Perception of diabetic foot ulcers among general practitioners in four European countries: knowledge, skills and urgency

García-Klepzig, José Luis; Sánchez-Ríos, Juan Pedro; Manu, Chris; Ahluwalia, Raju; Lüdemann, Claas; Meloni, Marco; Lacopi, Elisabetta; Buruaga, Víctor Rodriguez-Saenz De; Bouillet, Benjamin; Vouillarmet, Julien; Lázaro‐Martínez, José Luis; Acker, Kristien Van

doi:10.12968/jowc.2018.27.5.310

Cited by 29 publications

(25 citation statements)

References 20 publications

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“…However, the adoption and implementation of the recommendations in clinical practice is rather disappointing and a National Health Survey in 2010 in the United Kingdom reported that more than 50% of individuals with diabetes do not recollect having their feet examined or being given any advice regarding foot care (42). One recent study examined perception and knowledge of the pathogenesis and management of DFU among 600 general practitioners (GPs) in four countries in Europe-France, United Kingdom, Spain, and Germany (150 GPs per country) (45). A total of 1,188 patient cases from the four countries were also collected.…”

Section: Discussionmentioning

confidence: 99%

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

et al. 2020

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Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM). Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis. Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460-7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546-5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277-5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU. Panagoulias et al. Skin Dryness and Foot Ulceration Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk.

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Section: Discussionmentioning

confidence: 99%

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

et al. 2020

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“…Although there are international guidelines, it would be beneficial to establish clear and specific competencies for the different health professionals involved in diabetic management. As a minimum, intra-country heterogeneity should be reduced with their development (Garciaklepzig et al, 2018;Ogilvie, Patel, Venkat Narayan, & Mehta, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Sayah, Soprovich, Qiu, Edwards, and Johnson (2015) found only 14% T2DM patients (N = 2040) performed foot self-care 6 days per week or more often. Almost 30% of general practitioners (GPs) in France and Germany thought diabetic foot ulcer (DFU) treatment was not well established due to the absence of clinical guidelines and protocols (Garciaklepzig et al, 2018).…”

Section: Backg Rou N Dmentioning

confidence: 99%

An educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers

Guo

2019

Journal of Clinical Nursing

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Aims and objectives To assess the effectiveness of a 12‐week educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers in China. Background Diabetes with the coexistence of diabetic retinopathy and foot problems complicating diabetes not only represents a personal disaster, but also becomes a serious burden to public health in China. A foot self‐care educational intervention is both cost‐effective and feasible even in a health resource‐limited setting, which should be developed and evaluated. Design Quasi‐experimental. Methods From July–September 2017, we enrolled 80 eligible hospitalised diabetic retinopathy patients and their primary caregivers by convenient sampling method in a first‐class comprehensive hospital in Nantong, in China. Before and after the educational intervention that is in accordance with the TREND statement (for details, see the “Supplementary File 1”), researchers and subjects filled out the self‐designed questionnaire on foot problems complicating diabetes and the Diabetic Foot Self‐care Behavior Scale, respectively. Results Scores of foot self‐care behaviour among the subjects significantly improved from 54.19 ± 8.01–75.85 ± 5.04. The number of patients with fasting blood glucoses <7.0 mmol/L improved from 43 (53.75%)–80 (100%). The results of incidence of foot problems complicating diabetes were not statistically significant. The complete execution of each item in Diabetic Foot Self‐care Behavior Scale of subjects was apparently higher. Conclusions This educational intervention can facilitate positive foot self‐care behaviours among the diabetic retinopathy patients with visual disability and their primary caregivers in China. Relevance to clinical practice. This study adds to the evidence of the effectiveness of an educational intervention to foster positive foot self‐care behaviours. This educational intervention appears to be prospective in promoting diabetic home‐based self‐management in China, and the delivery method of the intervention may be applied to other chronic diseases.

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“…According to recent literature, PVD, which is associated with lower probability of healing, longer healing times, higher probability of recurrence and greater risk of amputation, is now estimated to be present in a majority of patients with a DFU. 7,[43][44][45][46] Early detection of DFUs and prompt referral by both the patient and health professional has been demonstrated to be crucial for optimal healing, reduction of amputation risk and of treatment cost. 5,25,47 First assessment by foot specialist comprehends in a holistic approach the identification of medical history and comorbidities of the patient, aetiology of the wound, biological and clinical exams, including an assessment of the foot perfusion which may lead to revascularisation if required, the investigation of local signs of infection, and the initiation of infection treatment if required, to avoid rapid deterioration of the DFU.…”

Section: Discussionmentioning

confidence: 99%

“…48 Reinforcing and supporting the education of health professionals and patients to these and to the need for surveillance of DFUs and their complications is essential. 2,[46][47][48] While new effective treatments and evidence-based treatment decisions can help to increase closure rate and gain time-to-closure in the management of these chronic wounds, additional efforts should be made to increase the early detection of DFUs and the prevention of their recurrence, notably by highlighting the importance of foot surveillance and hyperkeratosis removal. 2 Patients with diabetes may find it difficult to detect a new wound due to neuropathy and if a possible plantar wound location.…”

Section: Discussionmentioning

confidence: 99%

Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer

et al. 2019

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Objective: In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect. Method: In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location. Results: For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group. Conclusion: This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.

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Perception of diabetic foot ulcers among general practitioners in four European countries: knowledge, skills and urgency

Cited by 29 publications

References 20 publications

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

An educational intervention on foot self‐care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers

Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer

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