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Clin Podiatr Med Surg ; 36(3): 355-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079602


Diabetes mellitus is an international epidemic. In the United States, the prevalence of diabetes has increased from estimates in 1990 when 6.5% of the population was affected and 6.2 million people had diabetes compared with the estimates in 2017 with 24.7 million people with diabetes or accounting 9.6% of the adult population. The diabetic foot syndrome manifests as a combination of diabetes-related diseases including diabetic sensory neuropathy, limited joint mobility, immunopathy, peripheral arterial disease, foot ulceration, and Charcot arthropathy. The culmination of these provides an ideal environment for unrecognized tissue injury that leads to ulceration, infection, infection, and amputation.

Diabetes Mellitus/epidemiologia , Pé Diabético/prevenção & controle , Amputação/estatística & dados numéricos , Diabetes Mellitus/economia , Pé Diabético/complicações , Neuropatias Diabéticas/complicações , Humanos , Equipe de Assistência ao Paciente , Prevalência , Estados Unidos/epidemiologia
Clin Podiatr Med Surg ; 36(3): 371-379, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079604


The etiology of ulcerations in diabetes mellitus is associated with the presence of peripheral sensory neuropathy and repetitive trauma due to normal walking activities to areas on the foot that are subject to moderate or high pressures and shear. The combination of loss of protective sensation, deformity, and repetitive trauma is the perfect storm for ulcer development. Once an ulcer is developed, the most important part of the healing process is offloading the ulcer site. Offloading is the mainstay of healing neuropathic ulcers.

Pé Diabético/prevenção & controle , Órtoses do Pé , Sapatos , Pé Diabético/etiologia , Neuropatias Diabéticas/complicações , Desenho de Equipamento , Humanos
Diabetes Res Clin Pract ; 152: 29-38, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082445


AIMS: To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS: A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS: The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS: The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.

Diabetes Mellitus Tipo 2/terapia , Pé Diabético/prevenção & controle , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Idoso , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Pé/patologia , Comportamentos Relacionados com a Saúde/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Método Simples-Cego
J Foot Ankle Res ; 12: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923577


Background: Aboriginal and Torres Islander Australians experience considerably higher rates of diabetes and diabetes related foot complications and amputations than non-Indigenous Australians. Therefore there is a need to identify aspects of Aboriginal and Torres Islander focussed foot health programs that have had successful outcomes in reducing diabetes related foot complications. Wider knowledge and implementation of these programs may help reduce the high burden of diabetes related foot disease experienced by Aboriginal and Torres Islander Australians. Methods: PubMeD, Informit Indigenous collection, CINAHL, SCOPUS, the Cochrane Library and grey literature sources were searched to 28th August 2018. We included any published reports or studies of stand-alone diabetes related foot care interventions, programs, services, educational resources or assessment of these interventions, designed for Aboriginal and Torres Strait Islander Australians. Results: Thirteen studies detailing interventions in the Northern Territory, New South Wales, Queensland and Western Australia met the inclusion criteria. Five reports described delivery of podiatry services while the other eight investigated educational and training programs. Half of the reports related to aspects of the Indigenous Diabetic Foot program which provides culturally appropriate foot education and training workshops for health care providers. One article reported quantitative data related to clinical patient outcome measures. Conclusions: No state- or nation-wide foot health programs for prevention of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians were identified. One program achieved high adherence to the national guidelines regarding timing of podiatry review treatments through use of an evidence based foot risk classification tool and provision of services in a culturally appropriate centre.

