Preventive interventions for diabetic foot ulcer adopted in different healthcare settings: A scoping review protocol.

BACKGROUND: Diabetic foot ulcers are challenging to heal, increase the risk of lower extremity amputation, and place a significant burden on patients, families, and healthcare systems. Prioritizing preventive interventions holds the promise of reducing patient suffering, lowering costs, and improving quality of life. This study describes a scoping review protocol that will be used to delineate the preventive interventions for diabetic foot ulcers employed in different healthcare settings. METHODS: The scoping review methodology was formulated in accordance with the PRISMA extension guidelines for scoping reviews and informed by the procedural insights provided by the JBI methodology group. Studies with participants diagnosed with type 1 and type 2 diabetes, aged 18 years or older, without an active ulcer at baseline, and studies of preventive interventions for foot ulcers in various healthcare settings will be screened. The search strategy was developed in collaboration with a research librarian using the PRESS checklist and no time or language limitations were applied. Data will be analyzed and summarized descriptively, including characteristics of studies, participants, and interventions. DISCUSSION: Understanding the strategies and gaps in diabetic foot ulcer prevention is critical. The literature can provide valuable insights for developing tailored interventions and strategies to effectively address these gaps, potentially accelerating progress toward improved outcomes in diabetic foot ulcer prevention. REVIEW REGISTRATION: Open Science Framework DOI 10.17605/OSF.IO/FRZ97 [June 19, 2023].

Photobiomodulation using red and infrared spectrum light emitting-diode (LED) for the healing of diabetic foot ulcers: a controlled randomized clinical trial.

Assessing the responses to the application of photobiomodulation using red and infrared spectrum light-emitting diodes (LED) on diabetic foot ulcers. Diabetic volunteers, of both genders, aged between 30 and 65 years, with grade I or II ulcers, were randomized into the groups: red LED, infrared LED, LED associated, and control. Home-based interventions took place on a daily basis for 12 weeks. Assessments of sample characterization were performed on day 1 and 90, and the variables wound healing index, mean skin temperature, sensitivity and pain in the wound area were measured at the pre-intervention time on days 1, 30, 60 and 90, with subsequent follow-up 30 days after the end of treatment. For statistical analysis, the software SPSS, version 17.0, intention-to-treat analysis, data normality was tested, and the linear mixed effects model, with a significance level of 5%. Magnitudes of clinical effect by Cohen's d. At the pre vs post intervention time of 90 days, we found a large clinical effect of G-LED V (d=1.7) and G -LED IV (d=1.6) in relation to G-C, where these intervention groups showed a tendency for faster wound healing compared to G-C. We also observed small clinical effect of G-LED IV, which showed greater reduction in the area in relation to G-LED V (d=0.4) and G-LED A (d=0.3). Conclusion: The use of individually applied red and infrared LED phototherapy clinically tended to be more effective for the reduction of diabetic foot ulcer areas, and infrared LED was the most effective. Trial registration: NCT03250533 (clinicaltrials.gov).

Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population.

INTRODUCTION: Elevated plantar pressure (PP) constitutes a risk factor for developing foot ulcers. Once present, elevated PP increases morbidity and mortality in patients with diabetes. Given the high prevalence of overweight and obesity in the Mexican population, this study aimed to describe the magnitudes and the distribution of the PP observed in a sample of newly diagnosed patients with diabetes, adjusting for body mass index (BMI) groups (normal weight, overweight, grade I obesity, and grade II and III obesity). MATERIALS AND METHODS: A total of 250 volunteers attending a comprehensive care program for the management of type 2 diabetes received foot assessments that included vascular and neurological evaluation, the identification of musculoskeletal changes, and measurements of PP. RESULTS: Diabetic neuropathy and peripheral arterial disease were present in 21.6% and 11.2% of all participants. Musculoskeletal alterations were present in 70.8% of participants. A positive and significant correlation (p<0.001) was observed between BMI and the peak PP of all anatomical regions assessed. After adjusting for BMI, significant differences (p<0.001) were seen between groups. The metatarsal region, particularly under the third metatarsal head, denoted the highest magnitudes across all BMI. CONCLUSIONS: Periodic PP assessment is recommended to identify the distribution of high-pressure points along the plantar surface. However, as a preventive measure, it is suggested to encourage patients with diabetes and overweight or obesity to wear appropriate footwear and pressure-relief insoles to relieve high-pressure areas - often seen in these populations - to help prevent foot complications.

