoidance of behaviours that place the foot at risk (eg, walking barefoot), consistent use of appropriate footwear, and attendance of annual foot screening . However, many individuals with diabetes do not practice these behaviours .…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Key behaviours that reduce the risk of developing DFU include daily inspection of feet and immediate reporting of irregularities to a health professional, avoidance of behaviours that place the foot at risk (eg, walking barefoot), consistent use of appropriate footwear, and attendance of annual foot screening. 9,10 However, many individuals with diabetes do not practice these behaviours. 8,11,12 For example, almost two-thirds check their feet rarely if at all, 8 and few adhere to footwear recommendations.…”

mentioning

confidence: 99%

Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta‐synthesis

Coffey

Mahon

Gallagher

2018

International Wound Journal

126

133

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Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot‐related behaviours, yet many individuals with diabetes do not adhere to foot care recommendations. The aim of this paper was to synthesise the findings of qualitative papers exploring diabetic people's perceptions and experiences of DFU in order to identify how they could be better supported to prevent ulceration or manage its impact. Five databases (MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science) were searched in May 2016 to identify eligible articles. Findings were synthesised using a meta‐ethnographic approach. Forty‐two articles were eligible for inclusion. Synthesis resulted in the development of five overarching themes: personal understandings of diabetic foot ulceration; preventing diabetic foot ulceration: knowledge, attitudes, and behaviours; views on health care experiences; development of diabetic foot ulceration and actions taken; and wide‐ranging impacts of diabetic foot ulceration. The findings highlight various barriers and facilitators of foot care experienced by people with diabetes and demonstrate the significant consequences of ulcers for their physical, social, and psychological well‐being. The insights provided could inform the development of interventions to promote foot care effectively and provide appropriate support to those living with ulceration.

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“…We believe this foot risk index in its current form can be applied to administrative data by health care providers, researchers, or insurers as a useful tool to identify people with diabetes who are at high risk of ILEA. Patients with diabetes often do not receive evidence‐based preventive treatment 11 . Targeting these individuals for appropriate services (e.g.…”

Section: Discussionmentioning

confidence: 99%

Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes*

Helmer

Tseng

Wrobel

et al. 2011

Journal of Diabetes

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Diabetic Foot Prevention

Cited by 62 publications

References 12 publications

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta‐synthesis

Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes*

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