Pé Diabético/etnologia , Pé Diabético/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Podiatria/organização & administração , Austrália/epidemiologia , Assistência à Saúde/organização & administração , Humanos , Grupo com Ancestrais Oceânicos/educação , Educação de Pacientes como Assunto/organização & administração , Serviços Preventivos de Saúde/organização & administração
J Foot Ankle Res ; 12: 2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636974


Background: Diabetic foot ulceration is a considerable cost to the NHS and foot orthotic provision is a core strategy for the management of the people with diabetes and a moderate to high risk of foot ulceration. The traditional process to produce a custom-made foot orthotic device is to use manual casting of foot shape and physical moulding of orthoses materials. Parts of this process can be undertaken using digital tools rather than manual processes with potential advantages. The aim of this trial was to provide the first comparison of a traditional orthoses supply chain to a digital supply chain over a 6 month period. The trial used plantar pressure, health status, and health service time and cost data to compare the two supply chains. Methods: Fifty-seven participants with diabetes were randomly allocated to each supply chain. Plantar pressure data and health status (EQ5D, ICECAP) was assessed at point of supply and at six-months. The costs for orthoses and clinical services accessed by participants were assessed over the 6 months of the trial. Primary outcomes were: reduction in peak plantar pressure at the site of highest pressure, assessed for non-inferiority to current care. Secondary outcomes were: reduction in plantar pressure at foot regions identified as at risk (> 200 kPa), cost-consequence analysis (supply chain, clinician time, service use) and health status. Results: At point of supply pressure reduction for the digital supply chain was non-inferior to a predefined margin and superior (p < 0.1) to the traditional supply chain, but both supply chains were inferior to the margin after 6 months. Custom-made orthoses significantly reduced pressure for at risk regions compared to a flat control (traditional - 13.85%, digital - 20.52%). The digital supply chain was more expensive (+£13.17) and required more clinician time (+ 35 min). There were no significant differences in health status or service use between supply chains. Conclusions: Custom made foot orthoses reduce pressure as expected. Given some assumptions about the cost models we used, the supply chain process adopted to produce the orthoses seems to have marginal impact on overall costs and health status. Trial registration: Retrospectively registered on ISRCTN registry (ISRCTN10978940, 04/11/2015).

Pé Diabético/prevenção & controle , Órtoses do Pé , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/economia , Feminino , Órtoses do Pé/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Desenho de Prótese/métodos , Qualidade de Vida , Sapatos , Medicina Estatal/economia
Diabetes Metab Syndr ; 13(1): 78-83, 2019 Jan - Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30641806


OBJECTIVE: To assess the role of ABI and TBI in the detection of ulcer wounds among diabetic patients. METHODS: A retrospective approach is used to enroll 192 diabetic patients to detect their ulcer wounds using ABI and TBI index. HbA1c and lipid profile were other important variables in determining the efficacy of screening test. Frequency analysis and Pearson Correlation were used to analyze the data through SPSS. FINDINGS: The results have shown that 57.1% male and 42.9% female were treated in <0.60 ABI group; 67.4% male and 32.6% female were treated in 0.60-0.90 ABI group; 65.9% male and 34.1% female were treated in 0.90-1.30 ABI group; and 63.8% male and 36.2% female were treated in >1.30 ABI group. The correlation showed insignificant association between ABI and ulcer outcomes, but significant association between TBI and ulcer outcomes at 5% level of significance. CONCLUSION: The study concluded that ABI should be based on standardized normal values to be used as an effective biomarker in screening diabetic foot ulcer patients.

Índice Tornozelo-Braço , Pé Diabético/prevenção & controle , Dedos do Pé/irrigação sanguínea , Cicatrização , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos
Rev. chil. cir ; 70(6): 535-543, dic. 2018. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-978027


Resumen Las úlceras del pie diabético son el principal factor de riesgo para las amputaciones no traumáticas en personas con diabetes. El éxito de la intervención requiere un completo entendimiento de la patogénesis y una implementación oportuna y estandarizada de un tratamiento efectivo. Es necesario un enfoque multidisciplinario para inicialmente controlar y tratar múltiples factores causantes de la ulceración severa del pie diabético. El desbridamiento, control de la infección y revascularización son pasos clave para la estabilización de la herida y su preparación para una reconstrucción exitosa. La microcirugía y supermicrocirugía permite proporcionar un tejido bien vascularizado para controlar la infección, un contorno adecuado para el calzado, durabilidad y anclaje sólido para resistir las fuerzas de cizallamiento durante la marcha. De esta manera, se puede lograr el salvataje de la extremidad, mejorando la calidad de vida y aumentando la sobrevida.

