Impact of educational interventions in reducing diabetic complications: a systematic review

Menezes, Marcela Machado; Lopes, Camila Takáo; Nogueira, Lilia de Souza

doi:10.1590/0034-7167.2016690422i

Marcela Machado Menezes CORRESPONDING AUTHOR: Marcela Machado Menezes E-mail: marcela.menezes@outlook.com

Universidade de São Paulo, School of Nursing, Nursing in Adult and Older Adults Health Residency Program. São Paulo, Brazil.

Camila Takáo Lopes

Universidade Federal de São Paulo, São Paulo School of Nursing, Department of Clinical and Surgical Nursing. São Paulo, Brazil.

Lilia de Souza Nogueira

Universidade de São Paulo, School of Nursing, Department of Clinical and Surgical Nursing. São Paulo, Brazil.

CORRESPONDING AUTHOR: Marcela Machado Menezes E-mail: marcela.menezes@outlook.com

Component	Definition	Descriptors	Keywords
P: Population of interest	Adults with diabetes mellitus	Neither descriptors nor keywords were adopted. Filters for age were used in the databases.
I: Intervention	Educational intervention	Health educationEducation of patientsHealth EducationPatient Education as Topic	EducationHealth educationEducational interventionHealth Education Patient Education Diabetes Education Diabetes Educators
C: Comparison	-	-	-
O: Result/Outcome	Reduction of metabolic and/or vascular complications of diabetes mellitus	Complications of Diabetes Diabetic ComplicationsDiabetes ComplicationsDiabetic KetoacidosisDiabetic FootDiabetic ComaDiabetic RetinopathyDiabetic Nephropathies Diabetic AngiopathiesDiabetic Cardiomyopathies	Complication diabetes Complications diabetes

DatabaseOnline Library	Search strategies
LILACS, IBECS, and CUMED - via Biblioteca Virtual de Saúde (Virtual Health Library)	(Education OR “health education” OR “educational intervention”) AND (diabetes OR “complications of diabetes” OR “diabetic complications”)Filters: language (English, Portuguese, and Spanish); adult; year of publication (2004 to 2014) and document type (article)
Medline - via PubMed	((((((Health Education[MeSH Terms]) OR Health Education[Title/Abstract]) OR Patient Education as Topic[MeSH Terms]) OR Patient Education[Title/Abstract]) OR Diabetes Education[Title/Abstract]) OR Diabetes Educator[Title/Abstract]) AND (((((((((((Diabetes Complications[MeSH Terms]) OR Diabetes Complications[Title/Abstract]) OR Complication diabetes[Title/Abstract]) OR Complications diabetes[Title/Abstract]) OR Diabetic Ketoacidosis[Title/Abstract]) OR Diabetic Foot[Title/Abstract]) OR Diabetic Retinopathy[Title/Abstract]) OR Diabetic Nephropathies[Title/Abstract]) OR Diabetic Angiopathies[Title/Abstract]) OR Diabetic Cardiomyopathies[Title/Abstract]) OR Diabetic Neuropathies[Title/Abstract])Filters: language (English, Portuguese, and Spanish); year of publication (2004 to 2014) and age (Adults: 19+ years)
CINAHL - via Ebsco Host	((MH health education) OR (Health Education) OR (MH Patient Education as Topic) OR (Patient Education) OR (MH Diabetes Education) OR (diabetes education) OR (MH Diabetes Educators) OR (diabetes educator)) AND ((MH Diabetic Ketoacidosis) OR (diabetes complications) OR (MH Diabetic Foot) OR (MH diabetic coma) OR (MH Diabetic Retinopathy) OR (MH Diabetic Nephropathies) OR (MH Diabetic Angiopathies) OR (MH Diabetic Cardiomyopathies) OR (MH Diabetic Neuropathies) OR (Complication diabetes))Filters: date of publication (20040101-20141231); age: all adults; Source type: Academic journals
SciELO - via scielo.br	Health Education OR Patient Education as Topic OR Patient Education OR Diabetes Education OR Diabetes Educator [All indexes] and Diabetes Complications OR Complication diabetes OR Complications diabetes OR Diabetic Ketoacidosis OR Diabetic Foot OR Diabetic Retinopathy OR Diabetic Nephropathies OR Diabetic Angiopathies OR Diabetic Cardiomyopathies OR Diabetic Neuropathies [All indexes] Filter: date of publication (2004 to 2014).

