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Evidence summaries

Patient Education for Preventing Diabetic Foot Ulceration

There is insufficient evidence on the effectiveness of patient education for the prevention of diabetic foot ulceration or amputations, although education may improve people's foot care knowledge and behaviour in the short term. Level of evidence: "D"

A meta-analysis 2 included 17 RCTs involving 2729 participants. 4 tested home foot temperature monitoring, 6 examined patient education and 7 assessed offloading footwear. Participants who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% CI 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823).

A Cochrane review [Abstract] 1 included 12 studies. Pooling of outcome data was precluded by marked, mainly clinical, heterogeneity. One of the RCTs showed reduced incidence of foot ulceration (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.14 to 0.66) and amputation (RR 0.33, 95% CI 0.15 to 0.76) during one-year follow-up of diabetes patients at high risk of foot ulceration after a one-hour group education session. However, one similar study, with lower risk of bias, did not confirm this finding (RR amputation 0.98, 95% CI 0.41 to 2.34; RR ulceration 1.00, 95% CI 0.70 to 1.44). Three other studies, also did not demonstrate any effect of education on the primary end points, but were most likely underpowered. Patients' foot care knowledge was improved in the short term in five of eight RCTs in which this outcome was assessed, as was patients' self-reported self-care behaviour in the short term in seven of nine RCTs. Callus, nail problems and fungal infections improved in only one of five RCTs

Comment: The quality of evidence is downgraded by study quality (several methodological shortcomings), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparison).

References

  • Dorresteijn JA, Kriegsman DM, Assendelft WJ et al. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2014;(12):CD001488. [PubMed]
  • Alahakoon C, Fernando M, Galappaththy C, et al. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020;37(8):1266-1279[PubMed]

Primary/Secondary Keywords