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Background: Foot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach. Method: This cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score. Results: XGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score. Conclusion: The study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group. [ABSTRACT FROM AUTHOR]

The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight‐threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10‐g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low‐ to middle‐income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One‐Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One‐Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource‐limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine the relationship between HbA1c variability and foot ulcer healing at 12 weeks and 12 months. Methods: Using National Diabetic Foot Care Audit (NDFA) and hospital records, demographics, baseline ulcer characteristics and healing outcomes for subjects presenting with a foot ulcer between 2017–2022 were collected at 12 weeks and 12 months. Subjects had diabetes duration > 3 years and ≥ 3 HbA1c recordings in the 5 years prior to presentation. Results: At 12 weeks, factors associated with an active ulcer were presence on hind foot (adjusted odds ratios) (2.1 [95% CI 1.3–3.7]), ischaemia (2.1 [95% CI:1.4–3.2]), area > 1 cm2 (2.7 [95% CI:1.7–4.2]) and diabetes duration > 24 years vs 3–10 (AOR 2.0 [95% CI 1.2–3.5]). After adjustment, HbA1c variability 6–10 mmol/mol and > 14.5 mmol/mol had AOR of 1.76 (95% CI 1.1–2.8; p = 0.0192) and 1.5 (95% CI 0.9–2.6; p = 0.1148) of an active ulcer at 12 weeks vs variability < 6 mmol/mol. At 12 months, ischaemia (AOR 2.4 [95% CI 1.5–3.8]) and diabetes duration > 24 years vs 3–10 years (AOR 3.3 [95% CI 1.7–6.4] were significant factors. HbA1c variability was not significant at 12 months. Conclusion: In keeping with the national NDFA data, in our cohort ulcer characteristics, but not HbA1c variability, were the key factors associated with ulcer healing at 12 weeks and 12 months. Plain Language Summary: Diabetes complications occur more frequently when glucose control is not as good as it could be. For a long time, HbA1c, or glycated haemoglobin, has been used as a measure of how well someone's diabetes has been controlled. However, another way of looking at diabetes control is to look at the changes of HbA1c over time—this is called glycaemic variability. Diabetes-related foot disease is one of the most feared complications of the condition, and our group has previously shown in a small study that glycaemic variability was associated with ulcer healing at 12 weeks—with lower variability leading to better healing. However, it did not consider other variables known to be associated with not being alive and ulcer free at 12 months. In the UK, data are collected as part of the National Diabetes Footcare Audit (NDFA). This dataset collects a lot of information on new foot ulcers and their outcomes 12 weeks later. We have used our centre's data to look at factors not included in the NDFA dataset—in particular glycaemic variability—to determine whether this influences ulcer outcomes at 12 weeks, but also at 12 months. We found that low glycaemic variability is associated with greater chances of healing but that the greatest association is the presence of poor blood flow and diabetes duration. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic Foot Complications (DFCs) are a growing cause of morbidity and mortality with less than one third of physicians able to discern the signs of diabetes related peripheral neuropathy. DFCs and resultant amputations account for a considerable proportion of surgeries in Fiji, with very limited literature available to verify the factors that influence these alarming figures. This study aimed to explore Health Care Workers' (HCWs) perspectives on diabetic foot complications and challenges of foot care management in Fiji. Method: An exploratory descriptive qualitative design was used among HCWs at the Sigatoka Sub Divisional Hospital (SDH), Fiji in 2021. HCWs at the SDH were required to have a minimum work experience of at least six months in public health. All participants who met the inclusion criteria were selected through purposive sampling. Data was collected using a focus group discussion guide composed of semi-structured open-ended questions to guide the Focus Group Discussions (FGDs). Focus discussions were audio recorded and transcribed with thematic analysis applied to derive the themes and sub-themes outlined in the study. Results: Twenty HCWs participated in four FGDs with four major themes identified. The first theme was HCWs' perceptions and practice of foot care which revealed that all participants had adequate diabetic foot care knowledge. The second theme was factors affecting foot care which was mainly focused on identified barriers such as inadequate patient foot care knowledge, the lack of resources such as manpower, and health system challenges like the COVID-19 pandemic. The third theme is creating awareness among patients and HCWs to improve foot care practices. The fourth theme is strengthening foot care practices at the different levels of health care that is aimed at optimizing diabetic foot outcomes. Conclusion: Various foot care barriers namely patient factors and the lack of resources is a concern depicted in this study. There is a need to address health system barriers and enforce diabetic foot education, screening and care for patients and the community. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot is a global threat to public health, as it can lead to infections and amputations and cause significant pain and economic costs for patients. Diabetic foot patients in northern China have more severe local ulcers, worse prognosis, and longer disease duration. Objective: This study assessed the foot risk levels and foot care knowledge and behavior status of people with diabetes with different foot risk levels, and investigated the factors that influence the occurrence of high-risk foot in diabetes. Methods: This cross-sectional survey included 410 hospitalized people with diabetes. Demographic and disease-related data and foot risk stratification status were collected using investigator-designed questionnaires. Foot care knowledge and behavior questionnaires were also used. Results: Among the 410 participants, a total of 367 cases were classified as high-risk feet, among which 135 cases were rated as grade 1, 202 cases grade 2, and 30 cases grade 3. Foot care knowledge surveys revealed low scores in the areas of shoe and sock selection, foot and footwear examination, and management of foot problems. Foot care behavior surveys showed low scores in the areas of foot and footwear examination, management of foot problems, and foot injury risk behavior. One-way ANOVA revealed significant differences in foot care behaviors among patients with different foot risk classifications (p < 0.05), while no significant differences were observed in foot care knowledge scores. Multivariate logistic regression analysis showed that age, history of cerebrovascular disease, and foot care behavior scores were factors influencing the occurrence of high-risk foot in people with diabetes. Conclusion: The results of this study showed a high prevalence of high-risk foot in diabetics; The knowledge and behavior of foot care in diabetics with different foot risk levels were both at a moderately low level; There were differences in foot behavior scores among patients with different foot risk classes, but, counter-intuitively, no significant differences in foot care knowledge. The study found that advanced age, history of cerebrovascular disease, and low foot care behavior scores are risk factors for high-risk foot in diabetes. Therefore, it is necessary to screen patients with diabetes for high-risk feet and implement targeted interventions according to the results. [ABSTRACT FROM AUTHOR]

Objectives To investigate the hypotheses that in patients with SSc, the temperature gradient between the dorsum of the foot and toes (distal–dorsal difference [DDD]) is 'more negative' (toes cooler) than in healthy controls, is greatest along the first (great) toe and that the severities of thermographic abnormalities in the feet and hands are correlated. Methods Thermographic images of the dorsum of each hand and foot were captured using a thermal camera attached to an iPhone in 40 patients with SSc and 20 healthy controls. DDDs along the fingers (index, middle, ring and little) and toes (great toe and 'others') were measured. Results There was a non-significant trend for the great toes to be colder in patients with SSc than in controls. The mean great toe DDD was more negative in patients (right: −2.89°C, left: −2.91°C, mean: −2.90°C) than in controls (right: −2.36°C, left: −2.42°C, mean: −2.39°C) (P  = 0.37 for mean values). Patients' great toes were colder than 'other' (lesser) toes (right: −2.58°C, left: −2.63°C), although not significantly. In patients with SSc, finger and great toe temperature gradients were correlated (r  = 0.406, ρ = 0.01). Conclusion Our findings suggest that the great toe is the coldest in patients with SSc and that patients with the coldest fingers tend to have the coldest toes. Severe RP symptoms in the hands should prompt podiatry assessment and foot care education. Mobile phone thermography is a convenient tool for assessing the digital vasculature but first requires validation in larger studies with a longitudinal component. [ABSTRACT FROM AUTHOR]

Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was to examine the relations between different facets of emotion dysregulation and diabetes self-management behaviors among a sample of 373 adults with type 2 diabetes. Separate median regression and binary logistic regression models were used to examine the association of emotion dysregulation facets and each diabetes self-care behavior (i.e., medication nonadherence, diet, exercise, self-monitoring of blood glucose (SMBG), foot care, and smoking). Generally, greater difficulties in emotion regulation were associated with poorer self-management behaviors. However, several facets of emotion dysregulation were linked with better self-management behaviors. Addressing emotion dysregulation among adults with type 2 diabetes has the potential to improve diabetes related self-management. [ABSTRACT FROM AUTHOR]

Abstract Background Foot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach. Method This cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score. Results XGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score. Conclusion The study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group.

Objective: The study was aimed to assess the knowledge and attitude toward foot care and evaluate the effectiveness of structured teaching program (STP) on the knowledge and attitude of patients with diabetes mellitus regarding foot care. Materials and Methods: A preexperimental research design was used in this study, which was conducted in medical–surgical wards of a secondary hospital in Northeast India, Nagaland. A total of 30 subjects were recruited by consecutive sampling technique. A closed-ended structured questionnaire and 5-point Likert scale was used to assess knowledge and attitude toward foot care. A STP was administered after which posttest was done after 24 h. Results: The majority (86.6%) of the participants in the pretest had inadequate knowledge and 80% had negative attitudes toward foot care. After STP, 70% had moderately adequate knowledge and 53.3% had a positive attitude regarding foot care. The structured teaching program was effective in improving the knowledge and attitude at P < 0.01 which is highly significant and there was a significant association between the pretest level knowledge and duration of diabetes at P < 0.01. Conclusion: STP was effective in enhancing the level of knowledge and attitude toward foot care among diabetic inpatients. This type of interaction can be organized at regular intervals to reinforce knowledge and attitude toward foot care among inpatients.

Background: Amputation related to foot ulcers that develop in diabetes is the worst consequence of improper foot care among diabetic patients. Considering this, the present research was conducted to assess the knowledge and practice regarding foot care in people with diabetes. Aim: The present study aimed to assess the knowledge and practice regarding foot care among persons with diabetes attending a diabetic clinic at a tertiary care centre in Uttarakhand and to distribute a teaching aid to educate them regarding foot care in diabetes. Patients and Methods: One hundred and fifty persons with diabetes attending a diabetic clinic were assessed using a cross-sectional, descriptive design. A self-structured questionnaire on knowledge and practice was used to collect the data from the participants, who were selected using a convenient sampling technique. Descriptive and inferential statistics were used for the analysis of the data. Results: About 21 (14.0%) patients had adequate knowledge, 108 (72.0%) had moderately adequate knowledge and 21 (14.0%) had inadequate knowledge. Most of the patients 97 (64.7%) had average practice, 52 (34.7%) had good practice and 1 (0.6%) had poor practice regarding foot care in diabetes. Pamphlets were made and distributed among patients to educate them regarding foot care for diabetes. Conclusion: People with diabetes, who visited the diabetic clinic at a tertiary centre in Uttarakhand had moderately adequate knowledge and average practice. This indicates patients need more education related to foot care in diabetes.

The aim of this study was to shed light on a crucial issue through a comprehensive evaluation of the cost-effectiveness and cost-utility of a cutting-edge web-based foot–ankle therapeutic exercise program (SOPeD) designed for treating modifiable risk factors for ulcer prevention in individuals with diabetes-related peripheral neuropathy (DPN). In this randomized controlled trial, 62 participants diagnosed with DPN were assigned to the SOPeD software or received usual care for diabetic foot. Primary outcomes were DPN symptoms and severity, foot pain and function, and quality-adjusted life years (QALYs). Between-group comparisons provided 95% confidence intervals. The study also calculated incremental cost-effectiveness and cost-utility ratios (ICERs), analyzed direct costs from a healthcare perspective, and performed a sensitivity analysis to assess uncertainty. The web-based intervention effectively reduced foot pain, improved foot function and showed favorable cost-effectiveness, with ICERs ranging from (USD) $5.37–$148.71 per improvement in different outcomes. There is a high likelihood of cost-effectiveness for improving DPN symptoms and severity, foot pain, and function, even when the minimum willingness-to-pay threshold was set at $1000.00 USD. However, the intervention did not prove to be cost-effective in terms of QALYs. This study reveals SOPeD's effectiveness in reducing foot pain, improving foot function, and demonstrating cost-effectiveness in enhancing functional and clinical outcomes. SOPeD stands as a potential game-changer for modifiable risk factors for ulcers, with our findings indicating a feasible and balanced integration into public health systems. Further studies and considerations are vital for informed decisions to stakeholders and the successful implementation of this preventive program on a larger scale. Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot is one of chronic complications that can cause significant issue on diabetes mellitus patient. In addition to contributing to mortality and morbidity rate, this disease also increases the family as well as national health economy burdens. Therefore, preventive efforts are necessary to decrease the risk of diabetic foot. In this case, intervention model in preventing diabetic foot is known to focus more on diabetes mellitus patients and healthcare service provider. Objective: Current research aims to identify the determinant of the efforts and issues in the prevention of diabetic foot in the community. Method: This research applied qualitative method through focus group discussion and indepth interview with 19 informants selected through purposive sampling, including the holder of Public Health Center programs, cadre, diabetes mellitus patients, and family. Data obtained through record were further transcribed and analyzed thematically. Result: There are several themes produced, including the education of foot care, cadre empowerment, role of cadre, strategy of cadre empowerment, knowledge, perception, self-efficacy, as well as patient and family strengthening. Conclusion: Diabetic foot preventive efforts focuses on the education of foot care and cadre empowerment in the community. Meanwhile, the issues discovered include the lack of knowledge, perception, efficacy and behavior in taking care of foot on diabetes mellitus patients. Hence, further study is needed in designing proper intervention strategy to prevent diabetic foot in the community. [ABSTRACT FROM AUTHOR]

