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A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

Published:August 20, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.08.004

      Abstract

      Objectives

      The impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU.

      Methods

      We evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period.

      Results

      We identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016).

      Conclusion

      A comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.

      Résumé

      Objectifs

      Les répercussions d’une éducation thérapeutique complète du patient (ETP) sur le pronostic de l’ulcère du pied diabétique (UPD) n’ont pas encore été évaluées dans la littérature. Le but de la présente étude était de déterminer si l’ETP est un prédicteur des résultats cliniques des patients atteints du diabète de type 2 qui ont un UPD.

      Méthodes

      Nous avons évalué 583 individus consécutifs qui avaient un UPD récent et unique. Ils ont été traités et suivis durant 42,8 ± 23,3 mois. Nous avons réparti les patients en 2 groupes. Le groupe ETP regroupait les sujets qui avaient eu des séances régulières d’ETP complète, notamment une éducation spécifique en soins des pieds (ESP), durant au moins 12 mois avant l’apparition de l’UPD (n = 129). Le groupe non-ETP regroupait les sujets restants (n = 454). Les 583 patients recevaient une ETP intensive durant la période du traitement.

      Résultats

      Nous avons constaté un pourcentage significativement plus élevé d’UPD guéris (96,0 % vs 74,9 %; p < 0,0001) et un pourcentage plus faible d’amputations majeures (0,8 % vs 4,4 %; p = 0,0511), d’amputations mineures (1,6 % vs 12,3 %; p = 0,0003), de persistance de l’UPD (1,6 % vs 8,4 %; p = 0,0069) et de décès (1,6 % vs 21,4 %; p < 0,0001) dans le groupe ETP que dans le groupe non-ETP. Parmi les 464 patients dont les ulcères étaient guéris, la proportion de sujets qui avaient une réulcération était plus grande dans le groupe non-ETP que dans le groupe ETP (48,8 % vs 6,5 %; p < 0,0001). L’analyse multivariée a montré que l’ETP peut contribuer à prédire la guérison (rapport de cotes [RC], 4,202; intervalle de confiance [IC] à 95 %, de 1,604 à 11,004; p = 0,0035) et il est possible qu’elle réduise significativement la récidive de l’UPD (RC, 0,093; IC à 95 %, de 0,043 à 0,201; p < 0,0001) et la mortalité (RC, 0,096; IC à 95 %, de 0,022 à 0,410; p = 0,0016).

      Conclusion

      Il se peut que l’ETP complète ait des répercussions positives sur la guérison de la plaie, la récidive de l’ulcère et la mortalité chez les personnes qui ont un UPD.

      Keywords

      Mots clés

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