Quantitative interpretation of infrared images of lower limbs in individuals with and without type 2 diabetes mellitus.

BACKGROUND: The quantitative interpretation of the radiometric information extracted from infrared (IR) images in individuals with and without type 2 diabetes mellitus (DM2) is an open problem yet to be solved. This is of particular value given that DM2 is a worldwide health problem and onset for evolution toward diabetic foot disease (DFD). Since DM2 causes changes at the vascular and neurological levels, the metabolic heat distribution on the outer skin is modified as a consequence of such alterations. Of particular interest in this contribution are those alterations displayed over the skin's heat patterns at the lower limbs. At the core of such alterations is the deterioration of the vascular and neurological networks responsible for procuring systemic thermoregulation. It is within this context that IR imaging is introduced as a likely aiding tool to assist with the clinical diagnosis of DM2 at stages early enough to prevent the evolution of the DFD. METHODS: IR images of lower limbs are acquired from a cohort of individuals clinically diagnosed with and without DM2. Additional inclusion criteria for patients are to be free from any visible wound or tissue-related trauma (e.g., injuries, edema, and so forth), and also free from non-metabolic comorbidities. All images and data are equally processed and analyzed using indices that evaluate the spatial and temporal evolution of temperature distribution in lower limbs. We studied the temporal response of individuals' legs after inducing an external stimulus. For this purpose, we combine the information of the asymmetry and thermal response index (ATR) and the thermal response index (TRI), computed using images at different times, improving the results previously obtained individually with ATR and TRI. RESULTS: A novel representation of the information extracted from IR images of the lower limbs in individuals with and without DM2 is presented. This representation was built using the ATR and TRI indices for the anterior and posterior views (PVs), individually and combining the information from both views. In all cases, the information of each index and each view presents linearity properties that allow said information to be interpreted quantitatively in a well-defined and limited space. This representation, built in a polar coordinate space, allows obtaining sensitivity values of 86%, 97%, and 97%, and specificity values of 83%, 72%, and 78% for the anterior view (AV), the PV, and the combined views, respectively. Additionally, it was observed that the angular variable that defines this new representation space allows to significantly (p < 0.01) differentiate the groups, while correlating with clinical variables of interest, such as glucose and glycated hemoglobin. CONCLUSION: The linearity properties that exist between the ATR and TRI indices allow a quantitative interpretation of the information extracted from IR images of the lower extremities of individuals with and without DM2, and allow the construction of a representation space that eliminates possible ambiguities in the interpretation, while simplifying it, making it accessible for clinical use.

The Effect of Dimple Insole Design on the Plantar Temperature and Pressure in People with Diabetes and in Healthy Individuals.

An increase in plantar pressure and skin temperature is commonly associated with an increased risk of diabetic foot ulcers. However, the effect of insoles in reducing plantar temperature has not been commonly studied. The aim was to assess the effect of walking in insoles with different features on plantar temperature. Twenty-six (F/M:18/8) participants-13 with diabetes and 13 healthy, aged 55.67 ± 9.58 years-participated in this study. Skin temperature at seven plantar regions was measured using a thermal camera and reported as the difference between the temperature after walking with an insole for 20 m versus the baseline temperature. The mixed analyses of variance indicated substantial main effects for the Insole Condition, for both the right [Wilks' Lambda = 0.790, F(14, 492) = 4.393, p < 0.01, partial eta squared = 0.111] and left feet [Wilks' Lambda = 0.890, F(14, 492) = 2.103, p < 0.011, partial eta squared = 0.056]. The 2.5 mm-tall dimple insole was shown to be significantly more effective at reducing the temperature in the hallux and third met head regions compared to the 4 mm-tall dimple insole. The insoles showed to be significantly more effective in the diabetes group versus the healthy group, with large effect size for the right [Wilks' Lambda = 0.662, F(14, 492) = 8.037, p < 0.000, Partial eta-squared = 0.186] and left feet [Wilks' Lambda = 0.739, F(14, 492) = 5.727, p < 0.000, Partial eta-squared = 0.140]. This can have important practical implications for designing insoles with a view to decrease foot complications in people with diabetes.