Background: Foot infections, a frequent complication of diabetes mellitus, are associated with heavy resource utilization, including antibiotic therapy and surgeries. However, the most common type of isolated pathogen in diabetic foot infections remains unknown. We aimed to identify the most common types of isolated pathogens in diabetic foot infections. Methods: This retrospective cohort study was conducted in a specialized medical center in Jeddah, Saudi Arabia. A total of 96 patients diagnosed with diabetes and presented with a foot ulcer showing clinical signs of infection were included. Results: The mean age was 63.03 ± 10.88 years, and 67.7% were males. The mean duration of diabetes diagnosis was 21.86 ± 9.66 years, and the majority had foot ulcers for over six weeks. Bacteria were present in 65 patients (67.7%), Gram-negative organisms were observed in 37 patients (38.5%), and Gram-positive organisms were present in 28 patients (29.2%). In the 65 patients with bacterial culture, Staphylococcus aureus was the most common isolated organism and was observed in 18 patients (27.7%), followed by Escherichia coli in 11 (16.9%) and Pseudomonas aeruginosa in 10 (15.4%). Binary regression analyses found that Gram-negative organisms were significantly more multidrug-resistant than Gram-positive organisms (P = 0.012, OR = 7.172, 95% CI = 1.542-33.352). Patient outcomes included healed ulcers (n = 10, 10.4%), minor amputation (n = 16, 16.7%), major amputation (n = 1, 1%), and debridement (n = 48, 50%). Conclusion: Gram-negative organisms were predominant in patients with diabetes and foot ulcers having clinical signs of infection. Treatment with an individualized antibiotic regimen is vital in ensuring optimal outcomes and preventing major amputations. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot may be a genuine and weakening complication of diabetes that affects millions of people around the world. It could be a constant condition that requires nonstop administration to anticipate dreariness and mortality. Aims and Objective: The present study was aimed to clinical study and management of diabetic foot. Material and Methods: This study was carried in Department of surgery and Department of Medicine, Muzaffarnagar medical college, Muzaffarnagar from June 2022 to February 2023. This study includes 380 diabetic patients who came in diabetic follow-up clinic. Results: This study was enrolled 380 patients with diabetes who came for follow-up. In this study, the prevalence of diabetic foot ulcer patients among diabetes was 14.21%. The mean age of the studied participants were 53 with 62.96% male and 37.04% female. 57.41% patient had diabetic retinopathy changes, 37.08% had the history of HTN, 20.37% patients had vascular disease, 59.26% had smoking history, 27.78% subjects on insulin, 46.30% on oral hypoglycemic drug and 25.92% patients were on both insulin and oral hypoglycemic drug. 50 (92.59%) patient had single ulcer and 04 (7.41%) patients multiple ulcer. The most common site of involvement was toe (62.97%) followed by dorsum of foot (12.96% cases). Conclusion: The prevalence of diabetic foot ulcer among diabetic patients is 14.21% Subjects. Proper education at high risk group like self-inspection, foot hygiene, use of suitable footwear, good sugar control, surveillance early recognition and prompt professional treatment are important. [ABSTRACT FROM AUTHOR]

Objective: The study was aimed to assess the knowledge and attitude toward foot care and evaluate the effectiveness of structured teaching program (STP) on the knowledge and attitude of patients with diabetes mellitus regarding foot care. Materials and Methods: A preexperimental research design was used in this study, which was conducted in medical-surgical wards of a secondary hospital in Northeast India, Nagaland. A total of 30 subjects were recruited by consecutive sampling technique. A closed-ended structured questionnaire and 5-point Likert scale was used to assess knowledge and attitude toward foot care. A STP was administered after which posttest was done after 24 h. Results: The majority (86.6%) of the participants in the pretest had inadequate knowledge and 80% had negative attitudes toward foot care. After STP, 70% had moderately adequate knowledge and 53.3% had a positive attitude regarding foot care. The structured teaching program was effective in improving the knowledge and attitude at P < 0.01 which is highly significant and there was a significant association between the pretest level knowledge and duration of diabetes at P < 0.01. Conclusion: STP was effective in enhancing the level of knowledge and attitude toward foot care among diabetic inpatients. This type of interaction can be organized at regular intervals to reinforce knowledge and attitude toward foot care among inpatients. [ABSTRACT FROM AUTHOR]

In diabetic patients, optimised plantar health necessitates meticulously designed hosiery. These specialised socks facilitate a healthy microclimate at the skin–textile interface. This requires that stable conditions of temperature and humidity are maintained during wear. This study investigated the thermal resistance and moisture management properties of socks for diabetics. Fabrics and socks were evaluated on the Alambeta and thermal foot manikin instruments and in wear trials. A novel in vitro method, mimicking in-use conditions, was employed to validate findings and assess sock performance during wear. Fabric structure, especially thickness, had a greater impact on thermal resistance than fibre composition, suggesting that socks with different levels of thermal resistance can be customised according to individual preferences. In terms of moisture management, mohair–wool socks outperformed polyester socks, maintaining significantly lower humidity between the skin and the sock, and meeting the requirement to prevent the drying out of the microclimate significantly better. The enhanced moisture vapour sorption exhibited by the mohair–wool fabric contributes to this effect. Overall, the findings suggest that mohair–wool is an excellent fibre choice for diabetic socks, due to its unique moisture management properties and the possibility to tailor thermal properties through fabric structural design. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot is a serious and often debilitating diabetes complication that poses a significant risk of morbidity and even mortality. However, ensuring good knowledge and good practice of appropriate foot care for patients with diabetes has been frequently neglected in diabetes management. Objectives: This study aimed to assess foot care knowledge and practice in patients with diabetes. Methods: We conducted a cross-sectional study on 400 patients with diabetes at Madinah Diabetes Center, Madinah City, Saudi Arabia, in 2023. Sociodemographic, knowledge score, practice of foot care, and diabetes-related data were collected using a valid interview structured questionnaire. The prevalence of good knowledge and practice level was calculated and compared using the studied patients' characteristics using appropriate statistical tests. Results: The prevalence of good knowledge of foot care and its practice was 35% and 27%, respectively. The knowledge level showed statistically significant differences among patients based on their age and diabetes type and duration. Patients who were >50 years (70.1%), had type 2 diabetes (89.5%), and with diabetes duration >10 years (65%) showed significantly better knowledge. Female patients (65.7%) had a higher good practice level compared with male patients (34.3%) (p < 0.001). Conclusions: This study highlights the insufficient knowledge and inadequate foot care practice among patients with diabetes in the studied population. Educational interventions and targeted strategies are necessary to improve knowledge about the importance of foot care and promote better foot care practices among patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Charcot neuro‐osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO. Aim: The aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency. Methods: A systematic search was performed to identify diabetes national CPGs across Europe. Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE‐II) tool, which comprises 23 key items organized within six domains with an overall guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each guideline was assessed by two reviewers, and inter‐rater agreement (Kendall's W) was calculated for AGREE‐II scores. Results: Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter‐rater agreement was strong (W = 0.882; p < 0.001). Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe. [ABSTRACT FROM AUTHOR]

