Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Matilde Filipa Monteiro Soares

    Autor

Participantes de fora da FMUP

  • van Netten, JJ
  • Raspovic, A
  • Lavery, LA
  • Paton, J
  • Rasmussen, A
  • Sacco, ICN
  • Bus, SA

Unidades de investigação

Abstract

Aims: Prevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta-analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof.Materials and Methods: We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.Results: From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non-controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31-0.84) and pressure-optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26-1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37-1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24-1.17), flexor tenotomy (1 RCT, 7 non-controlled studies, no meta-analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58-1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration.Conclusions: Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure-optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high-quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low-to-moderate risk of ulceration.

Dados da publicação

ISSN/ISSNe:
1520-7552, 1520-7560

DIABETES-METABOLISM RESEARCH AND REVIEWS  John Wiley and Sons Ltd

Tipo:
Review
Páginas:
-
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 5

Citações Recebidas na Scopus: 38

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Keywords

  • foot ulcer; home monitoring; podiatry; prevention; self-management; shoes

Financiamento

Proyectos asociados

iHIPI: Hiper-inflamação e perfil imunológico dos doentes com COVID-19 no Centro Hospitalar de Vila Gaia/Espinho

Investigador Principal: Matilde Filipa Monteiro Soares

Estudo Clínico Académico (iHIPI) . FCT . 2020

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