EDUCATION AND EXERCISE IN THE DIABETIC FOOT
DOI:
https://doi.org/10.19230/jonnpr.4451Abstract
One of the complications that Diabetes Mellitus can present is the diabetic foot, a complication that is associated with high levels of morbidity and mortality as well as significant economic costs for health systems. The risk factors are diabetic neuropathy, peripheral arterial disease and/or anatomical alterations of the foot. One of the final complications is amputations, which occur 15 times more frequently in diabetic patients than in healthy patients.
Objectives: Efficacy of education and self-care by patients with UPD and to assess the effects of exercise in patients with UPD.
Method: Search in the Pubmed database with the terms: “diabetic foot”, “prevention”, “education” and “offloading”.
Results: In 2 studies they did not show data in favor, in the rest they consider that a correct training of the patient and routine self-assessment of their lower extremities can partially prevent the formation of wounds and ulcers. Much heterogeneity of the studies: Adherence, Follow-up (between 6 months to 2 years). The increase in plantar pressure that physical activity can cause is a factor that is generally avoided, however, the work by Morica M. Tran et al. establishes that physical exercise improves ulcer healing, however, it does not specify the type of activity or the time spent. Two other studies assess the indirect effect of exercise on this pathology with notable improvements in the factors predisposing to UPD.
Conclusions: Health professionals should instruct diabetic patients, improving their control capacity, teaching them to identify possible foot problems and motivating them for their prevention. Physical activity should be a priority in the primary prevention of patients at risk of DFU, carried out in a supervised and individualized manner depending on the patient.
Keywords: Diabetes Mellitus; diabetic foot, ulcer, diabetic foot ulcer, prevention, diabetes education.
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References
Federación Internacional de Diabetes. Atlas de Diabetes de las FDI, 8a ed. Bruselas, Bélgica: Federación Internacional de Diabetes; 2017.
Estimaciones mundiales y regionales de prevalencia de la diabetes para 2019 y proyecciones para 2030 y 2045: Resultados del Atlas de Diabetes de la Federación Internacional de Diabetes, 9th Edición
Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 1 de junio de 2012;41(3):384-97.
Lazzarini PA, Pacella RE, Armstrong DG, van Netten JJ. Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med 2018 May 23.
Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. Int Wound J 2016 Oct;13(5):892-903.
Kerr M, Rayman G, Jeffcoate WJ. Cost of diabetic foot disease to the National Health Service in England. Diabet Med 2014 Dec;31(12):1498-1504.
Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N.Engl.J.Med. 2017;376:2367-2375
Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev 2012 Oct;28(7):574-600.
Crawford F, Cezard G, Chappell FM, Murray GD, Price JF, Sheikh A, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess 2015 Jul;19(57):1- 210.
Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of International Working Group on Diabetic Foot (IWGDF). Pak J Med Sci 2013; 29: 730-734
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World Journal of Diabetes. 15 de febrero de 2015;6(1):37-53.
Leone S, Pascale R, Vitale M, Esposito S. [Epidemiology of diabetic foot]. Infez Med 2012; 20 Suppl 1: 8-13
Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 1 de junio de 2012;41(3):384-97.
Bus SA. The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence. Plast Reconstr Surg. 2016;138(3 Suppl):179S-87S.
Morbach S, Furchert H, Groeblinghoff U, Hoffmeier H, Kersten K, Klauke G-T, Klemp U, Roden T, Icks A, Haastert B, Ruemenapf G, Abbas ZG, Bharara M, Armstrong DG. Long-Term Prognosis of Diabetic Foot Patients and Their Limbs. Dia Care. 2012;35(10):2021-2027.
Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Research and Clinical Practice. 2018;142:63-73.
Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, et al. Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review. Diabetes/Metabolism Research and Reviews. 2020;36(S1).
Richter L, Freisinger E, Lueders F, Gebauer K, Meyborg M, Malyar NM. Impact of diabetes type on treatment and outcome of patients with peripheral artery disease. Diab Vasc Dis Res. 2018;15(6):504-510.
Blinc A, Kozak M, Šabovi? M, Boži? Mijovski M, Stegnar M, Poredoš P, Kravos A, Barbi?Žagar B, Stare J, Pohar Perme M. Survival and event-free survival of patients with peripheral artery disease undergoing prevention of cardiovascular disease. Int Angiol. 2017;36(3):216-227.
Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev. 16 de diciembre de 2014;(12)
van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco ICN, et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev. marzo de 2020;36 Suppl 1:e3270.
Crawford F, Nicolson DJ, Amanna AE, Martin A, Gupta S, Leese GP, et al. Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data. Diabetologia. 2020;63(1):49-64.
Ren M, Yang C, Lin DZ, Xiao HS, Mai LF, Guo YC, et al. 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. septiembre de 2014;16(9):576-81.
Moreira JB, Muro ES, Monteiro LA, Iunes DH, Assis BB de, Chaves E de CL. The effect of operative groups on diabetic foot self-care education: a randomized clinical trial. Rev Esc Enferm USP. 2020;54:e03624.
Monami M, Zannoni S, Gaias M, Nreu B, Marchionni N, Mannucci E. Effects of a Short Educational Program for the Prevention of Foot Ulcers in High-Risk Patients: A Randomized Controlled Trial. Int J Endocrinol. 2015;2015:615680.
Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, et al. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technol Assess. noviembre de 2020;24(62):1-198.
Tran MM, Haley MN. Does exercise improve healing of diabetic foot ulcers? A systematic review. J Foot Ankle Res. 20 de marzo de 2021;14(1):19.
Francia P, Bellis AD, Seghieri G, Tedeschi A, Iannone G, Anichini R, et al. Continuous Movement Monitoring of Daily Living Activities for Prevention of Diabetic Foot Ulcer: A Review of Literature. Int J Prev Med. 2019;10:22.
Francia P, Gulisano M, Anichini R, Seghieri G. Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment. Curr Diabetes Rev. marzo de 2014;10(2):86-99.
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