Diabetic foot ulcers are the main risk factor for non-traumatic amputations in people with diabetes. A succesful intervention requires a thorough understanding of the pathogenesis and a timely and standardized implementation of an effective treatment. A multidisciplinary approach is needed to initially control and treat multiple factors that cause severe diabetic foot ulceration. Debridement, infection control, and revascularization are key steps in wound stabilization and preparation for successful reconstruction. Microsurgery and supermicrosurgery provide a well-vascularized tissue to control infection, an adequate shoe contour, durability and solid anchorage to resist shearing forces during gait. In this way, the salvage of the limb can be achieved, improving the quality of life and increasing the survival rate.

Humanos , Pé Diabético/cirurgia , Pé Diabético/complicações , Pé Diabético/prevenção & controle , Medicina Regenerativa/métodos , Fatores de Risco , Guia de Prática Clínica , Pé Diabético/etiologia , Extremidade Superior/cirurgia , Comunicação Interdisciplinar , Diagnóstico Precoce
Rev. cuba. endocrinol ; 29(3): 1-9, set.-dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-978396


El síndrome del pie diabético constituye una de las complicaciones crónicas más temidas de la diabetes mellitus. En cuanto a su tratamiento, lo ideal sería prevenir su aparición actuando sobre los factores de riesgo de la úlcera del pie diabético. Sin embargo, una vez que el síndrome está presente, se reconoce la importancia que tiene para garantizar la cura de la úlcera y evitar el agravamiento de esta complicación, incluida la amputación de miembros inferiores, instaurar un tratamiento integral que se extienda más allá de la atención podálica, encaminado tanto a educar y apoyar al paciente, como a lograr un control glucémico óptimo y a atender los factores de riesgo vascular. Acerca del tratamiento integral y ampliado del síndrome del pie diabético trata esta revisión(AU)

Diabetic foot syndrome is one of the most feared chronic complications of diabetes mellitus. In terms of its treatment, the ideal thing to do would be to prevent its appearance by acting upon the risk factors for diabetic foot ulceration. However, once the syndrome is present, comprehensive treatment should be applied which extends beyond podiatric care and is geared to educate and support patients as well as achieve optimal glycemic control and ensure attention to vascular risk factors, so as to make sure ulceration is healed, thus preventing the worsening of this complication, which might otherwise lead to lower limb amputation. The present review deals with the comprehensive broadened treatment of diabetic foot syndrome(AU)

Humanos , Fatores de Risco , Pé Diabético/complicações , Pé Diabético/prevenção & controle , Pé Diabético/terapia
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(8): 438.e1-438.e10, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176284


Antecedentes y objetivo: El objetivo de este estudio fue evaluar qué factores de riesgo se asociaban con la reulceración en el pie diabético después de la implementación de un nuevo programa preventivo de cuidado integrado del pie (CIP), desarrollado por un podólogo y un endocrinólogo en una unidad multidisciplinar de pie diabético y su impacto potencial en reducir la tasa de reulceración. Material y métodos: Estudio de cohortes y retrospectivo que incluyó de manera consecutiva a pacientes que consultaron por primera vez por una úlcera de pie diabético durante el período 2008-2014, y que se resolvió mediante cicatrización. Los sujetos fueron seguidos hasta la reulceración o en su defecto hasta el 30 de junio de 2016, con un máximo de 8,1 años. Se analizó la incidencia acumulada de reulceraciones durante el período 2008-2010 (antes del CIP) y 2011-2014 (tras la implementación del CIP). Resultados: Se incluyeron 280 sujetos, mediana de edad 69,5 años (P25: 60,2-P75:78); 64,6% varones y 92,1% tenían diabetes tipo 2. Ciento veintiséis (45%) se reulceraron. La mediana hasta la reulceración fue de 0,97 (P25:0,44-P75:1,74) años. El análisis multivariante demostró que la neuropatía sensitiva (HR [IC 95%] 1,58 [0,99-2,54] p=0,050); amputación menor (HR [IC 95%] 1,66 [0,12-2,46] p=0,011); y período 2011-2014 versus 2008-2010 (HR [IC 95%] 0,60 [0,42-0,87] p=0,007) se asociaron independientemente a la reulceración. Conclusiones: Los factores predictivos para reulceración fueron neuropatía sensitiva, amputación menor y la implementación del programa de CIP. La implementación del CIP se asoció con una reducción del 40% en la reulceración. La prevención de la reulceración es factible y debiera ser prioritaria en una unidad multidisciplinar de pie diabético

