Is There a Role for Informal Caregivers in the Management of Diabetic Foot Ulcers? A Narrative Review

Abstract

Successful management of diabetic foot ulceration (DFU) is crucial for preventing long-term morbidity and lowering risk of amputations. This can be achieved with a multifaceted approach involving a multidisciplinary team, with the patient at the centre. However, not all healthcare setups enable this, and the rate of lower limb amputations continues to rise. It is therefore time to consider new approaches to diabetic foot care, capitalising on engagement from patients in self-management while supported by their informal caregivers (ICGs) to help improve outcome. The role of ICGs in DFU care has the potential to make a significant difference in outcome, yet this resource remains, in most cases, underutilised. Limited research has been conducted in this area to reveal the true impact on patient outcomes and the caregivers themselves. This narrative review aims to explore how ICGs can benefit DFU management with applicability to different healthcare setups while benefiting from established experience in the care of other chronic health conditions.

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

“…A úlcera do pé diabético é uma das complicações mais prevalentes em longo prazo, e cerca de 20% dos pacientes que vivem com DM têm alto risco de desenvolverem essa complicação nos pés em razão da presença de neuropatia 12,39 . A existência de úlcera é uma das principais causas de hospitalizações, sendo de difícil tratamento, com cerca de 40% de úlceras que não curam com medidas específicas nos 6 primeiros meses 12 .…”

“…Assim, as complicações do pé diabético correlacionamse com baixa produtividade, custos individuais com a saúde, dificuldades para praticar exercícios físicos e problemas relacionados a ansiedade, depressão e estresse, bem como aqueles que intensificam sentimentos de isolamento social. Essas condições contribuem para a redução na qualidade de vida dos pacientes portadores de DM 12 .…”

“…No Brasil, entre 2011 e 2016, ocorreram 102.056 cirurgias de amputação pelo Sistema Único de Saúde (SUS), sendo 94% do membro inferior, 70% em pacientes com DM e 85% antecedidas de úlcera não evitada 9,10 . O pé diabético gera consequências drásticas para o paciente, pois ocasiona baixa qualidade de vida [11][12][13][14] .…”

Prevention and Management of Diabetes-Related Foot Ulcers through Informal Caregiver Involvement: A Systematic Review

“…Thus, the social environment consisting of family members, friends, and significant others of persons with diabetes stands as one of the factors that can significantly influence individual's ability to manage diabetes-related foot ulcers (DFUs) at home [ 16 – 18 ]. Consequently, it has been suggested that diabetes self-management interventions should demonstrate active patient engagement and involvement of the caregivers of people with diabetes [ 18 – 20 ]. Involving informal caregivers (ICG) in caring for DFU is particularly important to achieving treatment goals especially in settings where family ties are strong [ 21 ], and it is also a cost-effective strategy [ 20 , 22 ].…”

Trajectory of Psychosocial Measures Amongst Informal Caregivers: Case-Controlled Study of 1375 Informal Caregivers from the English Longitudinal Study of Ageing

“…They may also be expected to provide emotional support [2]. This group of individuals are therefore heterogeneous both in their relationships to caregivers, being family members or friends [3], in their characteristics both in age and employment status and other life commitments, but also in the roles and tasks which these individuals provide care-recipients [4,5]. Caregivers are expected to support their family members or friends more due to an increasing shift from professional to informal care [6].…”