Effectiveness of negative pressure wound therapy in treating diabetic foot ulcers: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Diabetic foot ulcers (DFUs) present devastating complications. Management of these wounds includes applying a vacuum device composed of a fenestrated tube embedded in a foam dressing and connected to a vacuum pump to collect the fluid in a vessel. OBJECTIVE: To review the effectiveness of negative pressure wound therapy (NPWT) in treating DFUs and evaluate the clinical outcomes of full and partial wound healing. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted after searching the PubMed, Web of Science, and Cochrane Library databases. Studies that described the use of NPWT in the management of DFUs were included and compared with different interventions for the proposed outcomes. RESULTS: A total of 14 studies were included, 1 of which was later excluded during internal validation. Wound healing outcomes were analyzed in 2 studies, showing the superiority of total wound healing in the NPWT group. Ten studies compared the effect of different interventions on wound area reduction and 8 of these results were best with NPWT. Three studies showed clinical and statistical homogeneity (I² = 100%), making it possible to conduct a meta-analysis. CONCLUSION: Although the articles included in this systematic review have limitations regarding methodological quality and clinical heterogeneity, the results showed the potential benefit of NPWT in healing and wound area reduction. These outcomes are essential in the prevention of amputation in patients with DFU.

Factors Associated With Major Lower Extremity Amputations in Diabetic Foot Infections at a County Hospital in Guatemala.

INTRODUCTION: Outcomes from diabetic foot infections (DFIs) at the major referral hospital (Hospital Nacional de San Benito) in El Petén, Guatemala have not been analyzed. We hypothesized that poor diabetic control might be associated with a high rate of major lower extremity amputations (mLEAs; above the ankle). METHODS: We performed a retrospective analysis at Hospital Nacional de San Benito between (8/14 and 6/23) in patients presenting with DFIs. Patients receiving mLEAs were compared with all others (AO = [trans-metatarsal amputations, toe amputations, incision and drainage, and antibiotic treatment]). Interviews surgeons were undertaken to ascertain reasons for index operation choice. Univariable and multivariable analyses were undertaken to determine factors associated with mLEAs. RESULTS: Of 110 patients with DFIs, there were 23 mLEAs (above the knee = 21, below the knee = 2). Age, duration with diabetes, and a prior ipsilateral minor amputation were associated with mLEAs. Multivariable analysis identified white blood cell count as significant for mLEA (odds ratio = 1.5 95% confidence interval [1.0 to 2.5]). Cited reasons for a high rate of above the knee amputation (AKAs) versus below the knee amputation were patient related (advanced disease, patient frailty, and poor compliance), systemic (lack of vascular equipment and knee immobilizer), and surgeon related. CONCLUSIONS: This cohort of patients presented with an average of 15 years with diabetes mellitus and poor adherence to diabetic treatment (40%). Many of these diabetic patients developed a DFI requiring mLEAs (21%), most of which were AKAs (91%). Efforts to minimize the number of AKA versus below the knee amputation require immediate attention. Programs to adhere to DM control and foot care in patients with DM are urgently needed.

Analysis of Circulating miRNA Expression Profiles in Type 2 Diabetes Patients with Diabetic Foot Complications.

