Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

australiandiabetescouncil.com
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10.07.2015 Views

Behaviour assessment scores, measured in all studies using newly developed and nonvalidated scoring lists, were also reported in those 3 RCTs (Barth et al, 1991; Krugeret al, 1992; Ronnemaa et al, 1997). The foot care behaviour of patients (e.g. washing,creaming, foot inspection, cutting toe nails, use of pumice stone, foot gymnastics)improved significantly at 6 months (Barth et al, 1991; Kruger et al, 1992) and oneyear (Ronnemaa et al, 1997).One RCT evaluated the effect of foot care education as part of general diabeteseducation in primary care (Bloomgarten et al, 1987). No significant effect was foundafter a follow up of approximately 1.5 years on the behaviour assessment scores (7questions on diabetes self care of which 1 asked how often the feet were checked forsores). Callus, nail dystrophy and fungal infections were not different betweenintervention and control groups after 1.5 years.One RCT evaluated the effect of a complex intervention that included patienteducation on foot care, in a primary care setting (Litzelman et al, 1993). Thisintervention was targeted at both patients and doctors. A significant positive effectwas found on patients' foot care behaviour.Two RCTs evaluated the effect of patient education, tailored to the educational needsof the patients (Mazzuca et al, 1986; Rettig et al, 1986). One was performed inprimary care (Mazzuca et al, 1986), the other study in the home environment (Rettiget al, 1986). In the first, foot care knowledge only was assessed at 1 year, and noeffect was found (Mazzuca et al, 1986). In the second, there was a statisticallysignificant improvement in foot care knowledge at 6 months follow up (Rettig et al,1986). However, no positive effects were found on foot appearance and foot careskills score.Mason et al (1999) reviewed 5 randomised footcare educational studies whichincluded people with Type 2 diabetes. They reached the conclusion that since therewere no consistent patterns in study methods or findings that it was necessary tointerpret the results of each study individually. Therefore studies which haveaddressesd this question are described in more detail below.Rettig et al (1986) evaluated the effects of an individualised diabetes self-care homeeducation programme. Of 471 people with Type 2 diabetes enrolled, 228 wereassigned to the home education group and 243 to the control group. After 6 monthsfootcare knowledge score was significantly higher among the intervention subjectscompared with the control subjects (62.2±1.7 v 53.1±1.8, p=0.001), but there were nodifferences in footcare skill score (71.8±2.0 v 68.9±1.8, p=NS) or foot appearancescore (70.2±0.7 v 68.8±0.7, p=NS). At 12 months there were no differences indiabetes-related hospitalisations between the2 groups.Bloomgarden et al (1987) evaluated a diabetes clinic education (general and footcare)programme in 266 people with insulin treated diabetes (127 in the education groupand 139 in the control group). There were no significant differences between groupsin type or duration of diabetes, insulin dosage, and educational background.Knowledge score (which did not include any question related to feet) increased in theeducation group (5.3±1.6 to 5.8±1.6) but did not change in the control group (5.3±1.7)60

(p=0.007). The behaviour score (which included 1 question about frequency of footinspection) improved in both groups (3.4±1.4 to 4.3±1.6; 3.6±1.6 to 4.1±1.6,respectively) (p=0.10). Among 83 people without foot lesion at the initial evaluationin the eduction group, 31 developed mild and 2 developed severe foot lesions duringthe 18 month period; while among 63 people without foot lesions in the control group,the corresponding number were 28 and 2, respectively (p=0.63).Barth et al (1991) compared a conventional group eduction programme with a similarprogramme which included 4 additional footcare sessions based on a cognitivemotivational technique in 70 Australian people with Type 2 diabetes with sub-optimalglucose control and who had not attended a diabetes education programme in the pastsix months. The intensive group showed a greater improvement than the conventionalgroup in footcare knowledge (p

(p=0.007). The behaviour score (which <strong>in</strong>cluded 1 question about frequency <strong>of</strong> foot<strong>in</strong>spection) improved <strong>in</strong> both groups (3.4±1.4 to 4.3±1.6; 3.6±1.6 to 4.1±1.6,respectively) (p=0.10). Among 83 people without foot lesion at the <strong>in</strong>itial evaluation<strong>in</strong> the eduction group, 31 developed mild <strong>and</strong> 2 developed severe foot lesions dur<strong>in</strong>gthe 18 month period; while among 63 people without foot lesions <strong>in</strong> the control group,the correspond<strong>in</strong>g number were 28 <strong>and</strong> 2, respectively (p=0.63).Barth et al (1991) compared a conventional group eduction programme with a similarprogramme which <strong>in</strong>cluded 4 additional footcare sessions based on a cognitivemotivational technique <strong>in</strong> 70 Australian people with <strong>Type</strong> 2 diabetes with sub-optimalglucose control <strong>and</strong> who had not attended a diabetes education programme <strong>in</strong> the pastsix months. The <strong>in</strong>tensive group showed a greater improvement than the conventionalgroup <strong>in</strong> footcare knowledge (p

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