Background and objective: The aim of this study was to assess the risk factors associated to recurrent diabetic foot ulcers after implementing a new preventive comprehensive foot care (CFC) program carried out by a podiatrist and an endocrinologist at a multidisciplinary diabetic foot unit (MDFU) and its potential impact in decreasing recurrent ulcers. Material and methods: A retrospective cohort study including consecutive patients who attended the MDFU for the first time from 2008 to 2014 complaining of a diabetic foot ulcer that finally healed. Patients were monitored until ulcer recurred or up to June 30, 2016. Maximum follow-up time was 8.1 years. Cumulative incidence of recurrent ulcers was analyzed during two periods: 2008-2010 (before CFC was implemented) and 2011-2014 (after implementation of CFC). Results: A total of 280 subjects with a median age of 69.5 years (Q25:60,2-Q75:78) were included. Of these, 64.6% were males and 92.1% had type 2 diabetes mellitus. One hundred and twenty-six (45%) suffered recurrent ulcers. Median time to recurrent ulceration was 0.97 (Q25:0.44-Q75:1.74) years. Multivariate analysis showed sensory neuropathy (HR [95% CI] 1.58 [0.99-2.54], P=.050); minor amputation (HR [95% CI] 1.66 [0.12-2, 46], P=.011); and 2011-2014 period versus 2008-10 period (HR [95% CI] 0.60 [0.42-0.87], P=.007) to be factors independently associated to recurrent ulcers. Conclusions: Sensory neuropathy, minor amputation, and implementation of the CFC program were predictors of reulceration. Implementation of the CFC program was associated to a 40% reduction in reulceration. Prevention of recurrent ulcers is feasible and should be a priority in a MDFU

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/complicações , Úlcera do Pé/epidemiologia , Pé Diabético/prevenção & controle , Fatores de Risco , Estudos de Coortes , Estudos Retrospectivos , Diabetes Mellitus Tipo 2/patologia
Rev. pesqui. cuid. fundam. (Online) ; 10(4): 919-925, out.-dez. 2018. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-915523


Objetivo: Identificar a prevalência de fatores de risco para o desenvolvimento de pé diabético. Métodos: Estudo descritivo, com abordagem quantitativa, realizado junto a 71 indivíduos com diabetes mellitus tipo 2 cadastrados em uma Unidade de Saúde da região noroeste do Paraná. Os dados foram coletados por meio de entrevista e exame clínico dos pés e analisados por meio de estatística descritiva. Resultados: Os fatores de risco mais prevalentes para o desenvolvimento de pé diabético foram: pele ressecada (78,9%), utilização de calçados inadequados diariamente (70,4%), rachadura nos pés (60,6%) e presença de calosidade (56,3%). A prevalência do pé de risco para ulceração foi de 35,2%, predominando alterações grau 2 (33,8%). Conclusão: O exame clínico dos pés deve fazer parte da consulta de Enfermagem ao indivíduo com diabetes, para que seja possível a identificação precoce de fatores de risco e posterior planejamento de ações de cuidado