Type 2 diabetes mellitus (T2DM) is associated with various complications, including diabetic foot, which can lead to significant morbidity and mortality. Non-healing foot ulcers in diabetic patients are a major risk factor for infections and amputations. Despite conventional treatments, which have limited efficacy, there is a need for more effective therapies. MicroRNAs (miRs) are small non-coding RNAs that play a role in gene expression and have been implicated in diabetic wound healing. miR expression was analyzed through RT-qPCR in 41 diabetic foot Mexican patients and 50 controls. Diabetic foot patients showed significant increases in plasma levels of miR-17-5p (p = 0.001), miR-191-5p (p = 0.001), let-7e-5p (p = 0.001), and miR-33a-5p (p = 0.005) when compared to controls. Elevated levels of miR-17, miR-191, and miR-121 correlated with higher glucose levels in patients with diabetic foot ulcers (r = 0.30, p = 0.004; r = 0.25, p = 0.01; and r = 0.21, p = 0.05, respectively). Levels of miR-17 showed the highest diagnostic potential (AUC 0.903, p = 0.0001). These findings underscore the possible role of these miRs in developing diabetes complications. Our study suggests that high miR-17, miR-191, and miR-121 expression is strongly associated with higher glucose levels and the development of diabetic foot ulcers.

Diretrizes para autocuidado do diabetes módulo 1: cuidados dos pés

Problemas nos pés são comuns em pessoas com diabetes. Isto ocorre porque um nível elevado de açúcar no sangue (hiperglicemia) sustentado por um longo período de tempo pode danificar os nervos, especialmente nas pernas e pés (neuropatia periférica diabética) e na circulação sanguínea. Esta publicação, que descreve um elemento-chave no cuidado do diabetes, dirige-se às pessoas com a doença, aos seus familiares e cuidadores. O seu objetivo é contribuir para a autogestão do diabetes, através de algumas recomendações básicas para prevenir o aparecimento de lesões nos pés. Eles não substituem as orientações do médico ou da equipe de saúde, mas podem ajudar a prevenir uma das complicações mais frequentes do diabetes.

Atherogenic markers and 1-year amputation risk in adults with diabetic foot in a tertiary level hospital: A retrospective cohort study.

AIM: To determine the association between atherogenic markers, such as total cholesterol/high density lipoprotein cholesterol ratio (TC/HDL-C), triglycerides/HDL-C ratio (TG/HDL-C), and triglycerides-glucose index (TyG), and the risk of 1-year amputation in adults with diabetic foot in a tertiary level hospital. METHODS: Retrospective cohort study conducted in 162 adult patients with diabetic foot. The outcome was amputation, defined as "primary amputation in patients' clinical history after their first hospitalization due to foot ulcer.". The cutoff point was determined using Youden's J statistic. The relative risk (RR) was presented as an association measure. RESULTS: A TyG index of >9.4 [RR: 1.64 (1.10-2.45)] was associated with a high risk of amputation after 1-year in adults with diabetic foot. However, while a TC/HDL ratio of >4.69 [RR: 1.38 (0.94-2.03)] and a TG/HDL-C ratio > 3.57 [RR: 1.35 (0.89-2.06)] did not show associations with risk of amputation after 1-year. CONCLUSIONS: Only a TyG index of >9.4 was associated with an increased risk of 1-year amputation in adults with diabetic foot. Future studies with larger samples and a longitudinal design may provide more robust evidence and a better understanding of clinical implications.

Affordable web-based foot-ankle exercise program proves effective for diabetic foot care in a randomized controlled trial with economic evaluation.

The aim of this study was to shed light on a crucial issue through a comprehensive evaluation of the cost-effectiveness and cost-utility of a cutting-edge web-based foot-ankle therapeutic exercise program (SOPeD) designed for treating modifiable risk factors for ulcer prevention in individuals with diabetes-related peripheral neuropathy (DPN). In this randomized controlled trial, 62 participants diagnosed with DPN were assigned to the SOPeD software or received usual care for diabetic foot. Primary outcomes were DPN symptoms and severity, foot pain and function, and quality-adjusted life years (QALYs). Between-group comparisons provided 95% confidence intervals. The study also calculated incremental cost-effectiveness and cost-utility ratios (ICERs), analyzed direct costs from a healthcare perspective, and performed a sensitivity analysis to assess uncertainty. The web-based intervention effectively reduced foot pain, improved foot function and showed favorable cost-effectiveness, with ICERs ranging from (USD) $5.37-$148.71 per improvement in different outcomes. There is a high likelihood of cost-effectiveness for improving DPN symptoms and severity, foot pain, and function, even when the minimum willingness-to-pay threshold was set at $1000.00 USD. However, the intervention did not prove to be cost-effective in terms of QALYs. This study reveals SOPeD's effectiveness in reducing foot pain, improving foot function, and demonstrating cost-effectiveness in enhancing functional and clinical outcomes. SOPeD stands as a potential game-changer for modifiable risk factors for ulcers, with our findings indicating a feasible and balanced integration into public health systems. Further studies and considerations are vital for informed decisions to stakeholders and the successful implementation of this preventive program on a larger scale.Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Association of multidrug-resistant bacteria and clinical outcomes in patients with infected diabetic foot in a Peruvian hospital: A retrospective cohort analysis.