Background Foot complications are common in people with diabetes mellitus (DM), leading to increased health care utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events. Methods People with DM admitted with foot complications (ulcer, skin and soft tissue infection, or osteomyelitis) from 2012 to 2014 were identified from Taiwan's National Health Insurance Research Database, with a 3-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admissions with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality. Results In this study, 28 754 eligible individuals were enrolled and classified into 3 groups: no repeated diabetic foot events (76.1%), 1 repeated event (16.0%), and 2 or more repeated events (7.9%). Logistic regression revealed that advanced age, male sex, congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared with those with no repeated events, the adjusted hazard ratios for all-cause mortality were 1.26 (95% CI, 1.19–1.34) for 1 repeated event and 1.36 (95% CI, 1.26–1.47) for 2 or more repeated events. Conclusions The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies. [ABSTRACT FROM AUTHOR]

Introduction: Painful Diabetic Peripheral Neuropathy (PDPN) is associated with pain and disturbed sensory symptoms. Altered Pressure Pain Threshold (PPT) in PDPN often leads to complications of diabetic foot and consequent amputations. Early detection of altered PPT can prevent future complications and reduce mortality rates. PPT may be determined with a pressure algometer, which measures the pressure and/or force at which the first perception of pain begins. The cost of algometers frequently prevents them from being used in clinical and research settings. An affordable and dependable algometer would be a valuable tool in PDPN, where health costs are already 20% higher than those of diabetic controls. Aim: To evaluate the test-retest and inter-rater reliability of a low-cost digital pressure algometer in individuals suffering from PDPN. Materials and Methods: This quantitative cross-sectional study was conducted for four months at Metro Heart Institute with Multispeciality Hospital, Faridabad, Haryana, India. PPT of 30 patients with PDPN aged 50-70 years (mean age 61.53±5.84 years) was collected twice by one rater (R1) after a gap of 24 hours. Another rater (R2) repeated the first reading at similar points on both feet. PPT was noted at the dorsum, 2nd, and 3rd metatarsal on the plantar surface of the foot. The main outcome measurements were the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and using the Bland-Altman approach, measurement bias was evaluated. Results: The ICC for test-retest reliability for the dorsal right and left foot was 0.85 and 0.83, respectively. The ICC for Plantar 2nd metatarsal right and left was 0.86 and 0.89, respectively. The ICC for the plantar third metatarsal right and left foot was 0.85 and 0.81, respectively. The inter-rater reliability ICC values varied from 0.63 to 0.87. Bland-Altman plots showed acceptable levels of agreement. Conclusion: The digital algometer showed good test-retest and moderate inter-rater reliability in patients with PDPN. [ABSTRACT FROM AUTHOR]

This study assessed the knowledge and practice of diabetic patients towards diabetic foot care and their general understanding of diabetes causes, complications, and treatment. Methods: A cross-sectional study was conducted at Aldaraga Clinic Centre, Sudan, with a sample size of 100 diabetic patients. A questionnaire and checklist were used to collect data for this study. The data was analyzed through SPSS Version 16 software. Results: The majority of respondents were females (62%), above 40 years old (66%), married, with a low educational level, and moderate-income (76%). The study revealed that most respondents did not attend any educational program about diabetes, indicating poor or no knowledge about diabetes mellitus. However, respondents had good knowledge of most signs and symptoms of diabetes, with the highest percentage (88%) for extreme thirst. Concerning the knowledge of respondents about complications of diabetes, it was generally poor, except for retinal diseases (70%). Participants' knowledge of signs and symptoms of hypoglycemia was found to be poor at 25%. The study showed that most respondents did not know what diabetes gangrene is. Foot infections were the most dominant cause of hospitalization among diabetic patients, often leading to amputations. Conclusion: Enhancing foot care behaviours in diabetic patients is crucial to reduce diabetic foot ulceration risks. Patient-friendly educational interventions and regular physician reinforcement are urgently needed, including awareness programs, specialized diabetes centres, and health education through mass media to improve foot care practices and prevent complications like amputations. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot complications impose a significant strain on healthcare systems worldwide, acting as a principal cause of morbidity and mortality in individuals with diabetes mellitus. While traditional methods in diagnosing and treating these conditions have faced limitations, the emergence of Machine Learning (ML) technologies heralds a new era, offering the promise of revolutionizing diabetic foot care through enhanced precision and tailored treatment strategies. Objective: This review aims to explore the transformative impact of ML on managing diabetic foot complications, highlighting its potential to advance diagnostic accuracy and therapeutic approaches by leveraging developments in medical imaging, biomarker detection, and clinical biomechanics. Methods: Ameticulous literature search was executed across PubMed, Scopus, and Google Scholar databases to identify pertinent articles published up to March 2024. The search strategy was carefully crafted, employing a combination of keywords such as "Machine Learning," "Diabetic Foot," "Diabetic Foot Ulcers," "Diabetic Foot Care," "Artificial Intelligence," and "Predictive Modeling." This review offers an indepth analysis of the foundational principles and algorithms that constitute ML, placing a special emphasis on their relevance to the medical sciences, particularly within the specialized domain of diabetic foot pathology. Through the incorporation of illustrative case studies and schematic diagrams, the review endeavors to elucidate the intricate computational methodologies involved. Results: ML has proven to be invaluable in deriving critical insights from complex datasets, enhancing both the diagnostic precision and therapeutic planning for diabetic foot management. This review highlights the efficacy of ML in clinical decision-making, underscored by comparative analyses of ML algorithms in prognostic assessments and diagnostic applications within diabetic foot care. Conclusion: The review culminates in a prospective assessment of the trajectory of ML applications in the realm of diabetic foot care. We believe that despite challenges such as computational limitations and ethical considerations, ML remains at the forefront of revolutionizing treatment paradigms for the management of diabetic foot complications that are globally applicable and precision-oriented. This technological evolution heralds unprecedented possibilities for treatment and opportunities for enhancing patient care. [ABSTRACT FROM AUTHOR]