Objective: To identify the prevalence of risk factors for the development of diabetic foot. Methods: A descriptive study, with a quantitative approach, carried out among 71 individuals with type 2 diabetes mellitus enrolled in a Health Unit in the northwestern region of Paraná. Data were collected through interviews and clinical examination of the feet and analyzed using descriptive statistics. Results: The most prevalent risk factors for diabetic foot development were: dry skin (78.9%), inadequate footwear daily use (70.4%), foot crack (60.6%) and presence of Callosity (56.3%). The prevalence of foot ulceration risk was 35.2%, with grade 2 abnormalities predominating (33.8%). Conclusion: Clinical examination of the feet should be part of the nursing visit to the individual with diabetes, so that early identification of risk factors and subsequent planning of care actions may be possible

Objetivo: Identificar la prevalencia de factores de riesgo para el desarrollo de pie diabético. Métodos: Se realizó un estudio descriptivo con um enfoque cuantitativo, realizado con 71 sujetos con diabetes tipo 2 inscritos en una Unidad de Salud de la región noroeste de Paraná. Los datos fueron recolectados a través de entrevistas y el examen clínico del pie y se analizaron mediante estadística descriptiva. Resultados: Los factores de riesgo para el desarrollo de pie diabético más prevalentes fueron: piel seca (78,9%), el uso de zapatos inadecuados al día (70,4%), pies (60,6%) y la presencia de grietas callosidades (56,3%). La prevalencia de riesgo de ulceración del pie fue del 35,2%, predominantemente de grado 2 cambios (33,8%). Conclusión: El examen clínico de los pies debe ser parte de la consulta de enfermería a la persona con diabetes para que la identificación temprana de los factores de riesgo y la posterior planificación de las acciones de atención posibles

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pé Diabético/complicações , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Diabetes Mellitus/enfermagem , Fatores de Risco
Singapore Med J ; 59(6): 291-294, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29974120


This paper discussed the importance of prevention of diabetic foot ulcers and our institution's protocol for prevention, reviewing the existing evidence in the literature regarding the effectiveness of the preventive approach. Diabetes mellitus is the second most significant cause of disease in Singapore after ischaemic heart disease. National University Hospital, Singapore, adopts a two-pronged strategy for the management of diabetic foot ulcers. The most important strategy is prevention, and education is key. Education should mainly be directed at patients and caregivers, but also professionals (general practitioners, allied health professionals and nurses) so that they can effectively educate patients and caregivers. Patient education includes care of diabetes mellitus, care of the foot and use of appropriate footwear. Patients also tend to have poor foot hygiene. Annual foot screening for diagnosed diabetics plays an important role. However, prolonged and sustained government intervention is necessary to provide education and screening on a national scale.

Complicações do Diabetes/prevenção & controle , Pé Diabético/prevenção & controle , Educação de Pacientes como Assunto/métodos , Algoritmos , Cuidadores , Complicações do Diabetes/diagnóstico , Pé Diabético/diagnóstico , , Hospitais Universitários , Humanos , Medicina Preventiva , Fatores de Risco , Singapura
Int J Low Extrem Wounds ; 17(2): 125-129, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30012065


High plantar pressure as a result of diabetic peripheral neuropathy is often reported as a major risk factor for ulceration. However, previous studies are confined to laboratories with equipment limited by cables, reducing the validity of measurements to daily life. The participant concerned in this case report was wearing an innovative plantar pressure feedback system as part of a wider study. The system allows for continuous plantar pressure monitoring and provides feedback throughout all activities of daily living. The participant concerned was a 59-year-old male with type 2 diabetes who presented with severe peripheral neuropathy. In addition, the right ankle had previously undergone fusion. Between monthly study appointments, the participant unknowingly had a screw embedded in his right shoe, while pressure was being recorded. Although no significant differences in pressure were present for the right foot with the embedded screw, the contralateral foot showed significantly higher pressure when the screw was embedded, compared with pre and post time periods. The increase in pressure on the contralateral foot is expected to result from the protrusion of the screw in the right shoe, causing a perturbation to balance and a shift in the center of pressure toward the contralateral side. This compensatory effect is likely to have been magnified by the limited mobility of the fused right ankle. These findings highlight the importance of checking both feet for ulcer risk, in the event of receiving high-pressure feedback. This innovative technology may improve our understanding of diabetic plantar foot ulcer development.