OBJECTIVE: To evaluate the association of multidrug-resistant bacteria (MDRB) and adverse clinical outcomes in patients with diabetic foot infection (DFI) in a Peruvian hospital. MATERIALS AND METHODS: This retrospective cohort study evaluated patients treated in the Diabetic Foot Unit of a General Hospital in Lima, Peru. MDRB was defined by resistance to more than two pharmacological groups across six clinically significant genera. The primary outcome was death due to DFI complications and/or major amputation. Other outcomes included minor amputation, hospitalization, and a hospital stay longer than 14 days. Relative risks were estimated using Poisson regression for all outcomes. RESULTS: The study included 192 DFI patients with a mean age of 59.9 years; 74% were males. A total of 80.8% exhibited MDRB. The primary outcome had an incidence rate of 23.2% and 5.4% in patients with and without MDRB, respectively (p = 0.01). After adjusting for sex, age, bone involvement, severe infection, ischemia, diabetes duration, and glycosylated hemoglobin, MDRB showed no association with the primary outcome (RR 3.29; 95% CI, 0.77-13.9), but did with hospitalization longer than 14 days (RR 1.43; 95% CI, 1.04-1.98). CONCLUSIONS: Our study found no association between MDRB and increased mortality and/or major amputation due to DFI complications, but did find a correlation with prolonged hospitalization. The high proportion of MDRB could limit the demonstration of the relationship. It is urgent to apply continuous evaluation of bacterial resistance, implement a rational plan for antibiotic use, and maintain biosafety to confront this threat.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico.

Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

PURPOSE: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. METHODS: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. RESULTS: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). CONCLUSION: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. CLINICAL TRIAL REGISTRATION NUMBER: NCT04246814.

Impact of oral nutritional supplement composition on healing of different chronic wounds: A systematic review.

Chronic wounds are characterized by prolonged non-healing, significantly affecting patients' quality of life. Oral formulas may enhance the wound healing process and contribute to cost reduction in care. This review aimed to evaluate the effects of oral nutritional supplementation on chronic wound healing and provide insights into formula characteristics. A comprehensive search across Cinahl, Embase, PubMed, and Web of Science databases yielded nine studies from the past decade involving 741 patients ages 52 to 81.7 across various care settings: hospitals, long-term care facilities, and home care. Primary wound types included pressure injuries (58%), diabetic foot ulcers (40%), and venous ulcers (2%). The intervention duration ranged from 2 to 16 wk, with sample sizes varying from 24 to 270 patients. Notably, four studies reported a reduction in wound area and an increased healing rate with a hypercaloric, hyperproteic formula enriched with zinc and vitamins A, C, and E. However, two studies found no significant differences compared with control groups. Two other studies investigated a combination of arginine, glutamine, and ß-hydroxy-ß-methylbutyrate; however, they did not yield significant results, and one study favored a hyperproteic formula instead of a hyperproteic formula with arginine. This review provides evidence supporting the potential of oral nutritional supplementation to enhance the healing process of chronic wounds. Based on our findings, a desirable formula should be characterized by a high calorie and protein content and the inclusion of antioxidant micronutrients, including, but not limited to, vitamins A, E, C, and zinc.

Needs and preferences regarding a mobile application to support diabetic foot self-care.