Objective: Africa presents a higher diabetic foot ulcer prevalence estimate of 7.2% against global figures of 6.3%. Engaging family members in self-care education interventions has been shown to be effective at preventing diabetes-related foot ulcers. This study culturally adapted and tested the feasibility and acceptability of an evidence-based footcare family intervention in Ghana. Methods: The initial phase of the study involved stakeholder engagement, comprising Patient Public Involvement activities and interviews with key informant nurses and people with diabetes (N = 15). In the second phase, adults at risk of diabetes-related foot ulcers and nominated caregivers (N = 50 dyads) participated in an individually randomised feasibility trial of the adapted intervention (N = 25) compared to usual care (N = 25). The study aimed to assess feasibility outcomes and to identify efficacy signals on clinical outcomes at 12 weeks post randomisation. Patient reported outcomes were foot care behaviour, foot self-care efficacy, diabetes knowledge and caregiver diabetes distress. Results: Adjustments were made to the evidence-based intervention to reflect the literacy, information needs and preferences of stakeholders and to develop a context appropriate diabetic foot self-care intervention. A feasibility trial was then conducted which met all recruitment, retention, data quality and randomisation progression criteria. At 12 weeks post randomisation, efficacy signals favoured the intervention group on improved footcare behaviour, foot self-care efficacy, diabetes knowledge and reduced diabetes distress. Future implementation issues to consider include the staff resources needed to deliver the intervention, family members availability to attend in-person sessions and consideration of remote intervention delivery. Conclusion: A contextual family-oriented foot self-care education intervention is feasible, acceptable, and may improve knowledge and self-care with the potential to decrease diabetes-related complications. The education intervention is a strategic approach to improving diabetes care and prevention of foot disease, especially in settings with limited diabetes care resources. Future research will investigate the possibility of remote delivery to better meet patient and staff needs. Trial registration: Pan African Clinical Trials Registry (PACTR) ‐ PACTR202201708421484: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=19363 or pactr.samrc.ac.za/Search.aspx. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. Management of DFUs relies heavily on patients' foot self‐care behaviour. This study aims to explore psychological determinants of this important behaviour among primary care patients. A total of 186 patients with active DFUs self‐reported their illness perception, diabetes distress, self‐efficacy, and foot self‐care behaviour. Structural equation modelling was performed to examine interrelationships among measured variables. The final model demonstrated satisfactory fit, CFI = 0.933, TLI = 0.913, RMSEA = 0.050, SRMR = 0.073, χ2(95) = 132.256 (p = 0.004), and explained 51.1% of the variance of foot self‐care. Illness threat perceptions (i.e., consequence, timeline, identity, concern, and emotion) had a direct positive effect on foot self‐care behaviours, but also indirectly decreased foot self‐care through increasing diabetes distress. Control perceptions (i.e., personal control, treatment control, and coherence) were not directly associated with foot self‐care behaviours, but indirectly improved foot self‐care by reducing diabetes distress and increasing foot care confidence. These findings suggest illness perceptions, diabetes distress, and self‐care confidence as modifiable predictors to be targeted in self‐management interventions for patients with DFUs. [ABSTRACT FROM AUTHOR]

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Background and Aims: Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low‐ and Middle‐Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self‐care, and preventive measures to reduce amputation rates. Methods: A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. Results: The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence‐based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. Conclusion: The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self‐care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow‐up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient‐centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life. [ABSTRACT FROM AUTHOR]

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point. [ABSTRACT FROM AUTHOR]

Background: Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. Methods: A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. Results: In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. Conclusions: An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association between type 2 diabetic patients' adherence to self-care routines, medication use, and health-related quality of life (HRQoL). Methods: This analytical and cross-sectional study was conducted in Hail Region of Saudi Arabia. The sample population comprised 400 men and women diagnosed with type 2 diabetes, all above the age of 18 years. A modified Euro QoL-five-dimensional (EQ-5D) health questionnaire was utilized to evaluate self-care habits and their association with health-related quality of life. Results: Participants' mean age ± standard deviation (SD) was 53 ± 9.4 years, with 50.5 % being female. Non-adherence rates measured were 32.7 % for foot care, smoking (28.2 %), diet (28 %), insulin usage (26.2 %), exercise (23.2 %), and blood sugar monitoring (15.2 %). Mobility challenges were reported in 14.2 % of cases, 26.2 % self-care, 28.2 % everyday activities, 48.2 % pain or discomfort, and 28.2 % anxiety or depression. Significant associations occurred between poor foot care and mobility difficulties (58.2 %), impairment in everyday activities (53.7 %), and experiencing pain and discomfort (63.9 %) with p-values of 0.002, 0.003, and 0.03, respectively. Likewise, significant correlations (p < 0.05) exist between self-care (47.5 %), pain/discomfort (58.7 %), anxiety/depression (31.1 %), and non-adherence to exercise. Regression analysis indicated a positive correlation between respondents' EQ-5D index and oral hypoglycemic agent non-adherence (R2 = 0.25; p = 0.001). A significant relationship exists between EQ-5D index and smoking non-adherence after normalization (p = 0.003; 95 % CI: 0.0001 to 0.0001). Conclusion: In Hail region of Saudi Arabia, the health-related quality of life for diabetics diminishes as self-care practices are neglected. [ABSTRACT FROM AUTHOR]

Objective: The study was aimed at assessing the self-care practices and the associated socio-demographic variables of persons with T2DM in South East, Nigeria. Methodology: A cross-sectional study involving 382 persons with T2DM proportionately selected from 4 tertiary health institutions in South Eastern, Nigeria. Data was collected using the Summary of Diabetes Self-Care Activities (SDSCA) and a researcher-developed questionnaire. The questionnaire was administered to persons with T2DM who attended a diabetic outpatient clinic. Data collected was analyzed in frequency percentage. Responses on SDSCA were ranked and rated as poor, moderate, and good self-care behavior. The level of significance was placed at P <.05. Result: The majority of the participants were within the age groups of 40 to 59 (46.9%) and 60 and above (46.9%); the majority (74.6%) were married while a good proportion were traders (59.7%). Also, the majority of participants (81.2%) were on oral hypoglycemic agents. Findings further showed that a good proportion (51.3% and 89.8%) of study participants had good self-care behavior in diet and medication domains respectively. Whereas the proportion of participants with poor self-care behavior was very high in foot care (75.1%) and fairly high in both self-blood sugar testing (37.7%) and exercise (37.2%) domains. Only 7.9% practiced 3-monthly laboratory blood glucose testing while 16.5% went for eye checks every 6 months. Conclusion: Individuals with diabetes mellitus have poor self-management behavior in most domains of the self-management practice. Age, gender, marital status, educational level, and occupation significantly influenced self-management practices. Hence nurses and health educators should take diabetes self-management education very seriously to help diabetes sufferers improve their self-management behavior. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to determine the extent of non‐adherence to the different dimensions of diabetes self‐management and to identify the factors influencing non‐adherence among peripheral patients in Bangladesh. Methods: A cross‐sectional study was conducted among 990 adult diabetic patients residing in Thakurgaon district, Bangladesh. Data were collected through face‐to‐face interviews including socio‐demographic information, disease and therapeutic, health services, knowledge and adherence to self‐management components. Results: The proportion of non‐adherence to drug prescription was 66.7%, dietary regimen (68.9%), physical exercise (58.0%), follow‐up visit/blood glucose test (88.2%), stopping tobacco (50.6%), and regular foot care (93.9%). Significant predictors for non‐adherence to drug were poorest socio‐economic status (OR = 2.47), absence of diabetic complications (OR = 1.43), using non‐clinical therapy (OR = 5.61), and moderate level of knowledge (OR = 1.87). Non‐adherence to dietary recommendations was higher for women (OR = 1.72), poorest socio‐economic status (OR = 3.17), and poor technical knowledge (OR = 4.68). Non‐adherence to physical exercise was lower for women (OR = 0.62), combined family (OR = 0.63), middle socio‐economic status (OR = 0.54), and moderate knowledge on physical exercise (OR = 0.55). Non‐adherence to follow‐up visits/blood glucose test was higher among patients who did not have diabetic complications (OR = 1.81) and with own transport (OR = 2.57), and respondents from high‐income group (OR = 0.23) were less likely to be non‐adherent. Non‐adherence to stopping tobacco was higher for older individuals (OR = 1.86); but lower for women (OR = 0.48), individuals with higher education level (OR = 0.17) and patients sick for a longer time (OR = 0.52). Non‐adherence to foot care was higher for patients who needed longer time to go to hospital (OR = 4.07) and had poor basic knowledge on diabetes (OR = 17.80). Conclusion: An alarmingly high proportion of diabetic patients did not adhere to diabetes self‐management. Major predictors for non‐adherence were related to patient's demographic characteristics and their experience with disease, treatment and health care services. [ABSTRACT FROM AUTHOR]

