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 the non-TPE group. Among 464 patients
with healed ulcers, the proportion of subjects with re-ulceration was greater in the
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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of DiabetesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: A ten-year retrospective cohort study.Endocrine. 2021; 71: 59-68
- Diabetic foot ulcers and their recurrence.N Engl J Med. 2017; 376: 2367-2375
- Current challenges and opportunities in the prevention and management of diabetic foot ulcers.Diabetes Care. 2018; 41: 645-652
- The role of patient education in the prevention and management of type 2 diabetes: An overview.Endocrine. 2016; 53: 18-27
- Effectiveness of group-based self-management education for individuals with Type 2 diabetes: A systematic review with meta-analyses and meta-regression.Diabet Med. 2017; 34: 1027-1039
- Structured therapeutic education in diabetes: Is it time to re-write the chapter on the prevention of diabetic complications?.Endocrine. 2016; 53: 347-349
- Diabetes structured self-management education programmes: A narrative review and current innovations.Lancet Diabetes Endocrinol. 2018; 6: 130-142
- Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration.Diabetes Metab Res Rev. 2019; 35e3105
- Patient education for preventing diabetic foot ulceration.Cochrane Database Syst Rev. 2014; 2014: CD001488
- Amputation prevention initiative in South India: Positive impact of foot care education.Diabetes Care. 2005; 28: 1019-1021
- Education for secondary prevention of foot ulcers in people with diabetes: A randomised controlled trial.Diabetologia. 2008; 51: 1954-1961
- Risk factors for diabetic foot ulcer recurrence: A prospective 2-year follow-up study in Egypt.Foot (Edinb). 2018; 35: 11-15
- A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU).Heliyon. 2018; 4e00614
- Effect of intensive nursing education on the prevention of diabetic foot ulceration among patients with high-risk diabetic foot: A follow-up analysis.Diabetes Technol Ther. 2014; 16: 576-581
- Service user and community clinician design of a partially virtual diabetic service improves access to care and education and reduces amputation incidence.BMJ Open Diabetes Res Care. 2021; 9e001657
- Impact of diabetes foot care education on amputation rate in the University of Abuja Teaching Hospital, Nigeria.Int J Low Extrem Wounds. 2020; 21: 275-278
- Impact of a diabetic foot care education program on lower limb amputation rate.Vasc Health Risk Manag. 2010; 6: 923-934
- Patient education for preventing diabetic foot ulceration.Diabetes Metab Res Rev. 2012; 28: 101-106
- Role of structured individual patient education in the prevention of vascular complications in newly diagnosed type 2 diabetes: the INdividual Therapeutic Education in Newly Diagnosed type 2 diabetes (INTEND) randomized controlled trial.Endocrine. 2018; 60: 46-49
- Screening for asymptomatic coronary artery disease can reduce cardiovascular mortality in type 2 diabetic patients.Intern Emerg Med. 2012; 7: 257-266
- Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus.Endocrine. 2012; 41: 89-95
- Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with asymptomatic coronary artery disease angiographically proven. A potential protective role for statins and 5-phosphodiesterase inhibitors.J Am Coll Cardiol. 2008; 51: 2040-2044
- Silent coronary artery disease in type 2 diabetes mellitus: The role of Lipoprotein(a), homocysteine and apo(a) polymorphism.Cardiovasc Diabetol. 2002; 22: 1-5
- Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes: Comparison with ankle-brachial index.Diabetes Care. 2013; 36: 1720-1725
- Association of the metabolic syndrome and insulin resistance with silent myocardial ischemia in patients with type 2 diabetes mellitus.Am J Cardiol. 2006; 97: 236-239
- Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifugate.Clin Chem. 1972; 18: 499-502
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients.Circulation. 2004; 110: 22-26
- People with diabetes do not learn and recall their diabetes foot education: A cohort study.Endocrine. 2018; 62: 250-258
- Patient, support-person and health-care provider perspectives on foot self-management for adults with type 1 and type 2 diabetes: Personal challenges.Can J Diabetes. 2022; 46: 40-46
- Outcomes of diabetic foot ulcers in a tertiary referral interdisciplinary clinic: A retrospective Canadian study.Can J Diabetes. 2021; 45: 255-260
- Effectiveness of psychosocial interventions for the prevention and treatment of foot ulcers in people with diabetes: A systematic review.Diabet Med. 2020; 37: 1256-1265
Article info
Publication history
Published online: August 20, 2022
Accepted:
August 12,
2022
Received in revised form:
June 18,
2022
Received:
December 27,
2021
Identification
Copyright
© 2022 Canadian Diabetes Association.
