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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Article Info
Publication History
Published online: August 20, 2022
Accepted:
August 12,
2022
Received in revised form:
June 18,
2022
Received:
December 27,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
