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

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Evidence Table: Section 8AuthorEffect of patient educationLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingBarth R (1991)(Adults – Australia)II RCT Medium High + HighBloomgarden ZT(1987)(Adults – US: majorityII RCT Medium High + LowAfrican American andHispanic)Calle-Pascual AL(2002)III-2 Cohort High High + High(Adults – Spain)Carrington AL (2001a)(Adults – UK)III-2 Cohort High Low HighCorbett CF (2003)(Adults – US)II RCT Medium High + HighDonohoe ME (2000)(Adults – UK)II RCT High High + HighHorswell RL (2003)(Adults – US)III-2 Cohort Medium High + HighKruger S (1992)(Adults – US)II RCT Medium Low HighLeMaster JW (2003)(Adults – US)III-2 Cohort Medium High + HighLitzelman DK (1993)(Adults – US)II RCT High High + LowMalone JM (1989)(Adults – US)II RCT Medium High + HighMason J (1999) I Systematic review High Medium + HighMazzuca SA (1986)(Adults – US)II RCT Medium Low HighPatout Jr CA (2000)(Adults – US)III-2 Cohort Medium High + LowPieber TR (1995)(Adults – Austria)III-2 Cohort Medium High + HighRettig BA (1986)(Adults – US)II RCT Low High + HighRonnemaa T (1997)(Adults & children –II RCT High High + HighFinland)Valk GD (2002) I Systematic review Medium Medium + HighWard A (1999)(Adults – US)III-2 Cohort Medium High + HighFor magnitude rating:+indicates positive effect of patient education on diabetic foot disease. High = clinically important & statistically significant;Medium = small clinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 9.66
Section 9: Diabetes Foot ProblemsIssueDoes improved glycaemic control decrease the development or progression of peripheralneuropathy?RecommendationAim to achieve the best possible glycaemic control in people with Type 2 diabetes in orderto prevent or reduce the development of peripheral neuropathy which is a major risk factorfor foot ulceration and amputation.Evidence Statements• The development and severity of peripheral neuropathy in Type 2 diabetes is related tothe long-term glycaemic controlEvidence Level I• Improved glycaemic control can prevent or reduce the development of peripheralneuropathy in people with Type 2 diabetesEvidence Level II67
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National Evidence Based Guidelinesf
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Research OfficersMs Linda SmithPodi
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2.2 Issues for Foot Problems in Typ
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• Aim to achieve the best possibl
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Background - Peripheral Neuropathy
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proportion of subjects with a durat
Page 16 and 17: and an OR 1.1-7.8. This study also
Page 18 and 19: Summary - Peripheral Neuropathy as
Page 20 and 21: Section 2: Diabetes Foot ProblemsIs
Page 22 and 23: predicting risk of amputation, 2.9
Page 24 and 25: Summary - Peripheral Vascular Disea
Page 28 and 29: Evidence - Foot Deformity and Previ
Page 30 and 31: people with both LJM and neuropathy
Page 32 and 33: Summary - Foot Deformity and Previo
Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
Page 42 and 43: The other frequently reported metho
Page 44 and 45: side; and 82% having the same resul
Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
Page 50 and 51: pulse was bilaterally absent in 1.8
Page 52 and 53: Evidence Table: Section 6AuthorClin
Page 54 and 55: Background - Frequency of Foot Exam
Page 56 and 57: Summary - Frequency of Foot Examina
Page 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
Page 64 and 65: with before the programme, after 1-
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71: In a previous Japanese randomised s
Page 72 and 73: Evidence Table: Section 9AuthorGlyc
Page 74 and 75: Background - Footwear to Reduce Ulc
Page 76 and 77: period. In addition people without
Page 78 and 79: Comparisons of in-shoe foot pressur
Page 80 and 81: The rate of plantar callus formatio
Page 82 and 83: Evidence Table: Section 10AuthorFoo
Page 84 and 85: Background - Foot Clinics and Multi
Page 86 and 87: A prospective non randomised contro
Page 88 and 89: Summary - Foot Clinics and Multi-di
Page 90 and 91: Section 12: Diabetes Foot ProblemsI
Page 92 and 93: and/or osteomyelitis; III - fore-fo
Page 94 and 95: Summary - Economic consequences•
Page 96 and 97: Section 13: Diabetes Foot ProblemsI
Page 98 and 99: Some ethnic groups are associated w
Page 100 and 101: Evidence Table: Section 13AuthorSoc
Page 102 and 103: Calle-Pascual AL, Duran A, Diaz A,
Page 104 and 105: Jannink MJ, van Dijk H, de Vries J,
Page 106 and 107: Moss SE, Klein R, Klein BE. The 14-
Page 108 and 109: Soulier SM, Godsey C, Asay ED, Perr
Page 110 and 111: Diabetes Foot Problems: General Ref
Page 112 and 113: McNeely MJ, Boyko EJ, Ahroni JH, St
Page 114 and 115: Diabetes Foot Problems: Other Refer
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Caputo GM, Cavanagh PR, Ulbrecht JS
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Garbalosa JC, Cavanagh PR, Wu G, Ul
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Lavery LA, Armstrong DG, Wunderlich
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Payne C. Regional variations of dia
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Tovi J, Svanborg E, Nilsson BY, Eng
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Criteria used to determine the suit
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QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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