Reference, location, and Quality of the study	Design/number of patients	Interventions	Follow-up strategies	Outcomes and conclusions
Chao et al.⁽¹⁹19 Chao YH, Usher K, Buettner PG, Holmes C. Cluster randomised controlled trial: educational self-care intervention with older Taiwanese patients with Type 2 diabetes mellitus-Impact on blood glucose levels and diabetic complications. Collegian [Internet]. 2014[cited 2014 Nov 18];21(1):43-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24772989 http://www.ncbi.nlm.nih.gov/pubmed/24772... ⁾, 2014 TaiwanJadad Score: 1	A total of 500 patients with DM 2 or blood glucose levels above the normal parameters for 3 consecutive months. Age: 50 to 80 yearsCG: 259 (52.2% > 65 years)IG: 241 (59.2% > 65 years) Time of evolution of DM: 30.6%: DM >10 years; 27.8%: DM 5-10 years; 26.2%: DM 2-5 years; 15.4%: DM <2 years	CG: Information brochure about DM.IG: Usual care + 1 hour session per week, for 3 weeks, education on DM (general information, specific dietary suggestions, and requirements of self-care) planned by physician, nurses, and nutritionists.	Follow-up of complications at 3 and 6 months following the intervention. Variables considered for measuring of results: blood glucose level (NR:70-110 mg/dL or 90-140 mg/dL), creatinine (NR: 0.6-1.5 mg/dL), levels of glucose and protein in urine (N: both nulls), microalbumin (N: less than 30 mg), presence of cataract or retinopathy.	Outcomes presented only 6 months after the intervention: Blood glucose level after 6 months: IG 128.8±41.0 versus CG 174.4±50.1 (p<0.001)Blood glucose levels above normal after 6 months: IG 60.4% versus CG 92.4% (p<0.001) Occurrence of complications:Basal: IG 42.0% versus CG 82.1% (p=0.003) After 6 months: IG 48.4% and CG 87.0% (p=0.006). Conclusion: The intervention was efficient in improving blood glucose levels and reduced the rates of complications.
Gershater et al.⁽¹⁵15 Gershater MA, Pilhammar E, Apelqvist J, Alm-Roijer C. Patient education for the prevention of diabetic foot ulcers. Eur Diab Nursing [Internet]. 2011[cited 2014 Oct 16];8(1):102-7b. Available from: http://onlinelibrary.wiley.com/doi/10.1002/edn.189/epdf http://onlinelibrary.wiley.com/doi/10.10... ⁾, 2011 Sweden Jadad Score: 5	131 patients with DM, neuropathy and prior feet ulcers. Age: 35-79 years (median 64 years), 73.2% men, 67.1% with DM 2 and 32.9% with DM 1CG: 35-79 years, median 64, 71.4% menIG: 37-78 years, median 64, 75.4% men. Time of evolution of DM: not reported.	CG: Footwear with soles adjusted for internal/external environments and recommendation of Podiatrist. Standard information based on International Consensus on Diabetic Foot and provided by a nurse specialist in DM. IG: Usual care + 1 hour group sessions with strategy of question conducted by a nurse “What are the causes of feet ulcers?” (10 sessions for men and 4 for women, 2 to 5 persons in each group who participated of sessions once).	Follow-up of new feet ulcers after 6 months of intervention, considering the classification of Wagner (level 0 represents no ulcer, level ≥ 1 represents ulcer).	Results: 58% of 98 patients who completed the follow-up developed no new feet ulcers (21 in IG and 36 in CG [NS]) Conclusion: The intervention was not efficient in reducing the incidence of new feet ulcers.
Cisneros et al.⁽²⁵25 Cisneros LL. Evaluation of a neuropathic ulcers prevention program for patients with diabetes. Rev Bras Fisioter [Internet]. 2010[cited 2014 Nov 09];14(1)31-7. Available from: http://www.scielo.br/pdf/rbfis/v14n1/en_06.pdf http://www.scielo.br/pdf/rbfis/v14n1/en_... ⁾, 2010 Brazil Jadad Score: 1	53 diabetic patients with peripheral neuropathy. CG: 23 (22 with DM 2 and 1 with DM 1) 59.8±9.0 years of age IG: 30 (29 with DM 2 and 1 with DM 1), 64.4 ± 9.2 years of age. Mean time of evolution of DM: 14.5 ± 10.2 years.	CG: Quarterly individual consultation with a physical therapist: instructions on foot care and footwear according to spontaneous demand. IG: Usual care + 4 weekly group meetings of 90 minutes with a physical therapist. Focus group to address and discuss complications of DM, treatments, hygiene inspection and care and cleaning of feet or choice and use of footwear + games as teaching tool with questions on the subject treated at the end of each meeting.Participants received a pair of shoes at the beginning of the study and another after the fourth re-evaluation.	