How effective is patient education in preventing diabetic foot ulceration?
There was little evidence to support the effectiveness of patient
education for the prevention of diabetic foot ulceration or amputations.
One randomised controlled trial (RCT) with good methodological
quality showed limited patient education did not result
in any beneficial effect on these primary outcomes. Patients’
foot care knowledge was improved in the short term (one to
six months) in five of eight RCTs in which this outcome was assessed,
as was patients’ self-reported self-care behaviour in the
short term (six to 18 months) in seven of nine RCTs. The effects
on callus, nail problems and fungal infections were described in
five of the included studies, of which only two reported temporary
improvements after an educational intervention. The effectiveness
of more comprehensive and/or more intensive educational
programmes, however, remains to be investigated further.
Most of the RCTs included in this review were at high or unclear
risk of bias. Only one of the included RCTs was considered to be
at low risk of bias. Follow-up ranged from four weeks to seven
years, with a median of six months.
Foot ulcers are common in people with diabetes, especially those
with peripheral neuropathy and/or peripheral vascular disease.
They affect 15% to 25% of people with diabetes at some time
in their lives.¹ Foot ulcers not only lead to physical disability and
loss of quality of life but also impose a significant economic
burden (healthcare costs, industrial disability).
1. Singh N et al. JAMA 2005; 293:217–28.