Nivel de autocuidados en pie diabético y concordancia de 3 sistemas de estratificación de riesgo en una zona básica de salud de Gran Canaria / Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria

Objetivo: Evaluar el nivel de autocuidados en la población con diabetes y determinar el riesgo de padecer lesiones de pie diabético mediante el uso de 3 sistemas de estratificación, así como establecer el grado de concordancia entre estos sistemas. Método: Estudio observacional, transversal y descriptivo realizado en la Zona básica de salud de Santa Brígida (Gran Canaria, Islas Canarias, España) en personas diagnosticadas de diabetes (DM tipo 1/DM tipo 2) (n = 182). Se realizaron entrevista, exploración física, revisión de la historia clínica y cumplimentación del cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga. Tras ello se calculó la estratificación del riesgo con 3 sistemas (sistema del National Institute for Health Care Excellence, clasificación del International Working Group on the Diabetic Foot y High-Risk Diabetic Foot-60-Second Tool© 2012). Se calculó el índice kappa para estudiar la concordancia entre sistemas, se estimaron el riesgo relativo de screening negativo de un método frente a otro y el test exacto de Fisher para establecer si existían diferencias. Resultados: Un 30,2% de los diabéticos tenían un nivel bajo de autocuidados, un 45,1% un nivel medio y un 24,7% nivel alto. Los niveles de riesgo calculados fueron: fueron clasificación National Institute for Health Care Excellence (riesgo negativo 71,4%; riesgo positivo 28,6%), clasificación del International Working Group on the Diabetic Foot (riesgo negativo 67,0%; riesgo positivo 33,0%) y High-Risk Diabetic Foot-60-Second Tool© (riesgo negativo 62,6%; riesgo positivo 37,4%). Conclusiones: Los 3 sistemas poseen una buena concordancia entre sí. El High-Risk Diabetic Foot-60-Second Tool© solo distingue 2 niveles de riesgo pero detecta mayor porcentaje de personas en situación de riesgo. El cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga puede ser útil en el contexto de Atención Primaria para evaluar el nivel de autocuidados de las personas con diabetes

Objective: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3 stratification systems as well as to establish the degree of concordance between these systems. Method: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n = 182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. Results: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). Conclusions: All 3 systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2 levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes

Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria. / Nivel de autocuidados en pie diabético y concordancia de 3sistemas de estratificación de riesgo en una zona básica de salud de Gran Canaria.

OBJECTIVE: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems. METHOD: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. RESULTS: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). CONCLUSIONS: All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.

Clasificaciones de lesiones en pie diabético. Un problema no resuelto / Classifications of injuries on diabetic foot. A non-solved problem

La necesidad de unificar criterios empleando un mismo lenguaje que favorezca la comunicación y el intercambio de conocimientos unido al desconocimiento existente en cuanto a las distintas formas de clasificación de las heridas crónicas, ha motivado a los autores para llevar a cabo esta revisión bibliográfica en la que se analizan quince sistemas de clasificación de lesiones de pie diabético y se abordan entre otros, aspectos como la metodología, facilidad de utilización, grado de conocimiento, utilidad de la información aportada y limitaciones de cada uno de ellos. Con ello, los autores no pretenden sino facilitar que los profesionales implicados en el cuidado de las úlceras diabéticas conozcan las distintas formas de estadiaje existentes en el pie diabético y en general en las heridas crónicas (AU)

The need of unify criterions using a same idiom contributing communication and interchanging knowledge together with ignorance existing in relation to the different ways of classificating chronic wounds is the reason for the authors to carry out this review analyzing fifteen classification systems in diabetic foot wounds dealing with subjects such as methodology, simplicity of use, grade of knowledge, usefulness of the information provided and limitations of each one. And so the authors pretend helping that those professionals taking care of diabetic foot ulcers can get to know different ways of staging diabetic foot wounds and chronic wounds in general (AU)

Estratificación de riesgo en pie diabético / Risk stratification in diabetic foot

El pie diabético es una complicación crónica de la diabetes mellitus y constituye una problemática sanitaria al conllevar un enorme gasto económico a losservicios sanitarios y provocar a las personas que lo padecen y a su entorno familiar enormes repercusiones emocionales. La educación sanitaria en el cuidado de los pies de los diabéticos, así como la cuantificación del riesgo son aspectos que el enfermero debe incorporar en los planes de cuidados de los pacientes diabéticos. La detección de los posibles factores de riesgo es un paso previo imprescindible para estos cometidos. Este estudio tiene como finalidad analizar la presencia de determinados factores de riesgo en pie diabético en la población diabética del Centro de Salud de Triana, con el objetivo de poder realizar, así, una estratificación del riesgo. Para ello, se optó por la realización de un estudio observacional descriptivo. La muestra analizada estaba constituidapor 96 sujetos diabéticos pertenecientes a dicho centro de salud. Para la recogida de datos se utilizó un sistema de tres niveles consistente en entrevista,exploración física y consulta de registros disponibles (a través de las historias clínicas de los sujetos). Los datos se registraron en un formulario de recogida de datos para pie diabético. Se determinó la existencia de factores de riesgo, analizando las relaciones entre éstos y permitiendo la estratificación del riesgo en la población estudiada (AU)

The diabetic foot is a chronic complication of diabetes mellitus and constitutes asanitary problem which causes not only enormous expenses for the sanitary system but also provokes emotional repercussions for the person who suffers the illness and for the family. The sanitary education in taking care of the feet of diabetics and the identification of the health risk are both aspects that the nurse must include in the healthcare planning of diabetic patients. The detection of the possible risk factorsis an essential previous step in nursing. The purpose of this study is to detect the presence of certain risk factors in diabetic foot in the diabetic population of Triana Healthcare Centre to be able to carry out a stratification of the risk. For this research, there was chosen an observational, descriptive and transversal study.The analyzed sample was constituted by 96 diabetic subjects belonging to the Healthcare Centre. For the data collection, we use different systems such as interviews,physical exams and the available records (clinical history of the patients).The information has been recorded in a questionnaire of the diabetic foot. The existence of risk factors was determined by analyzing the relationship between them allowing the risk stratification of the studied sample (AU)