Follow-up of occurrence and recurrence of neuropathic lesion on feet in individual quarterly consultations in the first 18 months and 24 months after the intervention and analysis of the time until development of the lesion. Variables for measuring results: skin conditions, quality of pulses, and the presence of deformities. We applied risk classification for feet lesion: risk 1 (insensitivity), risk 2 (plantar hyperpressure and insensitivity or deformity), risk 3 (insensitivity and prior ulcer), risk 4 (insensitivity, prior ulcer, and plantar hyperpressure), and risk 5 (neuropathic fracture). Insensitivity was verified by esthesiometry and hyperpressure, by plantigraphy.	Results: Occurrence of neuropathic lesion:IG 38.1% versus CG 57.1% (p=0.317) Recurrence of neuropathic lesion:IG 16.7 versus CG 83.3 (p=0.119)Time until development of the lesion:IG versus CG (p=0.362)Conclusion: The intervention was not efficient in reducing the incidence or recurrence of neuropathic lesion in the lower limbs.
Lincoln et al.⁽²⁰20 Lincoln NB, Radford KA, Game FL, Jeffcoate WJ. Education for secondary prevention of foot ulcers in people with diabetes: a randomized controlled trial. Diabetologia [Internet]. 2008[cited 2014 Nov 18];51(11):1954-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18758747 http://www.ncbi.nlm.nih.gov/pubmed/18758... ⁾, 2008 United Kingdom Jadad Score: 5	172 patients with DM and feet ulcers healed for at least 28 days. CG: 85, 81% with DM 2, 63±12.1 years of age IG: 87, 74% with DM 2, 64.9±10.9 years of age.Time of evolution of DM: not reported.	CG: Brochure about foot care, discharge for care with the general practitioner with or without Podiatrist and orthotics.IG: Usual care + educational home visit by nurse or occupational therapist with brief explanation about the main causes of feet ulcers, examination of feet and personal risk factors for lesions, examination of shoes and soles and use of images of feet lesions. Patients were instructed to contact the clinic when they identified problems with the feet and, after 4 weeks, the professional conducted telephone contact with the patient.	Incidence of new feet ulcers or amputations determined through the medical records and the patients’ accounts (discrepancies verified by blinded observers) after 6 and 12 months of intervention.	Results: Ulcers after 6 months: No differences between the groups (IG 30% versus CG 21%) Ulcers after 12 months: No differences between the groups (41% in both) Amputations after 6 months: No differences between the groups (IG 3% versus CG 0%)Amputations after 12 months: No differences between the groups (IG 10% versus CG 11%) Conclusion: The intervention was not efficient in improving the incidence of ulcers or amputations.
Rachmani et al.⁽²¹21 Rachmani R, Slavacheski I, Berla M, Frommer-Shapira R, Ravid M. Treatment of high-risk patients with diabetes: motivation and teaching intervention: a randomized, prospective 8-year follow-up study. J Am Soc Nephrol [Internet]. 2005[cited 2014 Oct 18];16(1):22-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15938028 http://www.ncbi.nlm.nih.gov/pubmed/15938... ⁾, 2005 Israel Jadad Score: 3	141 patients with DM 2, hypertension and Dyslipidemia.CG: 70 (56.8 ± 4.0 years of age, 6.3 ± 1.9 years of time of evolution of DM).IG: 71 (57.4 ± 4.2 years of age, 6.2 ± 2.5 years of time of evolution of DM).	CG: Two standard consultations in two weeks and, thereafter, on an annual basis.IG: Usual care + individual 2-hour sessions with physicians on how to achieve precise control of modifiable risk factors. They were encouraged to call the consultants if they needed advice for to reinforce the instructions.	Evaluations twice a week in the first two weeks after the intervention and, thereafter, annually for about 7.7 years. Variables considered for measuring results: cardiovascular events (mortality by cardiovascular disease, non-fatal AMI, non-fatal stroke, CABG, TCA, amputation or vascular surgery), estimated glomerular filtration rate, retinopathy, nephropathy (identified by the albumin/creatinine ratio>300 mg/g).	Outcomes when comparing usual care versus intervention, respectively:Results: Annual decrease in GFR: 4.6±2.1 versus 3.0±1.8 ml/min/1.73 m² (p=0.01); Albumin/creatinine ratio>34 mg/mmol: 22% versus 12.5% (p=0.02); Reduction in retinopathy: 35 versus 21 patients (p=0.03) Incidence:- AMI (19 versus 15, p=0.06); CVA (17 versus CG 8, p=0.008); Nonfatal CV events (72 versus 47, p=0.001); CABG+TCA (37 versus 26, p=0.001) Conclusion: The intervention was efficient in reducing cardiovascular risk and decreased the speed of progression of microvascular disease.

