RESUMO
Background: Many strategies exist to prevent diabetic ulcer recurrence, yet an effective method does not currently exist. This study evaluates the effectiveness of a prevention strategy to reduce ulcer recurrence in patients with Diabetes Mellitus (DM). Materials and Methods: A quasi-experimental, two group study was undertaken with 60 participants with type 2 DM. Two trained nurses participated in this study as study assistants. Participants were divided into two groups: the intervention group received preventive treatment, including examination and assessment, foot care, and an educational program; the control group received standard care using the five pillars of DM management in Indonesia. Results: An equal number of men (n = 30) and women (n = 30) participated in this study. Neuropathy was noted in 76.70% and 56.70% of patients in the intervention and control groups, respectively. Furthermore, 63.30% of patients in the control group and 56.70% in the intervention group had foot deformities. The recurrence rate was lower in the intervention group (13.30%) than in the control group (33.30%). Moreover, 83.30% in the control group and 76.70% in the intervention group did not smoke. The duration of DM in both groups was >9 years (50% in the intervention and 43.30% in the control group). There were no significant differences between the two groups, with mean (SD) in age (t29 = -0.87, p = 0.389), ankle-brachial index (t29 = -1.05, p = 0.144), and HbA1C (t26 = -0.35, p = 0.733). Conclusions: Prevention strategies combining examination and assessment, foot care, and educational programs can reduce ulcer recurrence in diabetic patients.
RESUMO
Diabetic foot ulcers are a common complication that occurs in approximately 15 percent of patients with diabetes mellitus. Over 60% of diabetic foot ulcers are caused by underlying neuropathy. Former studies on diabetic animals with foot wounds found that vibration platforms significantly accelerate wound healing by catalyzing epithelization, promoting angiogenesis, and enhancing muscle bulk. This result suggests that there is evidence that vibrations may accelerate diabetic neuropathic ulcer healing in human patients. However, to the best of our knowledge, the effect of vibration on the enhancements of diabetic foot ulcer healing in human patients is rarely investigated. Hence, in this work, we conducted an experimental study with human subjects to investigate whether vibration therapy, as a complement to the standard wound treatment, can accelerate the wound healing rate of diabetic neuropathic foot ulcers. In this prospective experimental study, 80 participants diagnosed with Wagner grades I−III diabetic neuropathic foot ulcers were randomly distributed to experimental (n = 40) and control groups (n = 40). Patients in the intervention group received standard wound treatment and vibration wound therapy (VWT), whereas patients in the control group retrieved only standard wound treatment. The results (p = 0.024, α = 0.05) show notable differences in the median healing rate between the intervention group (25 days, 95% CI: 20.3−29.7) and control group (33 days, 95% CI: 25.6−40.4), with the effect-size r, Cohen's d, Glass's Δ, and Hedges' g, respectively, being 0.810, 2.764, 2.311, and 2.772. Moreover, the nitric oxide (NO) level, wound closure area, and wound healing score after intervention significantly differed between the two groups (p < 0.05), putting the intervention group on a higher level than the control group. Furthermore, positive associations were found between the NO level and wound healing closure rates. These findings suggested that VWT enhances diabetic neuropathic foot ulcer healing in terms of healing rate, wound closure area, healing score, and elevated NO level. Considering that no clinically adverse effects were found in the patients induced with vibration intervention, VWT can be regarded as a complementary therapy to the existing ones to accelerate the healing of DFUs.
RESUMO
This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas University) and Wagner wound classification systems in Indonesia. A prospective cohort study included patients with diabetic foot ulcers at Kitamura wound clinic in Indonesia. A total of 111 diabetic foot ulcer patients were assessed with SHID, TU, and Wagner wound classification systems. Two postgraduate nursing students assessed 111 wounds of bedside patients and observed them for 4 weeks. The predictive validity test indicated that the cut-off score of ≤grade 2 for SHID was 74% and 97%, ≤grade IB for TU was 77% and 92%, then ≤grade 2 for Wagner was 84% and 71% for sensitivity and specificity, respectively. The area under the curve (AUC) in SHID, TU, and Wagner tools was 0.90 (95% CI: 0.828-0.950), 0.85 (95% CI: I0.766-0.910), and 0.86 (95% CI: 0.775-0.917), respectively. The Youden index for SHID, TU, and Wagner was 0.72%, 0.70%, and 0.55%, respectively. The wound classification systems are good tools for identifying diabetic foot ulcers. However, the newly developed SHID tool produced the best AUC and Youden Index values compared to the Wagner tool.