OBJECTIVE: To identify the needs and preferences of individuals with type 2 diabetes regarding the functionalities and characteristics for a mobile application to support foot self-care. METHOD: Qualitative research with 16 individuals diagnosed with type 2 diabetes recruited during clinical care at a university hospital in Porto, Portugal. Data were collected through semi-structured interviews between March and June 2022 and analyzed using inductive content analysis. RESULTS: Three categories and nine subcategories were identified. Categories included informational needs, essential functionalities for foot health self-care, and user-relevant experience. The preference for objective, limited data input, flexible, and customizable applications was an important factor influencing technology engagement. CONCLUSION: The research highlighted a preference for customizable and flexible applications, aiding nurses in creating solutions that transform care delivery and enhance the quality of life for individuals living with diabetes.

Homogenized and Lyophilized Amniotic Membrane Dressings for the Treatment of Diabetic Foot Ulcers in Ambulatory Patients.

BACKGROUND: Diabetic foot ulcers (DFUs) constitute a complication that occurs in 19% to 34% of patients with diabetes mellitus (DM). The aim of this study is to describe median days to healing, average velocity of wound closure, and percentage of wound surface closed at 3, 6, and 12 weeks through the use of homogenized and lyophilized amniotic membrane (hAMpe) dressings for the treatment of DFUs in ambulatory patients. METHODS: An observational, descriptive, longitudinal study was performed. Patients presenting with granulation-based DFU, after proper debridement, were included from August 19, 2021, until July 14, 2023. hAMpe dressings placed every 3 days were used for the treatment of these ulcers. RESULTS: Sixteen patients were included with a mean age of 52.38 (8.07) years. The analyzed lesions were postsurgical ulcers in 15 of the 16 included patients. Median ulcer size was 19.5 cm2 (6.12-36). The median ABI was 1.10 (1-1.14). The median days to healing was 96 (71-170). The median percentage closure of the wound at 3 weeks was 41% (28.9%-55.3%), at 6 weeks it was 68.2% (48.6%-74.2%), and at 12 weeks it was 100% (81%-100%). The average velocity closure was 1.04% per day (95% CI 0.71%-1.31%). It was higher during the closure of the first 50% of the ulcer, 2.12% per day (95% CI 0.16%-4.09%), and decreased from 50% to 25% of the ulcer size to 0.67% per day (95% CI 0.23%-1.10%) and from 25% to closure to 0.47% per day (95% CI 0.14%-0.80%), P < .001. CONCLUSION: These results are difficult to compare to other studies given the higher surface area of the ulcers included in our sample. The development of hAMpe dressings enables patients to apply them without requiring assistance from health care teams and was not associated with any recognized complications.

Intervenções terapêuticas não farmacológicas para o tratamento de úlceras no pé diabético: revisão integrativa / Intervenciones terapéuticas no farmacológicas para el tratamiento de las úlceras diabéticas: revisión integral de la literatura / Non-pharmacological therapeutic interventions for the treatment of diabetic foot ulcers: an integrative literature review

Introdução: As úlceras no pé diabético surgem da interação complexa entreneuropatia periférica e doença arterial periférica, comprometendo a cicatrização após traumas. Objetivo: Explorar a diversidade de intervenções terapêuticas não farmacológicas que têm sido estudadas e avaliadas quanto à sua eficácia e segurança no tratamento de úlceras no pé diabético. Metodologia: Pesquisa do tipo revisão integrativa da literatura. Para obtenção dos resultados foi realizado um levantamento nas plataformas PubMed e Biblioteca Virtual em Saúde. Para elaboração dos resultados foram selecionados 21 artigos. Resultados: As intervenções encontradas foram oxigenoterapia hiperbárica, terapia de feridas por pressão negativa, uso de matriz dérmica, plasma rico em plaquetas, plasma atmosférico frio, tratamentos com curativos especiais e uso de solas rígidas, entre outros. Mostraram uma variabilidade na taxa de cicatrização e no tempo de fechamento da ferida, bem como na melhoria da regeneração tecidual. Conclusão: As pesquisas mostram uma diversidade de intervenções terapêuticas não farmacológicas utilizadas no tratamento de úlceras no pé diabético, ressaltando a necessidade de abordagens individualizadas e mais estudos para determinar a eficácia e segurança de cada intervenção (AU).

