Preventing foot ulceration in diabetes:systematic review and meta-analyses of RCT data

Aims/hypothesis: Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data. Methods: We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses. Results: Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions. Conclusions/interpretation: Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit

Iron Distribution In Ortho-pyroxene - A Comparison of Mossbauer-spectroscopy and X-ray Refinement Results

The Fe-Mg distribution over the MI and M2 octahedral sites in five natural orthopyroxenes has been determined by single-crystal X-ray diffraction (XRD) and Mossbauer spectroscopy (MS). The results from the two methods are in good agreement for two Fe/Mg intermediate composition samples, provided that the MS data are thickness-corrected. For two Fe-poor and one Al-rich sample, the results diverge ; XRD gives a more ordered Fe-Mg distribution than MS, with up to 0.05 more Fe atoms per formula unit in the M2 position. The thickness effect on MS for ordered orthopyroxene is shown to cause considerable distortion of the spectra, resulting in an underestimate of the degree of ordering. For normally thick absorbers (5 mg Fe/cm2), MS data will allocate approximately 2% too much of total Fe to the M1 position. However, the Fe distribution obtained from MS data can be corrected by extrapolation to zero thickness according to the formula Fe(M1)/Fe(tot)corr = [Fe(M1)/Fe(tot)meas - 0.004085t]/(1 - 0.003031t), where t is the Fe > of the absorber in mg Fe/cm2

Patients’ Expectations of Evidence-Based Service at the Pharmacy Regarding Information on Self-Care of the Feet for Persons with Diabetes at Risk of Developing Foot Ulcers – A Cross-Sectional Observational Study in Sweden

Ulla Hellstrand Tang,1,2 Isabella Scandurra,3 Leif Sundberg,4 Magdalena Annersten Gershater,5 Roland Zügner2 1Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden; 2Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; 3Centre of Empirical Research in Information Systems, Örebro University, Örebro, Sweden; 4Gothenburg Diabetes Association, Gothenburg, Sweden; 5Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, SwedenCorrespondence: Ulla Hellstrand Tang, Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Falkenbergsgatan 3, Gothenburg, SE-412 85, Sweden, Tel +46 70 6397913, Fax +46 31 40 81 62, Email [email protected]: Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients’ expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet.Patients and Methods: The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade.Results: Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU.Conclusion: The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use.Clinical Trial: NCT05692778.Plain Language Summary: Persons living with diabetes have better opportunities to be physically active, keep on walking and participate in social activity if the feet are in good health. Besides getting support from healthcare, on how to promote good foot health, the pharmacies offer services and products aimed for self-care of the feet. Seventeen persons living with diabetes in the western region of Sweden answered a survey regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. The study found that persons living with diabetes self-managed their feet in different ways. The services being available from the pharmacies should be improved, promoting good foot health for persons living with diabetes, and in its prolongation prevent the development of diabetic foot ulcers.Keywords: diabetic foot, prevention, diabetes type 1, diabetes type 2, self-care, self-management, self-monitorin