Bus SA, van Netten JJ, et al.
Diabetes/metabolism research and reviews. Date of publication 2016 Jan 1;volume 32 Suppl 1():195-200.
1. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:195-200. doi: 10.1002/dmrr.2738.
A shift in priority in diabetic foot care and research: 75% of foot ulcers are
preventable.
Bus SA(1)(2), van Netten JJ(2).
Author information:
(1)Department of Rehabilitation Medicine, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands.
(2)Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The
Netherlands.
Diabetic foot ulceration poses a heavy burden on the patient and the healthcare
system, but prevention thereof receives little attention. For every euro spent on
ulcer prevention, ten are spent on ulcer healing, and for every randomized
controlled trial conducted on prevention, ten are conducted on healing. In this
article, we argue that a shift in priorities is needed. For the prevention of a
first foot ulcer, we need more insight into the effect of interventions and
practices already applied globally in many settings. This requires systematic
recording of interventions and outcomes, and well-designed randomized controlled
trials that include analysis of cost-effectiveness. After healing of a foot
ulcer, the risk of recurrence is high. For the prevention of a recurrent foot
ulcer, home monitoring of foot temperature, pressure-relieving therapeutic
footwear, and certain surgical interventions prove to be effective. The median
effect size found in a total of 23 studies on these interventions is large, over
60%, and further increases when patients are adherent to treatment. These
interventions should be investigated for efficacy as a state-of-the-art
integrated foot care approach, where attempts are made to assure treatment
adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art
integrated foot care is implemented, the majority of problems with foot ulcer
recurrence in diabetes can be resolved. It is therefore time to act and to set a
new target in diabetic foot care. This target is to reduce foot ulcer incidence
with at least 75%.
Copyright © 2016 John Wiley & Sons, Ltd.
DOI: 10.1002/dmrr.2738
PMID: 26452160 [Indexed for MEDLINE]
