Diabetic Foot: Prevention and Treatment

Guideline to Preventing Diabetic Foot

Tobin and Kennedy wrote the article, A Health Care Provider’s Guide to Preventing Diabetes Foot Problems in 2009 in collaboration with the National Institute of Health, the Centers for Disease Control and Prevention, and joint efforts of other partners in the health care system. The study aimed at enhancing awareness of diabetes mellitus and diabetic foot in the population by providing guidelines that are imperative in the prevention and management of diabetic conditions. In 1996, statistical studies carried out in the United States showed that about 86,000 patients with diabetes developed diabetic feet, which forced them to undergo amputation. Following the statistics, Tobin and Kennedy realized that, “diabetes is the leading cause of amputation of lower limbs, yet it is clear that as many as half of these amputations might be prevented through simple but effective foot care practices” (2009, p.6). For effective foot care practices to occur in the health care institutions and the population, comprehensive education was imperative.

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The research focused on educating both the health care professionals and the patients on the need to reverse the increasing trends of diabetes mellitus and diabetic foot in the population. The health care professionals in various institutions filled out questionnaires to show whether their diabetic patients had any education concerning their conditions. Findings revealed that, only 55% of the diabetic patients were aware of prevention, treatment, and management measures of their diabetic conditions (Tobin & Kennedy, 2009, p.23). The research proposed that comprehensive education of diabetic patients would effectively reduce the incidences in the population and encourage patients to seek health care services. The strength of the research is that health care professionals filled medical details of the diabetic patients in the questionnaires and the weakness is that the data collected is partial because it only focused on the diagnosed patients who attend various health care institutions leaving many who are in the population.

Prevention of Diabetic Foot Development

According to the article, Draft Program of Prevention of Diabetic Foot Development and Lower Extremity Amputation in Persons with Diabetes Mellitus, which was completed in 2005 by Poljicanin, Pavlic-Renar, Metelko, and Coce, 40-60% of amputations occur in patients with diabetes mellitus, while over 85% are due to diabetic foot. Due to high incidences of amputations, the objective of the research was to enhance health care practices of prevention and management of diabetic conditions through comprehensive education of patients at specific clinics with the aim of reducing amputations by 50% within five years. Research carried extensive education on the regular patients and those on first diagnosis of diabetic conditions. Poljicanin, Pavlic-Renar, Metelko, & Coce argue that, the objective of extensive education program is “to enhance the patients’ motivation and to improve their skills in diabetic foot care …the patient should be educated on how to recognize the potential foot problems and undertake necessary measures in case these occur” (2005, p.47). The extensive education provided the patients with healthy skills of managing diabetes mellitus and prevention of diabetic foot.

The research planned to conduct yearly assessments of patients through the five-year period. The level of glucose in the blood was the parameter that showed the extent of managing diabetes mellitus while the occurrence of diabetic foot and other complications depicted the degree of prevention of the diabetic conditions. The weakness of the research is that it only concentrated its studies in one clinical center making it have low external variability. The strength of the research is that it took a period of five years thus enhancing the credibility of its findings by eliminating possible extraneous variables.

Prevention and Treatment of Diabetic Foot

Ortegon, Redekop, and Nissen wrote the article, Cost-Effectiveness of Prevention and Treatment of Diabetic Foot: a Markov Analysis in 2004. The objective of the study was to ascertain the cost-effectiveness of standard guidelines in prevention and treatment of the diabetic conditions. According to Ortegon, Redekop, and Nissen “management of the diabetic foot according to guideline-based care improves survival, reduces diabetic foot complications, and is cost-effective and even cost-saving compared with standard care” (20004, p. 901). The research employed Markov model by carrying out prospective studies of patients, newly diagnosed with diabetes mellitus and managed through guideline-based care of optimal foot care and intensive glycemic control. The research assessed occurrence of foot complications, quality of health, costs of managing diabetic conditions and survival of period of patients as the outcomes of prospective management of diabetic conditions.

The research suggested that intensive education of patients using guideline-based care is very effective in the prevention and reduction of incidences of diabetic conditions. Ortegon, Redekop, and Nissen argue that “intensive glycemic control and optimal foot care reduces foot ulcers and amputations, and leads to an improvement in life expectancy” (2004, p.904). Since the research is a prospective study that examined and assessed lives of patients, it has strong external validity but its weakness is that, it used estimates of health and economic costs in determining the effectiveness of preventive and management measures.