Introduction:Diabetic foot ulcers arise from the complex interaction between peripheral neuropathy and peripheral arterial disease, compromising wound healing after traumas. Objective:To explore the diversity of non-pharmacological therapeutic interventions that have been studied and evaluated for their effectiveness and safety in the treatment of diabetic foot ulcers. Methodology: An integrative literature review was conducted. The search for results was performed on the PubMed and Virtual Health Library platforms. Twenty-one articles were selected for result elaboration.Results:The identified interventions included hyperbaric oxygen therapy, negative pressure wound therapy, use of dermal matrix, platelet-rich plasma, cold atmospheric plasma, treatments with special dressings, and the use of rigid soles, among others. They exhibited variability in the healing rate and wound closure time, as well as improvement in tissue regeneration.Conclusion:The research demonstrates a diversity of non-pharmacological therapeutic interventions used in the treatment of diabetic foot ulcers, emphasizing the need for individualized approaches and further studies to determine the effectiveness and safety of each intervention (AU).

Introducción: Las úlceras en el pie diabético surgen de la interacción compleja entre neuropatía periférica y enfermedad arterial periférica, comprometiendo la cicatrización después de traumas.Objetivo: Explorar la diversidad de intervenciones terapéuticas no farmacológicas que han sido estudiadas y evaluadas en cuanto a su eficacia y seguridad en el tratamiento de úlceras en el pie diabético.Metodología: Investigación del tipo revisión integrativa de la literatura. Para obtener los resultados se realizó un estudio en las plataformas PubMed y Biblioteca Virtual en Salud. Para la elaboración de los resultados se seleccionaron 21 artículos. Resultados: Las intervenciones encontradas fueron oxigenoterapia hiperbárica, terapia de heridas por presión negativa, uso de matriz dérmica, plasma rico en plaquetas, plasma atmosférico frío, tratamientos con curativos especiales y uso de suelas rígidas, entre otros. Mostraron una variabilidad en la tasa de cicatrización y en el tiempo de cierre de la herida, así como en la mejora de la regeneración tisular. Conclusión: Las investigaciones muestran una diversidad de intervenciones terapéuticas no farmacológicas utilizadas en el tratamiento de úlceras en el pie diabético, resaltando la necesidad de enfoques individualizados y más estudios para determinar la eficacia y seguridad de cada intervención (AU).

Content analysis of the nursing diagnosis of ineffective peripheral tissue perfusion in patients with diabetic foot.

AIM: To analyse the content of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. DESIGN: A methodological study with a quantitative approach was performed. METHODS: The analysis was performed between January and May 2021 by 34 nurses with clinical/theoretical/research experience with diabetes or nursing diagnoses. These nurses evaluated the relevance, clarity and precision of 12 diagnosis-specific etiological factors, 22 clinical indicators and their conceptual and operational definitions. FINDINGS: All 12 etiological factors analysed were considered relevant to diagnostic identification. However, five showed inconsistencies regarding the clarity or precision of the operational definitions, requiring adjustments. Regarding the 22 clinical indicators evaluated, all of them presented a Content Validity Index (CVI) that was statistically significant. However, in the indicators, the colour does not return to lowered limb after 1 min of leg elevation, and cold foot had Content Validity Index (CVI) <0.9 regarding relevance and accuracy of operational definitions. CONCLUSIONS: Twelve etiological factors and 22 clinical indicators were validated. Thus, this study revealed new and relevant aspects characterising peripheral perfusion in patients with diabetic foot that have not yet been clinically validated. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to support the professional practice of nurses through the early identification of etiological factors and clinical indicators in persons with diabetic foot. As a proposal, we suggest the inclusion of new defining characteristics and related factors for the nursing diagnosis ineffective peripheral tissue perfusion in the NANDA-I taxonomy. IMPACT: The research highlights new and relevant aspects such as etiological factors and clinical indicators to characterise peripheral perfusion in patients with diabetic foot. Based on these findings, clinical validation is recommended to confirm the relevance of the proposed elements in the population studied for greater reliability and improved diagnostic assessment for the professional practice of nurses. REPORTING METHOD: EQUATOR guidelines were adhered to using the GRRAS checklist for reporting reliability and agreement studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.