RESUMEN
BACKGROUND: Information communication technology (ICT) tools are an integral part of day-to-day human activities. However, evidence of how ICT tools are used to engage individuals with diabetes to prevent diabetic foot ulcers (DFUs) is limited. In this review, we summarize the evidence on ICT tools used in DFU prevention programs and associated outcomes. METHODS: We conducted a scoping review of the literature based on the Arksey and O'Malley methodologic framework. Four databases (MEDLINE, Embase, PsycINFO and CINAHL) were searched from 1960 to 2020 using keywords. Two reviewers independently screened the articles and performed data extraction and summarization. RESULTS: Seventeen of 312 articles screened met the inclusion criteria and were included in the final analysis. Eleven ICT tools were utilized in 4 types of intervention: patient education, multidimensional foot health programs, remote temperature monitoring and pressure-sensitive insole systems. The identified ICT tools were used for presenting educational information, follow-up reinforcement of education, counselling, self-monitoring, remote patient monitoring by health-care professionals, self-care reminders, problem-solving, motivation and communication. In 59% of the studies, the interventions led to a significant reduction in recurrence of DFUs, improvement in self-care behaviour and cognition, and reduction of risk factors. CONCLUSIONS: This review provides insight into a range of ICT tools used in DFU prevention programs. The findings suggest that interventions involving 1 or more ICT tools are often effective in improving diabetic foot care-related outcomes. Therefore, DFU prevention programs should include ICT tools among their components.
Asunto(s)
Diabetes Mellitus , Pie Diabético , Comunicación , Pie Diabético/prevención & control , Personal de Salud , Humanos , Autocuidado , TecnologíaRESUMEN
BACKGROUND: Diabetic foot ulcers (DFUs) are common and disabling, necessitating lengthy hospitalizations. In this study we sought to identify potentially modifiable determinants of high-intensity hospital care use among adults with DFUs. METHODS: Three related case-control studies were conducted using Canada-wide cohorts of adults hospitalized with a DFU from 2011 to 2015. In study 1, cases comprised the top 10% with the highest cumulative 1-year acute care hospital costs; controls were randomly selected from those below the top 10%. Study 2 comprised cases/controls within/below the top 10% for cumulative acute care hospital length of stay (LOS). Study 3 included cases/controls within/below the top 10% for cumulative number of acute care hospitalizations. Using generalized linear models, predictor variables were tested between cases and controls, while adjusting for age and sex. RESULTS: In study 1, mean acute care costs among 8,971 cases and 3,174 controls were $71,757 and $13,687, respectively. Sepsis conferred the greatest excess cost (mean, $38,790; 95% confidence interval [CI], $34,597 to $43,508), followed by chronic kidney disease (mean, $30,607; 95% CI, $28,389 to $32,825) and major lower limb amputation (mean, $30,884; 95% CI, $28,613 to $33,155). In study 2, mean LOS was higher among 8,477 cases (69 days) than 3,467 controls (12 days). Lower limb amputation conferred the greatest adjusted excess in mean LOS (mean, 28 days; 95% CI, 27 to 28 days). In study 3, there was a mean of 3 hospitalizations among 10,341 cases and 1 among 5,509 controls. Peripheral artery disease conferred the greatest excess number of hospitalizations (1.3 more hospitalizations; 1.2 to 1.4). CONCLUSIONS: Early aggressive treatment of chronic kidney disease and peripheral artery disease, alongside guideline-based amputation prevention strategies, may reduce high-intensity hospital care use among adults with DFUs.
Asunto(s)
Diabetes Mellitus , Pie Diabético , Enfermedad Arterial Periférica , Insuficiencia Renal Crónica , Adulto , Amputación Quirúrgica , Pie Diabético/epidemiología , Pie Diabético/terapia , Hospitales , Humanos , Estudios RetrospectivosRESUMEN
OBJECTIVES: Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs. METHODS: We conducted retrospective cohort study of adult patients who had DFUs and were referred to a single Canadian advanced diabetic foot and wound care centre between January 1, 2010, and December 31, 2010. The primary outcome was the healing rate at 52 weeks. The generalized estimating equation model was used to identify potential risk factors associated with delayed healing of DFUs. RESULTS: Of the 40 patients for whom there were complete follow ups, 35 (87.5%) had healing of all DFUs by 52 weeks. Predictors of poor healing were the presence of chronic ulcers, ulcer sizes >1 cm2, peripheral vascular disease and multiple ulcers at first presentation. Of the patients, 7.1% required amputation, and 8.9% of patients receiving our treatment died before 52 weeks. At 52 weeks of follow up, 16 of 17 recurrent ulcers and 68 of 108 pre-existing ulcers had healed. Compared to the unadjusted healing rate of preexisting ulcers (63.0%), the unadjusted healing rate of recurrent ulcers (94.1%) was significantly higher (p=0.01). CONCLUSIONS: Our findings demonstrate that patients with DFUs in Canada who receive early and continued care from specialized, outpatient, advanced wound care centres experience significantly improved rates of healing of recurrent DFUs compared to pre-existing DFUs.