Objectives: The important role of prevention in controlling chronic diseases such as diabetes, the major impact of self-care behaviors as preventive behaviors, and the lower cost of self-care measures should be considered. Therefore, this study was conducted to systematically review and meta-analyze the status of diabetes self-care activities status in type 2 diabetic patients worldwide. Methods: As far as we know, our study is the first systematic based meta-analysis estimating the pooled score of diabetes self-care activities (SDSCA) and its dimensions among type 2 diabetic patients. Keywords were searched in Scopus, Web of Science, Google Scholar, PubMed, Cochrane, Ovid, and ProQuest databases from 2012 to 2022. The self-care pooled score estimates through a fixed-effects meta-analysis using STATA 15. Also, I2 statistic was used to determine heterogeneity across the articles. Results: Seventeen studies on the diabetes self-care activities were included in the meta-analysis. Variation in pooled mean attributable to heterogeneity for exercise and self-care is zero, while the variation for foot cares, general diet, and blood testing were estimated to be 53, 20.6, and 81.4%, respectively (p < 0.01). The random effects based pooled mean was estimated as follows: foot care (FC) 2.02 (95% CI: 1.05, 2.98), general diet (GD) 3.91 (95% CI: 3.21, 4.60), and blood testing (BT) 1.82 (95% CI: 0.64, 3.01). As well as based on the fixed effects, the pooled mean of exercise (E) and the total score of self-care (TSC) were obtained 2.12 (95% CI: 1.77, 2.47) and 3.35 (95% CI: 2.96, 3.74), respectively. Conclusion: The overall level of self-care was moderate and far from ideal. Dimensions of foot care, exercise, and blood glucose testing were also below average. Based on this evidence, policies to prevent diabetes should be directed toward educating patients on preventive activities. On the other hand, it is necessary to ensure that patients' interpretations are in line with doctors' recommendations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the association between social determinants of health (SDOH) and a diagnosis of diabetic foot ulcer (DFU) infection. RESEARCH DESIGN AND METHODS: Targeted interrogation of electronic health record data using novel search engines to analyze individuals with a DFU infection during a 5-year period (2013–2017) was performed. We extracted geolocated neighborhood data and SDOH characteristics from the National Neighborhood Data Archive and used univariate and multiple logistic regression to evaluate associations with outcomes in the population with diabetes. RESULTS: Among 4.3 million people overall and 144,564 individuals with diabetes seen between 2013 and 2017, 8,351 developed DFU, of which cases 2,252 were complicated by a DFU infection. Sex interactions occurred, as men who experienced a DFU infection more frequently identified as having nonmarried status than their female counterparts. For the population with DFU infection, there were higher rates for other SDOH, including higher neighborhood disadvantaged index score, poverty, nonmarriage, and less access to physician/allied health professionals (all P < 0.01). In multiple logistic regression, those individuals who developed DFU infection came from neighborhoods with greater Hispanic and/or foreign-born concentrations (odds ratio 1.11, P = 0.015). CONCLUSIONS: We found significant differences in neighborhood characteristics driving a higher risk for DFU infection in comparisons with the grouping of individuals with diabetes overall, including increased risk for individuals with Hispanic and/or foreign-born immigration status. These data strongly support the need to incorporate SDOH, particularly ethnic and immigration status, into triage algorithms for DFU risk stratification to prevent severe diabetic foot complications and move beyond biologic-only determinants of health. [ABSTRACT FROM AUTHOR]

Torsional stiffness of athletic footwear plays a crucial role in preventing injury and improving sports performance. Yet, there is a lack of research focused on the biomechanical effect of torsional stiffness in badminton shoes. This study aimed to comprehensively investigate the influence of three different levels of torsional stiffness in badminton shoes on biomechanical characteristics, sports performance, and injury risk in badminton players. Fifteen male players, aged 22.8 ± 1.96 years, participated in the study, performing badminton-specific tasks, including forehand clear stroke [left foot (FCL) and right foot (FCR)], 45-degree sidestep cutting (45C), and consecutive vertical jumps (CVJ). The tasks were conducted wearing badminton shoes of torsional stiffness measured with Shore D hardness 50, 60, and 70 (referred to as 50D, 60D, and 70D, respectively). The primary biomechanical parameters included ankle, knee, and MTP joint kinematics, ankle and knee joint moments, peak ground reaction forces, joint range of motion (ROM), and stance time. A one-way repeated measures ANOVA was employed for normally distributed data and Friedman tests for non-normally distributed data. The 70D shoe exhibited the highest ankle dorsiflexion and lowest ankle inversion peak angles during 45C task. The 60D shoe showed significantly lower knee abduction angle and coronal motions compared to the 50D and 70D shoes. Increased torsional stiffness reduced stance time in the FCR task. No significant differences were observed in anterior-posterior and medial-lateral ground reaction forces (GRF). However, the 70D shoe demonstrated higher vertical GRF than the 50D shoe while performing the FCR task, particularly during 70% - 75% of stance. Findings from this study revealed the significant role of torsional stiffness in reducing injury risk and optimizing performance during badminton tasks, indicating that shoes with an intermediate level of stiffness (60D) could provide a beneficial balance between flexibility and stability. These findings may provide practical references in guiding future badminton shoe research and development. Further research is necessary to explore the long-term effects of altering stiffness, considering factors such as athletic levels and foot morphology, to understand of the influence of torsional stiffness on motion biomechanics and injury prevalence in badminton-specific tasks. [ABSTRACT FROM AUTHOR]

Introduction: According to International Diabetes Federation (IDF), approximately 425 million people worldwide suffer from diabetes. 11.6 million deaths per year are directly attributed to it. Currently 39 million people in the MENA region suffer with diabetes. This region also has the second highest rate of increase in diabetes globally, where the number of people with diabetes is predicted to increase by 96.2% in 2035.315% of the U.A.E adult population are categorized as patients of type-2 diabetes mellitus (DM). Materials and Methods: This prospective cross-sectional study was conducted in the outpatient department of General Medicine in Tagore Medical College and Hospital, Rathinamangalam, Melakottaiyur, Chennai, wherein 50 to 60 patients with diabetes visit the OPD every day to get their weekly anti diabetic drugs. 100 such patients were screened. Inclusion criteria included a diagnosis of either type 1 or type 2 diabetes mellitus diagnosed at least six months prior. Patients underwent a detailed history and examination and investigations were done. Educational status of each respondent was assessed and classified as literate or illiterate. Literate participants were further classified as matric (high school), below (primary school) and beyond high school. Results: Of the 100 patients assessed, 63 were men. 11 (11%) of the 100 had a current or past history of foot ulcers. The mean age of the respondents was 46 years (range 16-83 years). Patients had diabetes for an average of 8.59 years (range 1-36 years). Nineteen percent of the 100 were illiterate. Primary school, High school and Beyond High school education was seen in 44.5%, 27.5% and 9% of the study population respectively. Only 23 patients had received either an educational session or reading material about foot care. 7 had similarly received an educational session or material about foot wear. Conclusion: Before diabetic foot care reaches the level desired by specialists in this field, many barriers must be recognized and overcome. Sound and cost-effective strategies need to be developed. Policymakers and health-care professionals should work together to remove the obstacles and facilitate the provision of adequate diabetic foot care. The impact of diabetic foot disease and amputations will only be reduced if sufficient attention is paid to the necessary preventive measures. This study emphasises that significant reductions in amputations can be achieved by well-organized diabetic foot care teams, good diabetes control and well-informed self-care. This study also stresses the need for opening patient centred diabetic foot care clinics for early diagnosis, treatment and prevention. [ABSTRACT FROM AUTHOR]