Reference, location, and Quality of the study	Design/number of patients	Interventions	Follow-up strategies	Outcomes and conclusions
Fan et al.⁽²²22 Fan L, Sidani S, Cooper-Brathwaite A, Metcalfe K. Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk for foot ulceration: a pilot study. Can J Diabetes [Internet]. 2013[cited 2014 Nov 13];37(3):195-201. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24070843 http://www.ncbi.nlm.nih.gov/pubmed/24070... ⁾, 2013 Canada Downs & Black score: 14	79 patients with DM type 2, with low risk of feet ulcers. Age: 55.8±13.2 years.Time of evolution of DM: 5.9±7.1 years (50% ≤1 year).	4 individual sessions over 3 weeks with a nurse. First 2 sessions: interactive classroom teaching and the last 2 sessions consisted of telephone contacts of 10 to 15 minutes, 1 time per week and during 2 weeks, to reinforce the information and clarify questions. 1st session: presentation and discussion of 1 hour on foot care; daily self-care of the feet. 2nd session: 1 hour practical training on feet self-care.	Basal evaluation and evaluation after 3 months: conditions of feet skin (calluses, dryness, cracks, red marks, blisters, humidity, fungal infection, lesions) and conditions of hallux nail (hygiene, length, thickness, interlocking, fungal infection), and such aspects were evaluated dichotomously (present/absent, appropriate/inappropriate, and normal/abnormal).	Results: Pre vs. post intervention group, respectively: Feet skin: Calluses: 57.1% versus 44.1% (p=0.089); Dryness: 42.9% versus 58.9% (p = 0.000); Cracks: 28.6% versus 0 (p = 0.000); Red marks: 17.9% versus 0 (p = 0.001); Cracks: 17.9% versus 3.6% (p = 0.219); Blisters: 1.8% versus 0 (p = 0.500); Humidity: no events in the two evaluations; Fungal infection: 3.6% versus 0 (p = 0.248); Lesions: 0 versus 3.6% (p=0.248); Hallux nails: Proper hygiene: 80.4% versus 100% (p = 0.000); Appropriate length: 76.8% versus 94.6% (p = 0.007); Normal thickness: 80.4% versus 94.6% (p = 0.022); Interlocking: no events in the two evaluations; Fungal infection: 8.9% versus 5.8% (p=0.103);Conclusion: The intervention was effective in reducing mild problems in the feet.
Kazawa & Moriyama⁽²³23 Kazawa K, Moriyama M. Effects of a self-management skills acquisition program on pre-dialysis patients with diabetic nephropathy. Nephrol Nurs J [Internet]. 2013[cited 2014 Oct 03];40(2):141-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23767338 http://www.ncbi.nlm.nih.gov/pubmed/23767... ⁾, 2013 Japan Downs & Black score: 14	30 patients with DM 2 and diabetic nephropathy.Mean age 67±4.3 years, 66.7% men.Time of evolution of DM: 15.1±9.2 years (2 to 30 years).	A total of 4 meetings of 60 minutes, every 15 days, in the participant’s house or in outpatient clinic + 2 sessions of 30 minute by telephone or email and monthly telephone follow-up with a nurse. Use of textbooks, periodicals and study materials on DM and its complications, dietotherapy, exercise therapy, stress therapy, foot care, and drug therapy.	Assessment after 3 and 6 months: kidney function (serum creatinine, estimated glomerular filtration rate, urea nitrogen, HbA1).	Results: Pre vs. post intervention (3 and 6 months), respectively: Creatinine: 1.67±0.53 versus 1.70±0.52 versus 1.67±0.57 (p=0.367); Glomerular filtration: 33.9±13.0 versus 33.1±13.3 versus 34.8±15 (p=0.401)Urea nitrogen: 30.7±13.1 versus 32.2±14.3 versus 30.8±13.2 (p=0.619)HbA1: 6.8±1.5 versus 6.3± 0.9 versus 6.3±0.9 (p=0.044) Conclusion: The intervention was effective in maintaining kidney function stable and decreasing HbA1.