Atividades Cotidianas , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/prevenção & controle , Neuropatias Diabéticas , Monitorização Fisiológica , Pressão/efeitos adversos , Pé Diabético/etiologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/etiologia , Neuropatias Diabéticas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Reprodutibilidade dos Testes
Rev. enferm. UFPE on line ; 12(7): 2021-2030, jul. 2018. ilus, graf, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-986849


Objetivo: identificar os critérios de avaliação dos pés da pessoa com Diabetes Mellitus. Método: revisão integrativa com busca nas bases de dados MEDLINE, LILACS, Cochrane, SCOPUS e biblioteca virtual SciELO, com delimitação temporal entre 2011 e 2017 e amostra final de 16 artigos categorizados em anamnese, avaliação da pele e anexos, avaliação neurológica, avaliação vascular, avaliação anatômica dos pés e autocuidado. Resultados: a maioria dos artigos foi de 2013, com nível de evidência II. A categoria anamnese compreendeu questões sociodemográficas e clínicas e a categoria avaliação da pele e anexos contemplou as afecções de pele, unhas, pelos e espaços interdigitais. Na categoria avaliação neurológica, predominou o teste com monofilamento Semmes-Weinstein 10g para a avaliação da sensibilidade tátil. Na avaliação vascular, destacou-se a palpação dos pulsos pediosos e tibiaisposteriores. Na categoria avaliação anatômica dos pés, apenas dois artigos retrataram o tipo de deformidade pesquisada e em quatro estudos foram realizadas orientações de autocuidado. Conclusão: Em síntese, o estudo permitiu extrair indicadores importantes para a avaliação dos pés e observou-se consonância entre as pesquisas analisadas com o que é recomendado.(AU)

Humanos , Masculino , Feminino , Exame Físico , Fatores de Risco , Pé Diabético , Pé Diabético/prevenção & controle , Diabetes Mellitus , Avaliação de Sintomas , Autocuidado , MEDLINE , Anamnese
J Foot Ankle Res ; 11: 22, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29854007


Background: Thermal imaging is a useful modality for identifying preulcerative lesions ("hot spots") in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet. Methods: Plantar skin foot temperatures were measured with the novel thermal imaging device (Diabetic Foot Ulcer Prevention System (DFUPS), constructed by Photometrix Imaging Ltd) and also with a hand-held infrared spot thermometer (Thermofocus® 01500A3, Tecnimed, Italy) after 20 min of barefoot resting with legs supported and extended in 105 subjects (52 males and 53 females; age range 18 to 69 years) as part of a multicentre clinical trial. The temperature differences between the right and left foot at five regions of interest (ROIs), including 1st and 4th toes, 1st, 3rd and 5th metatarsal heads were calculated. The intra-instrument agreement (three repeated measures) and the inter-instrument agreement (hand-held thermometer and thermal imaging device) were quantified using intra-class correlation coefficients (ICCs) and the 95% confidence intervals (CI). Results: Both devices showed almost perfect agreement in replication by instrument. The intra-instrument ICCs for the thermal imaging device at all five ROIs ranged from 0.95 to 0.97 and the intra-instrument ICCs for the hand-held-thermometer ranged from 0.94 to 0.97. There was substantial to perfect inter-instrument agreement between the hand-held thermometer and the thermal imaging device and the ICCs at all five ROIs ranged between 0.94 and 0.97. Conclusions: This study reports the performance of a novel thermal imaging device in the assessment of foot temperatures in healthy volunteers in comparison with a hand-held infrared thermometer. The newly developed thermal imaging device showed very good agreement in repeated temperature assessments at defined ROIs as well as substantial to perfect agreement in temperature assessment with the hand-held infrared thermometer. In addition to the reported non-inferior performance in temperature assessment, the thermal imaging device holds the potential to provide an instantaneous thermal image of all sites of the feet (plantar, dorsal, lateral and medial views). Trial registration: Diabetic Foot Ulcer Prevention System NCT02317835, registered December 10, 2014.