To evaluate the risk factors connected with diabetic foot care and investigate the impact of health education on promoting proper diabetic foot care practices. An explanatory and mixed‐method study was performed. We administered a structured pretest questionnaire to patients diagnosed with Type 2 diabetes who frequented our health examination center and community health clinics. The survey encompassed patient demographics, basic knowledge concerning diabetic foot care, and self‐care practices pertaining to diabetic foot care. Concurrent assessments and scoring were carried out. Following the survey, patients underwent health education sessions focusing on foot self‐care behaviours. Their progress was reevaluated after 2 weeks to gauge its effectiveness. We identified educational attainment, diabetes duration, regular follow‐up, and blood sugar control as critical factors influencing knowledge about foot care and self‐care practices related to it. Pearson correlation analysis demonstrated a positive relationship between scores for diabetic foot care knowledge and scores for self‐care behaviours (r = 0.32, p < 0.001). Health education led to a significant improvement in the self‐care behaviours of diabetic patients. A variety of factors affect the occurrence of diabetic foot complications and the self‐care behaviours associated with diabetic foot care. Health education proves to be an effective means of enhancing diabetic foot care behaviours. [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short‐term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double‐blinded randomized controlled clinical trial. Methods: This double‐blinded, placebo‐controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five‐time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021. Results: Both groups showed significant improvement in ulcer healing over 4 weeks (ptime < 0.001), with more remarkable progress in the Dermaheal group (pgroup = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (ptime < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between‐group difference was observed in pain severity levels. Conclusion: Dressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long‐term efficacy. Key messages: Ulcer healing significantly improved in the Dermaheal group compared to the placebo group.Reduction in ulcer size was significantly more in the Dermaheal group than in the placebo group.The pain‐alleviating effect of Dermaheal was not superior to the placebo. [ABSTRACT FROM AUTHOR]

The article discusses the importance of a holistic approach to managing diabetic foot complications. It emphasizes the need for a comprehensive strategy that includes pre-hospital preventive measures, a multi-disciplinary team approach in the hospital setting, and post-hospital care. The article highlights the prevalence of diabetic foot complications and the high rate of amputations, emphasizing the importance of early detection and effective management. It also discusses various preventive strategies, regular foot care, appropriate footwear, and the role of education and awareness in reducing diabetic foot complications. The article emphasizes the need for a dedicated foot protection team, glycemic control, wound care, and surgical interventions in managing diabetic foot problems. It also mentions the importance of spiritual care and post-hospital care management for successful outcomes. Overall, the article highlights the urgent need for action to address the increasing prevalence of diabetic foot problems and emphasizes the importance of a holistic approach in patient management. [Extracted from the article]

Background: This study aimed to examine the relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes based on Orem's Self-Care Theory. Methods: The research involved 341 patients with type 2 diabetes in Rasht, Iran, using a descriptive-analytical cross-sectional design. The data collection included questionnaires assessing Self-Care Behaviors, Self-Efficacy, and Health Deviation Self-Care Requisites based on Orem's model. Results: Demographic factors such as gender, marital status, employment, education, age, duration of disease, and oral treatment and insulin had no consistent effect on self-care behaviors. Self-efficacy was a key factor influencing Self-Care Behaviors in diabetic patients. There was a strong and direct correlation between Self-Care Behaviors and Self-Efficacy, indicating the role of individuals' confidence in managing diabetes. Health Deviation Self-Care Requisites had both positive and negative correlations with different domains of Self-Care Behaviors.The physical exercise construct of self-efficacy was the most significant predictor of Self-Care Behaviors. Conclusions: This study provides valuable insights into the complex relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes. The findings underscore the importance of addressing Self-Efficacy and specific self-care domains, such as physical activity and foot care, in diabetes management strategies. This research contributes to the existing knowledge base and may inform healthcare professionals and policymakers in developing targeted interventions to improve self-care practices in diabetic patients. [ABSTRACT FROM AUTHOR]

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. [ABSTRACT FROM AUTHOR]

This article, published in the Arab Journal of Interventional Radiology, evaluates the effectiveness of a multidisciplinary team in treating patients with the neuroischemic form of diabetic foot syndrome at the Almazov National Medical Research Center. The study analyzed the treatment outcomes of 51 patients over a period of 2 years 8 months to 4 years 8 months. The results showed that 88.3% of patients experienced successful healing of ulcers or postoperative wounds, with more than half of them healing within 3 months after the operation. The study also found that 11.7% of patients required major amputations, and the 3-year survival rate was 80%. Overall, the multidisciplinary approach demonstrated improvements in limb preservation and reduced bone-plastic. [Extracted from the article]

Since diabetic foot ulcers (DFUs) are common among diabetes patients, it is essential to increase patients' knowledge and self-care practices to ensure early recognition and management and reduce amputation risk. Therefore, the goal of this review was to identify the range and level of knowledge of people with DFUs and the type of self-care they undertake. A literature review was conducted using the electronic databases PubMed and Google scholar with 'diabetic foot', 'self-care', 'practice' and 'behaviour' as searching keywords. The identification and selection process were conducted to sort the eligible papers through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The criteria are the original papers describing knowledge and practice in DFU; reporting knowledge and practice in their non-intervention studies; writing in English language; and publishing between years 2016 and 2022. The eligible papers were assessed using the strength of reporting observational studies in epidemiology (STROBE) checklist for appraising their quality. Twenty-two papers of 2,073 titles met the inclusion criteria and included in the review. The lowest and the highest quality score of included papers based on STROBE checklist are 11 and 26, respectively. The included papers showed various levels of knowledge from good to poor, which prominent the highest percentage are 88% (good knowledge) and 84.8% (poor knowledge). The majority of the foot-care activities found in the reviewed papers involved the following steps: washing, drying, applying moisturiser and trimming nails routinely. Those activity should be followed by checking the feet with a mirror for ulcers, looking for ingrown nails, choosing appropriate footwear, not walking barefoot and routinely consulting a healthcare provider. The knowledge levels were found variable and acceptable. Daily foot care, choosing the right footwear, foot activity and regular health checks should all be used to manage diabetes. [ABSTRACT FROM AUTHOR]