Reda et al.⁽¹⁸18 Reda A, Hurton S, Embil JM, Smallwood S, Thomson L, Zacharias J, et al. Effect of a preventive foot care program on lower extremity complications in diabetic patients with end-stage renal disease. Foot Ankle Surg [Internet]. 2012[cited 2014 Oct 02];18(4):283-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23093125 http://www.ncbi.nlm.nih.gov/pubmed/23093... ⁾, 2012Canada Downs & Black score: 13	58 patients with DM and dialytic chronic kidney disease.Age: 62 ± 12 years.No information concerning the DM evolution time and DM type.	Inspection of feet during the hemodialysis session by a nurse trained in wound and feet care + instructions on the use of appropriate shoes, maintenance of hydration, monitoring of the development of calluses and ulcers, and on maintaining a healthy lifestyle. If ulcers were detected, referral to orthopedists, vascular surgeons, specialists in infectious diseases and in wound care. Prescription of custom soles and orthoses, as appropriate.	Basal evaluation and, after 4 to 6 months: peripheral neuropathy (evaluated by monofilament), absent pedial pulses, amputation, ulcer, Charcot foot, and adequacy of footwear.	Results: Outcomes when comparing current versus previous study, respectively:Neuropathy: 52% versus 88% (p<0.0001); Absent pedial pulses: 36% versus 17% (p<0.009); Amputation: 16% versus 27% (NS); Ulcer: 16% versus 28% (NS); Neuro-osteoarthropathy: 9% versus 15% (NS); Proper footwear: 59% versus 37% (p<0.04); Proper premanufactured footwear: 50% versus 24% (p<0.03); Proper custom footwear: 86% versus 63% (NS)Conclusion: The intervention was effective in decreasing the frequency of peripheral neuropathy, the absence of pedial pulses, and improving the adequacy of the footwear. It was not effective in reducing the frequency of amputations, ulcers, and neuro-osteoarthropathy.
Chen et al.⁽¹⁶16 Chen MY, Huang WC, Peng YS, Guo JS, Chen CP, Jong MC, et al. Effectiveness of a health promotion programme for farmers and fishermen with type-2 diabetes in Taiwan. J Adv Nurs [Internet]. 2011[cited 2014 Oct 16];67(9):2060-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21535092 http://www.ncbi.nlm.nih.gov/pubmed/21535... ⁾, 2011 Taiwan Downs & Black score: 15	323 fishermen and farmers with DM 2. Age: 68.9±9.5 years.Time of evolution of DM: 8.2 ± 6.3 years.	Multidisciplinary approach with nurses and physicians. 1st phase: promoting health through education in a small community group. Control of diet, adherence to medication, foot care, mild/moderate physical activity; 2nd phase: telephone counseling 1 to 3 times per person, for 15 to 30 minutes, adapted individually according to the results of the 1st phase; Phase 3: Re-evaluation of participants at high risk, self-care of feet and peripheral vasculopathy and neuropathy.	Evaluations after 6 months: HbA1 (N: < 7%), fasting blood glucose level (N: < 130 mg/dL), peripheral neuropathy (MNSI): 5 parameters: 1. appearance of feet: deformities, dry skin, abnormal nails, calluses or infections; 2. feet ulcers; 3. test of vibration perception threshold in the back of the hallux; 4. degree of ankle reflexes; 5. feeling of pressure to the touch with monofilament. MNSI score >2 in a 10-point scale was considered neuropathy; peripheral vasculopathy (ABI: normal >0.9 and <0.89 peripheral vascular).	Results: Outcomes when comparing post-intervention versus pre-intervention. Fasting glucose level (mg/dL): 184.66±36.97 versus 192.30±41.16 (p=0,002) MNSI (peripheral neuropathy): 1.93±1.73 versus 2.25±1.74 (p=0.002)ABI (peripheral vasculopathy): 1.03±0.14 versus 0.99±0.15 (p=0.002)Conclusion: The intervention was effective in improving most physiological variables, the peripheral vasculopathy, and the capacity for feet self-care.
Fujiwara et al.⁽¹⁷17 Fujiwara Y, Kishida K, Terao M, Takahara M, Matsuhisa M, Funahashi T, et al. Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study. J Adv Nurs [Internet]. 2011[cited 2014 Nov 15];67(9):1952-62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21480962 http://www.ncbi.nlm.nih.gov/pubmed/21480... ⁾, 2011 Japan Downs & Black score: 14	88 patients with DM (75 with DM 2, 8 with DM 1, 5 with hyperglycemia due to use of steroids).Age: 68 ± 10.3 years.Time of evolution of DM: 22 ± 11.4 years.The classification of risk for ulcers used was based on the International Working Group on the Diabetic Foot.The patients were divided into: 52.3% with low risk of diabetic neuropathy (G0); 9.1% with diabetic neuropathy (G1); 12.5% with neuropathy and peripheral artery disease and/or deformity (G2);26.1% with a history of ulcers or foot amputation (G3).	