Effects of nursing care on patients in an educational program for prevention of diabetic foot

Scain, Suzana Fiore; Franzen, Elenara; Hirakata, Vânia Naomi

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Artigo Original • Rev. Gaúcha Enferm. 39 • 2018 • https://doi.org/10.1590/1983-1447.2018.20170230 copy

Effects of nursing care on patients in an educational program for prevention of diabetic foot

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVES

Identify in patients with type 2 diabetes what changes in the feet would be associated with demographic, clinical, biochemical and treatment characteristics and which would increase the risk of mortality.

METHODS

Retrospective longitudinal study evaluating the alterations in feet of outpatients attended at a nursing visit. Data from the clinical history and foot exam were collected from 918 medical records of a convenience sample.

RESULTS

At 10 years, the cumulative mortality attributable to peripheral polyneuropathy was 44.7%, to peripheral artery disease was 71.7%, to both conditions were 62.4%, and to amputation was 67.6%. After multivariate analysis, duration of nursing follow-up remained as the only protective factor against death (p < 0.001).

CONCLUSIONS

The risk of death in these patients decreased when they had consultations with a nurse educator. Ischemic feet, amputation, and coronary artery disease remained independent risk factors.

Keywords:
Diabetes mellitus; Mortality; Diabetic foot; Nursing care; Ambulatory care

Characteristics	n = 918
Known DM duration, years^* * Mean and standard deviation;	10.8 (±8.1)
Age^* * Mean and standard deviation;	62.4 (±10.4)
Male gender	434 (47.3)
Follow-up duration, years^* ** Median.	2.0 (0.1-4.6)
Amplitude	0.1-23.1
Hospitalization	217 (23.7)
Smoking	358 (39.0)
Glycated hemoglobin (A1C)	7.9 (±2.2)
Triglycerides^* * Mean and standard deviation;	184.2 (±152.0)
Total Cholesterol^* * Mean and standard deviation;	200.2 (±51.0)
LDL-Cholesterol ^* * Mean and standard deviation;	116.4 (±42.2)
HDL-Cholesterol^* * Mean and standard deviation;	46.8 (±13.0)
Comorbidities
Dyslipidemia (hypercholesterolemia)	375 (46.1)
Coronary Arterial Disease	299 (32.6)
Hypertension	780 (85.0)
Obesity	427 (46.5)
Stroke	65 (7.1)
Classification of the diabetic foot
Normal	404 (44.0)
Ischemic	102 (11.1)
Neuropathic	215 (23.4)
Mixed (Neuro-ischemic)	197 (21.5)
Ulcer	162 (17.2)
Amputation	125 (13.6)
Medications prescribed
Anti-hypertensive drugs	759 (82.5)
Antidyslipidemic drugs	426 (46.9)
Antihyperglycemic agents
None	82 (9.0)
Oral	401 (44.2)
Insulin	155 (17.1)
Both	270 (29.7)

Risk factors	Cox multiple regression
Risk factors	HR (IC95%)	M1^† M1†: Multivariable analysis for type (classification) of the foot, adjusting for the other variables with p < 0.20 in univariate analysis; : HR (IC95%)	M2^‡ M2‡: Multivariable analysis for ulcer, adjusting for the other variables with p < 0.20 in univariate analysis; : HR (IC95%)	M3^§ M3§: Multivariable analysis for amputation, adjusting for the other variables with p < 0.20 in univariate analysis. : HR (IC95%)
Foot classification
Normal	1 (reference)	1	─	─
Ischemic	3.07 (1.96-4.8)	2.41 (1.42-4.11)^* * p < 0, 05;	─	─
Neuropathic	1.66 (1.1-2.5)	1.22 (0.75-1.98)	─	─
Mixed	2.74 (1.85-4.06)	1.53 (0.94-2.49)	─	─
Ulcer	2.48 (1.8-3.41)	─	1.3 (0.89-1.89)	─
Amputation	2.36 (1.72-3.25)	─	─	2.51 (1.69-3.7)^* * p < 0, 05;
Known DM duration	1.02 (1-1.04)	1.02 (1.00-1.05)^* * p < 0, 05;	1.02 (1-1.05)^* * p < 0, 05;	1.02 (1-1.05)^* * p < 0, 05;
Age	1.05 (1.03-1.06)	1.02 (1-1.04)^* * p < 0, 05;	1.02 (1.01-1.04)^* * p < 0, 05;	1.03 (1.01-1.04)^* * p < 0, 05;
Male gender	1.39 (1.03-1.88)	1.1 (0.73-1.65)	1.16 (0.78-1.72)	0.98 (0.66-1.45)
Follow-up duration	0.64 (0.6-0.69)	0.66 (0.61-0.71)^* * p < 0, 05;	0.67 (0.62-0.72)^* * p < 0, 05;	0.6 (0.61-0.71)^* * p < 0, 05;
Hospitalization	1.13 (0.82-1.54)	─	─	─
Smoking	1.02 (0.75-1.37)	─	─	─
Glycated hemoglobin (A1C)	1.12 (1.04-1.21)	1.09 (1-1.17)^* * p < 0, 05;	1.09 (1.01-1.18)^* * p < 0, 05;	1.07 (0.99-1.16)
Dyslipidemia (Hypercholesterolemia)	1.27 (0.91-1.78)	─	─	─
Coronary Arterial Disease	1.72 (1.28-2.31)	1.72 (1.22-2.44)^* * p < 0, 05;	1.8 (1.28-2.55)^* * p < 0, 05;	1.59 (1.12-2.27)^* * p < 0, 05;
Hypertension	0.85 (0.55-1.32)	─	─	─
Obesity	0.55 (0.4-0.76)	0.75 (0.51-1.09)	0.72 (0.49-1.05)	0.84 (0.57-1.24)
Stroke	1.95 (1.26-3.03)	0.83 (0.45-1.55)	1.23 (0.69-2.19)	1.35 (0.76-2.41)
Use of Anti-hypertensive drugs	1.27 (0.8-2)	─	─	─
Use of Antidyslipidemic drugs	0.6 (0.44-0.81)	0.89 (0.6-1.31)	0.85 (0.57-1.25)	0.86 (0.59-1.27)
Antihyperglycemic agents
None	1 (reference)	1	1	1
Oral	1.04 (0.58-1.88)	1.38 (0.61-3.12)	1.36 (0.61-3.01)	1.17 (0.52-2.61)
Insulin	2.1 (1.13-3.88)	2.05 (0.89-4.75)	1.92 (0.83-4.42)	1.62 (0.69-3.76)
Both	0.88 (0.47-1.64)	1 (0.41-2.39)	1.07 (0.46-2.53)	0.95 (0.4-2.25)

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Autor correspondente:
Suzana Fiore Scain. suzana.scain@gmail.com