NONPF 40th Annual Meeting
Evidenced Based Interventions in the Prevention of Diabetes related Foot Ulcers
This integrative review of the literature was compiled from research within allied health literature (i.e., nursing, medicine and podiatry).
Primary objective: Develop a best practice algorithm as a prevention tool for health care providers (HCPs) to assist patients to prevent the formation of diabetes related foot ulcers. Secondly, this literature review also sought to determine if there are any other better testing methods than the monofilament test to detect diabetes related peripheral neuropathy at the various stages of the disease process.
Objective: Determine the most efficacious evidenced based interventions for the prevention of diabetes related foot ulcers among patients living with diabetes.
Methods: A substantive review of research of literature was implemented by reviewing the PubMed, Cinahl and Cochrane databases. Searched terms used: “diabetes mellitus”, “self-management”, “education” , “prevention”, “foot ulcers”, and covered the period from 2000-2013.
Findings: Clinical information the HCP gathers from their assessment such as diabetes related neuropathy and foot infections are important predictors of future foot ulcers. The best tools to prevent diabetes related foot ulcers was the temperature guided avoidance therapy (TGAT). The tuning fork was also validated as being highly sensitive in diagnosing diabetes related peripheral neuropathy and HCPs can use it at the bedside. Diabetes nurse led educational programs are all valuable in the prevention of foot ulcers.
Implications for practice: An overall better understanding of interventions used to prevent foot ulcers will guide HCPs to prescribe early treatment and provide optimal methods of examining for diabetes related peripheral neuropathy.
Conclusion: Patient education is important in the prevention diabetes related foot ulcers. Once neuropathy is diagnosed the monofilament test is not useful in predicting diabetes related foot ulcers. The HCP should introduce and teach the patient about temperature guided avoidance therapy to assess for diabetes related peripheral neuropathy at home. The HCPs can use clinical information predictors to assist patients in the prevention of foot ulcers. Temperature guided avoidance therapy and tuning forks are valuable tools in diagnosing diabetes related peripheral neuropathy and are more sensitive than the monofilament test.