Pé/fisiologia , Temperatura Cutânea/fisiologia , Termografia/métodos , Adolescente , Adulto , Idoso , Pé Diabético/diagnóstico , Pé Diabético/prevenção & controle , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Reprodutibilidade dos Testes , Termômetros , Adulto Jovem
Wounds ; 30(4): E44-E48, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29718822


INTRODUCTION: Diabetic foot ulcers (DFUs) are associated with increased morbidity, mortality, and resource utilization. Remote temperature monitoring (RTM) is an evidence-based and recommended component of standard preventative foot care for high-risk populations that can detect the inflammation preceding and accompanying DFUs. OBJECTIVE: This case series illustrates the use of a RTM foot mat for the early detection and prevention of DFUs in patients with a history of DFUs. MATERIALS AND METHODS: Three patients with a history of diabetes, neuropathy, and DFUs were provided a RTM foot mat and instructed in its daily use. Persistent localized temperature differences exceeding 1.75˚C between the left and right feet prompted the clinical staff to call the patient to collect subjective history for further triage. RESULTS: Each patient presented with persistent temperature differences exceeding 1.75˚C. In one case, the patient was instructed to offload, and during a subsequent clinical exam, a callus was debrided and accommodative insoles were issued, resulting in resolution of the temperature differences. In the other 2 cases, the RTM foot mat prompted communication with and examination of the patient when there was damaged tissue deep to callus, resulting in early detection and treatment of uninfected DFUs. CONCLUSIONS: The findings of this case series are consistent with literature supporting the use of RTM for high-risk patients.

Temperatura Corporal/fisiologia , Pé Diabético/fisiopatologia , Termometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/prevenção & controle , Desenho de Equipamento , Medicina Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Educação de Pacientes como Assunto , Valor Preditivo dos Testes
J Foot Ankle Res ; 11: 12, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29636823


Background: The purpose of this study is to document what and how diabetes specific foot health information was provided during a podiatry consultation, and what information was retained at 1 month post consultation. Methods: This project was embedded within a prospective cohort study with two groups, podiatrists and people with diabetes. Data collection included the Problem Areas in Diabetes Questionnaire (PAID), Montreal Cognitive Assessment (MoCA), information covered during the consultation, method of delivery and perceived key educational message from both participant perspectives at the time of the appointment and 1 month post appointment. Results: There were three podiatrists and 24 people with diabetes who provided information at the two time points. Diabetes education provided by the podiatrists was mostly verbal. The key educational message recalled by both groups differed at the time of the appointment (14 out of 24 of responses) and at 1 month post the appointment time (11 out of 24 of responses). Conclusions: Education is a vital component to the treatment regime of people with diabetes. It appears current approaches are ineffective in enhancing understanding of diabetes impact on foot health. This study highlights the need for research investigating better ways to deliver key pieces of information to this population.

Pé Diabético/prevenção & controle , Rememoração Mental , Educação de Pacientes como Assunto/normas , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Podiatria/normas , Autocuidado , Vitória
Diabetes Care ; 41(4): 645-652, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29559450


Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.

Procedimentos Clínicos , Assistência à Saúde , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Assistência à Saúde/economia , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Pé Diabético/economia , Pé Diabético/epidemiologia , Geografia , Custos de Cuidados de Saúde , Humanos , Incidência , Medicina Preventiva/economia , Medicina Preventiva/métodos , Medicina Preventiva/organização & administração , Medicina Preventiva/normas , Melhoria de Qualidade , Resultado do Tratamento
PLoS One ; 13(3): e0192417, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29534070


BACKGROUND: Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. METHODS: A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. RESULTS: 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). CONCLUSION: The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12616000210471.

Diabetes Mellitus/terapia , Pé Diabético/prevenção & controle , Promoção da Saúde/métodos , Autocuidado/métodos , Autoeficácia , Idoso , Feminino , Educação em Saúde/métodos , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida