ABSTRACT
Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
ABSTRACT
BACKGROUND: Low level of physical activity is an independent risk factor of civilization disorders. Intervention for increasing physical activity has been for generations mentioned in health care. Because of low adherence of the population to those general appeals it is necessary to improve radically the knowledge of health professionals about individual exercise prescription. The aim of this study was to analyze approach of medical doctors in this particular dilemma. METHODS AND RESULTS: A questionnaire was distributed at postgraduate courses for medical doctors. Data from doctors of different specializations were summarized (N=657, from which 458 were females, i.e. 69,7 %, mean age=38,8+/-9,74). 96,4 % of doctors stated that they recommend exercise to their patients though only up to 23,4 % of them are regularly asked by their patients about the exercise. Concrete (type, intensity, duration and frequency) or individually tailored recommendation give 66,2 %, or 62,6 % of doctors respectively. Most respondents (56,0 %) also recommend a consultation of another specialist (mostly rehabilitation doctor and physiotherapist). Majority of addressed professionals shows that current medical education structure does not enable adequate prescription of physical activity without the help of specialist. CONCLUSIONS: Study showed a positive attitude of medical doctors to exercise prescription. However, information about the need of individualized prescription and knowledge about possibilities of exercise therapy in particular regions should be increased.