Program of feet care led by nurse, sessions of 30 to 60 minute per patient. G0: one session per year. Education on nail clipping and development of feet self-care skills. G1: one session every 6 months. Education on clipping the nail of the hallux, removal of keratinized layers of calluses by professional every 6 months, application of moisturizer and local antifungal medications, feet self-care skills, instructions to avoid walking barefoot, prevention of infections and burns, and referral to orthopedic center for the manufacture of custom shoes. G2: one session every 3 months. Patients with peripheral artery disease were told to avoid clipping the nail of the hallux or removing calluses alone. G3: one session every 1 to 3 months. Referral to a dermatologist for treatment and the same instructions provided to the other groups.	Incidence or recurrence of diabetic foot ulcer after 2 years. Neuropathy evaluated with monofilament (impaired sensation: one or more monofilaments not sensed in 10) and vibration perception threshold (positive if the patient answered incorrectly to at least 2 of 3 applications in the hallux). Peripheral artery disease (present when dorsal and tibial pulses were absent in the affected limb). Forefoot deformity: hallux valgus, rigid contractures of feet and bulgy metatarsal head. Feet ulcers: skin lesions distal to ankle and present for at least 2 weeks.	Results: Decreased tinea pedis severity score (p<0.001), increased percentage of patients without tinea pedis. Improvement of calluses (p=0.001) and degree of calluses reduced in 7 of 15 patients in groups 1 to 3. No G3 patient had recurrence of feet ulcers related to the calluses.6 patients developed feet ulcers, but were cured with no development of gangreneConclusion: The program was effective in reducing the occurrence of feet ulcers.
Viswanathan et al.⁽²⁴24 Viswanathan V, Madhavan S, Rajasekar S, Chamukuttan S, Ambady R. Amputation prevention initiative in South India: positive impact of foot care education. Diabetes Care [Internet]. 2005[cited 2014 Nov 15];28(5):1019-21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15855560 http://www.ncbi.nlm.nih.gov/pubmed/15855... ⁾, 2005 India Downs & Black score: 10	4,872 patients with DM 2 with high risk of diabetic foot. Age: 60.5±8.8 yearsDistribution of groups: 1,837 persons with DM and neuropathy (G1).149 persons with DM, neuropathy, and deformity (G2).1,259 persons with DM, neuropathy, deformity and feet ulcers or peripheral vascular disease (G3).Mean DM evolution time: 13.7±7.6 years.	All patients received counseling in the presence of the families: education on diabetic foot and its complications, examination of the feet with a mirror, pedicure techniques, images of patients with infections, ulcers and amputations of feet, leaflets emphasizing the need of care for the feet, request of support from family for the examination of the feet. G1: education on foot care, assistance in selection of proper footwear, routine follow-up. G2 and G3: received custom orthoses to reduce pressure on feet and follow-up was carried out in more regular intervals.The implementation method and the professionals involved were not cited.	Basal evaluation and after 18 months: healing of diabetic foot ulcers, infection, new ulcer or need for surgical procedure.	Results: G1 and G2: 6 (0.3%) and 7 (4.7%) patients, respectively, developed infection or ulcer.G3: Healing of ulcers in 82% of patients who adhered to treatment versus 50% of those who did not adhere. Significantly higher proportion of new problems (26%) and need for surgical procedures (14%) among those who did not adhere versus those who adhered (5 and 3%, respectively, p<0.0001).Conclusion: The recurrence of ulcers was less frequent and the healing process faster among patients who adhered to the program.

[1] CORRESPONDING AUTHOR: Marcela Machado Menezes E-mail: marcela.menezes@outlook.com

Brasil

Brasil

Impact of educational interventions in reducing diabetic complications: a systematic review

ABSTRACT

Objective:

Method:

Results:

Conclusion: