Diabetic Foot Self Care Pada Diabetisi

ABSTRACT: DIABETIC FOOT SELF CARE ON DIABETES PATIENTS Background: Diabetes Mellitus (DM) can cause complications in various body systems. One of the complications of DM is complications in the feet which can cause diabetic foot ulcers and lead to leg amputation. Diabetic foot complications can be prevented by performing routine foot care or diabetic foot care. Objective: The purpose of this study was to determine the description of diabetic foot care in patients with diabetes mellitus consisting of personal self-care, podiatric care, and footwear and socks. Method: This type of research is descriptive quantitative research. Data was collected using a diabetic foot care questionnaire. The number of samples in this study was 51 people. The sampling method is a non-probability technique using consecutive sampling. The study was conducted in the Kuranji Health Center Working Area in July – November 2021. Result: The results showed that most respondents (64.70%) had poor personal self-care in foot care, 82.3% of respondents had poor podiatric care habits. and 52.94% of respondents have good habits in choosing footwear. Conclusion: From the results of the study, it was concluded that people with diabetes have bad habits in performing foot care so that this is one of the risk factors for complications in the feet. To increase awareness of people with diabetes in performing foot care, it is recommended that nurses can provide education and teach people with diabetes to take care of their feet Keywords: Diabetes Mellitus; Foot Complications; Foot Care INTISARI : DIABETIC FOOT SELF CARE PADA DIABETISI Latar Belakang : Diabetes Melitus (DM) dapat menyebabkan komplikasi pada berbagai sistem tubuh. Salah satu komplikasi DM adalah komplikasi pada kaki yang dapat menimbulkan ulkus kaki diabetik dan berujung dengan amputasi kaki. Pencegahan komplikasi pada kaki dapat dilakukan diabetisi dengan melakukan perawatan kaki rutin atau diabetic foot care.Tujuan : Tujuan penelitian ini adalah untuk mengetahui gambaran diabetic foot care pada pasien diabetes melitus yang terdiri dari personal self care, podiatric care, serta footwear and sock.Metode : Jenis penelitian ini adalah penelitian deskriptif kuantitatif. Pengumpulan data dilakukan menggunakan kuesioner diabetic foot care. Jumlah sampel dalam penelitian ini adalah 51 orang. Metode pengambilan sampel adalah dengan Teknik non probability dengan menggunakan consecutive sampling. Penelitian dilakukan di Wilayah Kerja Puskesmas Kuranji pada Bulan Juli – November 2021.Hasil : Hasil penelitian menunjukkan bahwa sebagian besar responden (64,70%) memiliki personal self care yang kurang baik dalam perawatan kaki, 82,3% responden memiliki kebiasan podiatric care yang kurang baik dan 52,94% responden memiliki kebiasaan baik dalam pemilihan alas kaki.Kesimpulan : Diabetisi memiliki kebiasaan yang kurang baik dalam melakukan perawatan kaki sehingga ini menjadi salah satu faktor resiko terjadinya komplikasi pada kaki. Untuk meningkatkan kesadaran diabetisi dalam melakukan perawatan kaki disarankan perawat dapat memberikan edukasi dan mengajarkan diabetisi untuk melakukan perawatan kaki Kata Kunci : Diabetes Melitus; Komplikasi Kaki; Perawatan Kaki

Survival of Patients Following First Diagnosis of Diabetic Foot Complications: A Nationwide 15-Year Longitudinal Analysis

Background and AimsThe long-term survival in people with type 2 diabetes following first diagnosis of diabetic foot complications (FDDFC) is unclear. The object is to evaluate the mortality rate in subjects with type 2 diabetes following FDDFC and the impacts of the major cardiovascular comorbidities.MethodsNationwide data were analyzed for subjects with T2D and DFC between 2003 and 2017 according to ICD-9 coding. DFC was defined with the codes of ulcers, infections, or severe peripheral artery disease that required intervention (PAD) to mimic the real world diagnosis. Criteria of FDDFC were preceded by a period without any DFC for at least 5 years. Major cardiovascular comorbidities: established PAD and cardiovascular diseases (CVD: including coronary heart disease (CHD), stroke, or heart failure) before the index date as well as lower-extremity amputations (LEA) at the index episode were analyzed.ResultsAmong 300,115 subjects with DFC, a total of 103,396 patients had FDDFC. The mean 5-year survival rate of these subjects was 81.05%. Using subjects without associated major cardiovascular comorbidity as baseline, the adjusted hazard ratios (aHR) were1.43 (95% confidence interval 1.38–1.49) in group PAD-/CVD+, followed by 1.70 (1.59–1.80) in PAD+/CVD- and 1.98 (1.89–2.08) in PAD+/CVD+. The aHR was further increased in patients with PAD who additionally had heart failure (3.77, 3.50–4.05), stroke (2.06, 1.95–2.18), or CHD (1.89, 1.79–2.00). Subjects with PAD rather than other CVD were associated with LEA at FDDFC. Patients with major LEA (above the ankle) at FDDFC episode had lower 5-year survival rate (65.01%) followed by those with minor LEA (72.24%) and without LEA (81.61%).ConclusionsCardiovascular comorbidity as well as LEA status at the event of FDDFCs were both associated with patient survival outcomes. Earlier identification of this large population could lead to higher survival rates.

Managing Diabetic Foot Complications During COVID-19 Lockdown in India: A Survey

To understand the management of diabetic foot complications by the Diabetic Foot Research India (DFRI) members during the lockdown period. An online survey link was created in “Survey Monkey", and the link was sent to all the members of Diabetic Foot Research India (DFRI) who are staying in different parts of India and data were collected from May 2020 to June 2020. The survey included questions on the type of consultation they provided to their patients, management of a patient with an active foot ulcer, and the various difficulties encountered by the doctors during the lockdown. A total of 33 diabetologists from all over the country participated in this survey. Among them, 26 doctors had attended to active diabetic foot infection at the time of the online survey. Almost three fourth of the (n = 24; 72.7%) doctors recorded difficulties during the inpatient consultations. Difficulty in regular follow-ups, the facility's workforce shortage was reported to be a significant concern. In managing active foot ulcer cases, 15 doctors (45.5%) opted for in-person consultation in their hospital as they felt the infection cannot be handled over a tele-consultation. Amputation was not performed by 78.7% of doctors, 15% (n = 5) of the doctors performed less than five amputations, and 6% (n = 2) of the doctors performed more than five amputations during the lockdown period. In the case of SMBG (Self-monitoring blood glucose) values, the regularity of patients reporting the values varied significantly. Only 8 (24.2%) doctors reported that 75% of their patients regularly shared their SMBG values while all the others mentioned that their patients were not performing SMBG regularly. Most of the physicians were able to manage the diabetic foot complications by tele-consultation during the lockdown and only a few asked the patients to get hospitalized for surgical intervention. All doctors should recommend SMBG to continuously monitor patients’ blood glucose levels and prevent complications of hyperglycemia, particularly during pandemic situations.

Diabetic Foot Amputations at Central and Provincial Hospital in Gauteng. A Signpost for Inadequate Foot Health Services at Primary Healthcare Level in South Africa

Background Diabetic foot amputations are the most devastating outcome for any diabetic patient and could be associated with failure to risk stratify the diabetic foot and create individualised treatment plans to lower risk at the primary healthcare level (PHC). In South Africa (RSA), PHC clinics are the first entry point to the public healthcare system. Failure to correctly identify, risk categorise, and refer diabetic foot complications may lead to poor clinical outcomes for diabetic patients. There is a need to highlight poor clinical outcomes and link them to limited access to foot health services at the PHC level. This approach may help drive the strategic allocation and deployment of limited podiatry force in RSA. This study looks at the incidence of diabetic-related amputations at central and tertiary hospitals in Gauteng to argue the case of the needed foot health services at the PHC level. Methods A cross-sectional retrospective study that reviewed theatre records. We reviewed records of all diabetic patients who had diabetic-related amputations between January 2017 and June 2019. Results There were 1862 diabetic-related amputations; however, only 1565 accurately recorded and met the inclusion criteria for the study. The first amputation was a major amputation in 73% of the cases, and an infected foot ulcer was a primary amputation cause in 75% of patients. Males had the most amputations, 62%. The majority, 71% of amputations, were in patients younger than 65 years. Nearly all patients (98%) came from a poor socio-economic background and are state-dependent; they earned ZAR 0.00- 70 000.00 or USD (0.00- 4754.41) per annum. Conclusion Amputations are a sign of poor clinical outcomes for diabetic patients and imply inadequate care of diabetic foot complications across the continuum of care, particularly at the PHC level in RSA. Due to the hierarchal nature of healthcare delivery in RSA, all patients in this study would have presented at a PHC facility to manage their diabetes and other chronic comorbidities. The findings show that most first amputations recorded in this study were major amputations. This finding is a significant signpost of the potential delay in recognising, treating and timely referral of diabetic-related foot complications. Arguably, a lack of access to structured foot health services at PHC levels impedes early identification of foot complication identification and appropriate referral resulting in the amputation in some of the patients.

Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.