This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients.Methods: Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method.Results: Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22– 1.57, p < 0.0001), shortened the healing time (Mean difference [MD] − 16.97 days (95% CI: − 32.64 to − 1.29; p < 0.00001), shortened the length of hospital stay (MD= − 20.11, 95% CI: − 38.02, − 2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02).Conclusion: APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment. [ABSTRACT FROM AUTHOR]

Variations of Community Health Workers (CHWs) interventions in diabetes self-management education (DSME) have been reviewed by many studies. In contrast, specific interventions regarding foot care intervention (FCI) are scarce and need to be explored further as one preventive measure to reduce diabetic foot problems in the community. This scoping review aimed to identify, and report nature of FCIs and the core components of FCIs delivered by CHWs. The scoping review was undertaken using PRISMA Extension for Scoping Reviews (PRISMA-ScR). The following electronic databases were searched for articles from data first indicated date through December 2022: CINAHL, EMBASE, Cochrane, Scopus, Web of Science, Theses ProQuest, PubMed, google scholar and other sources by using search terms related to foot care, community health workers, and diabetes mellitus. Descriptive synthesis was used to summarise the data. Nine studies from 1644 were included. All studies found that CHWs provided DSME in general, and foot care education was included. There was no detailed description of the core components of the intervention on foot care. Although, all studies might not provide detailed data on how CHW provided FCIs; the CHW intervention is an undoubtedly vital strategy to promote and prevent foot problems in medically underserved communities. [ABSTRACT FROM AUTHOR]

Peer group support plays a crucial role in enhancing diabetic foot care. However, diabetic patients often exhibit suboptimal foot care behavior due to a lack of support. This study aimed to explore the correlation between peer group support and foot care practices in individuals with diabetes mellitus. Employing a cross-sectional design, the research focused on diabetes mellitus patients aged 40-55 years, and those with less than five years of diabetes history. A purposive sampling technique was utilized to select 64 participants. The research variables encompassed demographic factors, peer group dynamics, and diabetic foot care behavior. These were assessed through a modified questionnaire, verified for validity and reliability. Data analysis involved descriptive analysis and chi-square analysis. The findings revealed a prevalence of 79.7% for inadequate peer group support and 20.3% for robust support. In terms of diabetic foot care behavior, 56.3% exhibited poor practices, while only 17.2% demonstrated good foot care behavior. All variables displayed significance concerning the dependent variable, with a p-value < 0.003. This underscores the positive impact of peer group support on improving foot care behavior in diabetes mellitus patients. This study highlights the need for further research to delve into the effects of educational interventions and family involvement in enhancing diabetic foot care behavior. [ABSTRACT FROM AUTHOR]

The diabetic foot ulcer is the precursor for diabetic foot and it is the most common sequel that occurs following any trauma or infection in a diabetic individual. The diabetic foot ulcers most commonly occur at the distal ends of the extremities because this is the area with the vascularity is the least as a result of microangiopathy that has occurs in in diabetes mellitus. The study was started after the ethical clearance was secured from the institution's ethical clearance committee. Following this the patients who came to the surgical outpatient department and the subspecialties of surgery that dealt with diabetic foot ulcers where well explained regarding the study. After they give informed consent to participate in the study, a thorough physical examination and history was taken based on a pre-defined questionnaire that was semi felt field. We noted that when insulin was used it reduced the size of the wound at a faster rate as compared to the conventional normal saline dressings. Also the quality of granulation tissue and the per cent reduction of the ulcer size was far better in the insulin group. We did not note any adverse effects as a result of insulin use in the test group. [ABSTRACT FROM AUTHOR]

Background In this study, we wanted to assess various presentations of diabetic foot, evaluate diabetic foot outcomes after non-invasive and invasive treatment modalities, and analyse the percentage of surgical intervention and outcome. Method This was a hospital-based cross-sectional study conducted among 80 patients of diabetic foot diseases both male and female attending the General Surgery outpatient department and inpatients at Basaveshwara Medical College Hospital and Research Centre, Chitradurga, from 1st March 2021 to 31st August 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results Our study involved 80 patients with most of them being males and of age more than 60 years. Most of the patients presented with cellulitis or foot ulcer. Wound debridement was found to be an effective mode of initial management followed by amputation. Conclusion The most frequent side effect of diabetes mellitus that surgeons are informed about is diabetic foot infection, which necessitates a multidisciplinary approach to treatment. The most crucial elements in the care of these patients are the efficient control of diabetes and the infection itself, as well as any necessary surgical operations based on the severity of the illness. The limitations of the study are the relatively small number of patients and a short period of study. [ABSTRACT FROM AUTHOR]

Calluses are thickened skin areas that develop due to repeated friction, pressure, or other types of irritation. While calluses are usually harmless and formed as a protective surface, they can lead to skin ulceration or infection if left untreated. As calluses are often not clearly visible to the patients, and some areas of dead skin can be missed during debridement, accessory tools can be useful in assessment and follow-up. The practical question addressed in this article is whether or not thermal imaging adds value to callus assessment. We have performed a theoretical analysis of the feasibility of thermographic imaging for callus identification. Our analytical calculations show that the temperature drop in the epidermis should be on the order of 0.1 °C for the normal epidermis in hairy skin, 0.9 °C for glabrous skin, and 1.5–2 °C or higher in calluses. We have validated our predictions on gelatin phantoms and demonstrated the feasibility of thermographic imaging for callus identification in two clinical case series. Our experimental results are in agreement with theoretical predictions and support the notion that local skin temperature variations can indicate epidermis thickness variations, which can be used for callus identification. In particular, a surface temperature drop on the order of 0.5 °C or more can be indicative of callus presence, particularly in callus-prone areas. In addition, our analytical calculations and phantom experiments show the importance of ambient temperature measurements during thermographic assessments. [ABSTRACT FROM AUTHOR]

This study investigated the effect of L-PRF on promoting full-thickness skin grafting for the treatment of diabetic foot ulcer wounds and attempted to characterize the mechanism. In a retrospective study, we centrifugated 10-20 ml of venous blood at 1006.2 g for 20 min. The fibrin clot between the top oligocellular plasma layer and the bottom erythrocyte layer was extracted and directly used, without compression, to cover the wound after debridement. Patients who received L-PRF before skin grafting underwent surgery earlier than patients in the control group. Skin necrosis occurred in 7 patients (28%) in the L-PRF group and 16 (64%) in the control group. The difference was statistically significant, P < .05. The postoperative infection rate in the control group (56%) was significantly higher than that in the L-PRF group (24%), P < .05. During a mean follow-up of 1 year, ulcer recurrence occurred in 9 patients (36%) in the control group compared with 4 patients (16%) in the L-PRF group, P < .05. The final amputation rate was also higher in the control group (48%) than in the L-PRF group (20%). The difference is statistically significant, P < .05. The Maryland scale score and SF-36 score of the two groups of patients after treatment were significantly better than those before treatment, and the difference was statistically significant (P < .05). The L-PRF group (94.80 ± 4.14) had better foot scores at the last follow-up after treatment than the control group (88.84 ± 5.22) (P < .05). The results showed that L-PRF played a positive role in the treatment of Wagner grade 4 ulcer gangrene with free full-thickness skin grafts. [ABSTRACT FROM AUTHOR]