Prevention of foot ulcers recurrence in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials for the development of the italian guidelines for the treatment of diabetic foot syndrome

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Acta Diabetologica Pub Date : 2024-09-05 DOI:10.1007/s00592-024-02353-7

Roberto Da Ros, Antonio Volpe, Corrado Bordieri, Rodolfo Tramonta, Andrea Bernetti, Alessia Scatena, Luca Monge, Benedetta Ragghianti, Antonio Silverii, Luigi Uccioli, Cristiana Vermigli, Matteo Monami, Cesare Miranda, for the Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome and on behalf of SID and AMD

{"title":"Prevention of foot ulcers recurrence in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials for the development of the italian guidelines for the treatment of diabetic foot syndrome","authors":"Roberto Da Ros, Antonio Volpe, Corrado Bordieri, Rodolfo Tramonta, Andrea Bernetti, Alessia Scatena, Luca Monge, Benedetta Ragghianti, Antonio Silverii, Luigi Uccioli, Cristiana Vermigli, Matteo Monami, Cesare Miranda, for the Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome and on behalf of SID and AMD","doi":"10.1007/s00592-024-02353-7","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim</h3><p>To compare the effectiveness of preventive interventions in reducing reccurrent diabetic foot ulcers. Meta-analysis (MA) was conducted to address clinical questions on this topic of the Italian guidelines on diabetic foot.</p><h3>Methods</h3><p>This MA includes randomized controlled trials evaluating the effectiveness of various preventive interventions, namely: treatment of pre-ulcerative foot lesions, structured educational programs, psychological interventions and the use of therapeutic footwear to relieve plantar pressure in people with diabetes mellitus and a history of previous ulcers.</p><h3>Results</h3><p>A total of 731 studies were identified and 14 were considered eligible for the analysis. We found that treatments of pre-ulcerative foot lesions did not provide any statistically significant effects (MH-OR: 0.84 [0.31, 2.33], p = 0.74, I<sup>2</sup> = 38%). Conversely, structured educational programs were associated with a trend toward reduction of ulcer recurrence risk (MH-OR: 0.13 [0.01, 1.64], p = 0.10, I<sup>2</sup> = 88%). No randomized controlled studies assessing the efficacy of psychological interventions have been retrieved. The use of therapeutic footwears can effectively reduce the risk of reulceration in diabetic patients with an history of previous DFU, in particular prefabricated rigid-soled therapeutic footwears showed a significant reduction of the risk of ulcer recurrence in comparison with semirigid soles (MH-OR: 0.17 [0.05, 0.57], p = 0.004).</p><h3>Conclusions</h3><p>The study provides low-certainty evidence that, among preventive strategies in patients with previous DFU, rigid-sole therapeutic footwear and structured education programs are capable of reducing the risk of foot re-ulceration.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"61 11","pages":"1363 - 1373"},"PeriodicalIF":3.1000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Diabetologica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00592-024-02353-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

To compare the effectiveness of preventive interventions in reducing reccurrent diabetic foot ulcers. Meta-analysis (MA) was conducted to address clinical questions on this topic of the Italian guidelines on diabetic foot.

Methods

This MA includes randomized controlled trials evaluating the effectiveness of various preventive interventions, namely: treatment of pre-ulcerative foot lesions, structured educational programs, psychological interventions and the use of therapeutic footwear to relieve plantar pressure in people with diabetes mellitus and a history of previous ulcers.

Results

A total of 731 studies were identified and 14 were considered eligible for the analysis. We found that treatments of pre-ulcerative foot lesions did not provide any statistically significant effects (MH-OR: 0.84 [0.31, 2.33], p = 0.74, I² = 38%). Conversely, structured educational programs were associated with a trend toward reduction of ulcer recurrence risk (MH-OR: 0.13 [0.01, 1.64], p = 0.10, I² = 88%). No randomized controlled studies assessing the efficacy of psychological interventions have been retrieved. The use of therapeutic footwears can effectively reduce the risk of reulceration in diabetic patients with an history of previous DFU, in particular prefabricated rigid-soled therapeutic footwears showed a significant reduction of the risk of ulcer recurrence in comparison with semirigid soles (MH-OR: 0.17 [0.05, 0.57], p = 0.004).

Conclusions

The study provides low-certainty evidence that, among preventive strategies in patients with previous DFU, rigid-sole therapeutic footwear and structured education programs are capable of reducing the risk of foot re-ulceration.

Abstract Image

查看原文本刊更多论文

预防糖尿病患者足部溃疡复发：为制定意大利糖尿病足综合征治疗指南而进行的随机对照试验系统回顾和荟萃分析。

目的：比较预防性干预措施在减少复发性糖尿病足溃疡方面的效果。为了解决意大利糖尿病足指南中有关这一主题的临床问题，我们进行了元分析（Meta-analysis，MA）：该分析包括评估各种预防性干预措施有效性的随机对照试验，这些干预措施包括：治疗溃疡前足部病变、结构化教育计划、心理干预措施以及使用治疗性鞋来减轻糖尿病患者足底压力和既往溃疡病史：结果：共发现了 731 项研究，其中 14 项符合分析条件。我们发现，对溃疡前足部病变的治疗没有任何统计学意义上的显著效果（MH-OR：0.84 [0.31，2.33]，P = 0.74，I2 = 38%）。相反，结构化教育计划则有降低溃疡复发风险的趋势（MH-OR：0.13 [0.01, 1.64]，P = 0.10，I2 = 88%）。目前尚未检索到评估心理干预疗效的随机对照研究。使用治疗性鞋袜可有效降低既往有 DFU 病史的糖尿病患者再次溃疡的风险，尤其是预制硬底治疗性鞋袜与半硬底鞋袜相比，可显著降低溃疡复发的风险（MH-OR：0.17 [0.05，0.57]，P = 0.004）：本研究提供的低确定性证据表明，在针对既往 DFU 患者的预防策略中，硬底治疗鞋和结构化教育计划能够降低足部再次溃疡的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Diabetologica 医学-内分泌学与代谢

CiteScore

7.30

自引率

2.60%

发文量

180

审稿时长

2 months

期刊介绍： Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.