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Cochrane Database of Systematic Reviews

Patient education for preventing diabetic foot ulceration

Overview of attention for article published in this source, October 2012
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Patient education for preventing diabetic foot ulceration
Published by
John Wiley & Sons, Ltd, October 2012
DOI 10.1002/14651858.cd001488.pub4
Pubmed ID

Dorresteijn, Johannes AN, Kriegsman, Didi MW, Assendelft, Willem JJ, Valk, Gerlof D


Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. Eligible studies were identified by searching The Cochrane Wounds Group Specialised Register (searched 1 August 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (2009 to July Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 31, 2012); Ovid EMBASE (2009 to 2012 Week 30); and EBSCO CINAHL (2009 to 26 July 2012). Prospective randomised controlled trials (RCTs) that evaluated educational programmes for preventing foot ulcers in people with diabetes mellitus. Two review authors independently undertook data extraction and assessment of risk of bias. Primary end points were foot ulceration or ulcer recurrence and amputation. Of the 12 RCTs included, the effect of patient education on primary end points was reported in only five. 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. Only one of the included RCTs was at low risk of bias. In some trials, foot care knowledge and self reported patient behaviour seem to be positively influenced by education in the short term. Yet, based on the only two sufficiently powered studies reporting the effect of patient education on primary end points, we conclude that there is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence.

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Geographical breakdown

Country Count As %
Italy 2 2%
United States 1 1%
Spain 1 1%
Unknown 89 96%

Demographic breakdown

Readers by professional status Count As %
Student > Master 13 14%
Researcher 11 12%
Other 9 10%
Student > Bachelor 9 10%
Student > Postgraduate 9 10%
Other 19 20%
Unknown 23 25%
Readers by discipline Count As %
Medicine and Dentistry 35 38%
Nursing and Health Professions 16 17%
Psychology 3 3%
Agricultural and Biological Sciences 2 2%
Economics, Econometrics and Finance 2 2%
Other 8 9%
Unknown 27 29%