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Prevention and Early Intervention

Prevention and Early Intervention for Diabetes Foot Problems: A Research Review is a 2009 article by Corken in collaboration with American Association of Diabetes Educators. The purpose of the research was to explore various preventive measures that are critical in reduction of diabetic conditions in the population. Corken argues that, the key preventive measures “…include: an annual examination of the feet by health care providers to determine risk factors for ulceration; subsequent exams of high-risk feet at each patient visit; patient education about daily self-care of the feet; and careful glucose management” (2009, p.4). The research carried out patient-intensive education that significantly enhanced patients’ compliance with the preventive, treatment and management measures thus reducing the incidences of diabetic conditions. The weakness of the study is that it only screened diabetic patients for ulceration leaving the entire population undiagnosed for diabetes, but its strengths lie in comprehensive education of diabetic patients and subsequent assessment, which increase external validity.

Prevention and Management

O’Bryan and Caputo wrote the article, Prevention and Management of Common Diabetic Foot Problems in 2008. The article seeks to demonstrate that preventive and management measures of diabetic conditions can effectively reduce the incidences of diabetic conditions in the population. The study used four patients to demonstrate effective management of diabetes mellitus and diabetic foot. O’Bryan and Caputo argue that “the program for prevention should include foot self-care education for the patient, periodic professional foot care and proper foot wear” (2008, p.2). The results of the research revealed that proper management of the diabetic patients through education and enhanced health care services are critical in the prevention of diabetic conditions. Intensive education enhances patient awareness of their health condition and therefore, they are able to make informed decisions regarding the kind of lifestyles they are living.

The strength of the research is that it is a prospective study, which enhances the internal validity of the findings since examination of patients over long period reduces extraneous influence of confounding factors. The weakness of the research lies in the fact that it has weak external validity because the findings from the four patients are not credible to allow generalizability of the findings. More patients are necessary to enhance external validity of the research.

Foot Care

Kandel, in conjunction with the American Association of diabetes, wrote the article, Take Care of Your Feet for a Life Time in 2000. The objective of the study was to establish the extent of reducing incidences of diabetic conditions through comprehensive education of the diabetic patients and the general population. Kandel (2000) argues that, “education of health care providers and patients regarding diabetic foot complications in various settings, using multiple methods is effective for improving foot care to patients with diabetes” (p.4). The study did carry out intensive education of health care professionals and the patients in various health care institutions for a period of one month. The researchers assessed improvement of patients by comparing the number of patients who seek medical services in different periods.

The findings revealed that there was the tremendous decline in the number of diabetic patients who seek regular treatment of diabetic foot. Thus, the research confirms that comprehensive education is imperative in prevention, treatment, and management of diabetic conditions in the population. The weakness of the study is that a month of education and assessment of diabetic patients is not enough to warrant extrapolation of the results because they may be due to confounding variables. Nevertheless, the strength of the research is that the rate of seeking medical services by diabetic patients is a plausible parameter that can significantly tell the impact of comprehensive education.

References

Corken, A. (2009). Prevention and Early Intervention for Diabetes Foot Problems: A Research Review. American Association of Diabetes Educators, 1-13.

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Kandel, S. (2000). Take Care of Your Feet for a Life Time. American Association of Diabetes, 1-13.

O’Bryan, T., & Caputo, G. (2008). Prevention and Management of Common Diabetic Foot Problems. Internal Medicine Board Review Manual, 10(2), 1-10.

Ortegon, M., Redekop, W., & Nissen, L. (2004). Cost-Effectiveness of Prevention and Treatment of Diabetic Foot: A Markov analysis. Diabetes Care, 27(4), 901-907.

Poljicanin, T., Pavlic-Renar, I., Metelko, Z., & Coce, F. (2005). Draft Program of Prevention of Diabetic Foot Development and Lower Extremity Amputation in Persons with Diabetes Mellitus. Diabetologia Croatica, 34(2), 43-49.

Tobin, C., & Kennedy, C. (2009). A Health Care Provider’s Guide to Preventing Diabetes Foot Problems. National Institute of Health and the Centers for Disease Control and Prevention, 1-50.

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