Diabetic Foot Wounds: Nursing Care Formula For Improved Outcomes
Diabetes mellitus (DM) is a rising global health threat, particularly in China, where associated healthcare costs are soaring. Among its severe complications, diabetic foot (DF) is a significant issue, leading to infections and high amputation rates. This study aims to evaluate the impact of continuous nursing interventions on high-risk DF patients through meta-analysis, providing crucial scientific evidence for clinical application.
THE STUDY BACKGROUND
Diabetes mellitus (DM) presents a substantial challenge to global healthcare systems, with its prevalence steadily rising alongside factors such as ageing populations, economic development, and shifting lifestyles [1,2]. Notably, China has emerged as a frontrunner in DM prevalence, with healthcare costs associated with the condition reaching staggering heights, second only to the United States [3]. This escalation underscores the urgent need for comprehensive strategies to address the multifaceted impact of DM on individuals, societies, and healthcare infrastructures worldwide.
One of the most severe long-term complications of DM is diabetic foot (DF), a condition arising from peripheral neuropathy and vascular disease in DM patients [4,5]. DF manifests as lower limb infections, ulcers, and deep tissue damage, significantly impairing patients’ quality of life and posing substantial economic burdens on healthcare systems [6]. Alarmingly, despite medical interventions, the amputation rate among DF patients remains unacceptably high, highlighting the pressing need for more effective preventive measures and treatment strategies [7].
Recognizing the pivotal role of nursing care in mitigating the adverse outcomes associated with diabetic foot, particularly in high-risk patient populations, continuous nursing interventions have gained increasing attention [8]. Continuous nursing, characterized by sustained and coordinated healthcare services, aims to optimize patient outcomes by maximizing resource integration, extending service duration, broadening care scope and levels, and addressing patients’ diverse healthcare needs [9,10].
By providing comprehensive nursing and guidance, specially tailored to high-risk diabetic foot patients, these interventions promise to enhance patients’ self-management skills and protective capabilities, ultimately reducing the incidence of DF-related complications and improving the overall quality of life [11]. Thus, a systematic evaluation of the impact of continuous nursing interventions on high-risk diabetic foot patients through meta-analysis is warranted to provide robust scientific evidence for informing clinical practice and guiding future healthcare initiatives.
THE STUDY METHOD
The research methodology involved a systematic search of relevant literature using keywords related to continuous nursing, diabetic foot (DF), foot ulcer, diabetic foot ulcers (DFU), diabetes mellitus (DM), and other related terms in various databases, including PubMed, Embase, Google Scholar, Cochrane Library, etc. The literature covered up to October 2023. The search was conducted using both thematic and free-word approaches.
This study included high-risk diabetic foot patients as participants, with the experimental group receiving continuous nursing interventions and the control group receiving standard nursing care. Outcome measures included fasting blood glucose, 2-hour postprandial blood glucose, glycated haemoglobin, and DF incidence. Only randomized controlled trials (RCTs) were considered for inclusion. Exclusion criteria were applied to publications needing more relevant raw data, incomplete or inaccessible full texts, duplications, reviews, case reports, systematic reviews, conference articles, and animal studies.
Data extraction was performed using Endnote X9 to remove duplicates. Two researchers independently reviewed the title, abstracts, and full texts to meet the inclusion and exclusion criteria. Inconsistencies in the study were resolved through consultation with a third researcher. Data extraction included author, publication year, sample size, sex, age, and outcome indicators.
The quality analysis of included RCTs was conducted using the Cochrane Collaboration’s bias risk tool, evaluating biases related to selection, performance, detection, attrition, reporting, and other potential sources of bias. This rigorous methodology ensured the selection of high-quality studies and reliable data for further analysis and interpretation.
ANALYSIS
The research analysis utilized Stata 17.0 software to conduct statistical analysis. Dichotomous variables were represented by odds ratios (OR) and their corresponding 95% confidence intervals (CI). Continuous variables were compared as standardized mean differences (SMD) with their respective 95% CI. Heterogeneity among studies was examined using χ2 tests and I2 values, with a fixed-effect model applied when I2 was less than 50% and p-value greater than 0.1, indicating no significant heterogeneity. In cases of substantial heterogeneity, a random-effects model was employed.
The robustness of the studies was evaluated through sensitivity assessment to ensure the reliability of the findings. Also, funnel plots were used to assess publication bias for studies exceeding a threshold of 10, providing insights into the potential impact of publication bias on the overall results. This rigorous approach to data analysis aimed to enhance the validity and generalizability of the study’s outcome. It also provides a comprehensive understanding of the effectiveness of continuous nursing interventions in high-risk diabetic foot patients.
RESULTS
- Characteristics of Included Studies:
- A total of 182 articles were initially identified, with 73 duplicates removed and 46 articles excluded based on relevance, leaving 63 full-text articles for review.
- Ultimately, 18 randomized controlled trials (RCTs) were included, involving 1450 high-risk diabetic foot (DF) patients, 725 of whom were in the continuous nursing group and 725 of whom were in the standard nursing group.
- Fasting Blood Glucose:
- Eleven RCTs reported fasting blood glucose levels, with 423 patients in each group.
- Significant heterogeneity was observed, leading to the use of a random-effects model.
- The continuous nursing group exhibited significantly lower fasting blood glucose levels than the standard nursing group.
- Two-Hour Postprandial Blood Glucose:
- Five RCTs reported 2-hour postprandial blood glucose levels, with 199 patients in each group.
- Significant heterogeneity was noted, and a random-effects model was employed.
- The continuous nursing group demonstrated significantly lower 2-hour postprandial blood glucose levels than the standard nursing group.
- Glycated Haemoglobin:
- Ten RCTs reported glycated haemoglobin levels, with 401 patients in each group.
- Significant heterogeneity was observed, leading to the use of a random-effects model.
- The continuous nursing group exhibited significantly lower glycated haemoglobin levels than the standard nursing group.
- DF Incidence:
- Thirteen RCTs reported DF incidence, with 526 patients in the continuous nursing group and 526 patients in the standard nursing group.
- No significant heterogeneity was found, and a fixed-effect model was employed.
- The continuous nursing group showed a significantly lower incidence of DF than the standard nursing group.
- Sensitivity Analysis and Publication Bias:
- Sensitivity analysis confirmed the robustness of the conclusions.
- Funnel plot results suggested minimal publication bias for fasting blood glucose and glycated haemoglobin. Still, they indicated potential publication bias for DF incidence.
This comprehensive analysis provides remarkable insights into the effectiveness of continuous nursing interventions in managing high-risk diabetic foot patients, indicating significant improvements in glycemic control and reduction in DF incidence.
DISCUSSION
Diabetes mellitus (DM) stands as a pervasive and chronic endocrine-metabolic disorder, notorious for its capacity to inflict damage upon peripheral blood vessels and nerves through prolonged hyperglycemia [1]. This predisposes individuals to develop diabetic foot (DF) complications if proper foot care is neglected [2]. DF, characterized by foot infections, ulcers, or deep tissue damage in the context of DM-induced neural and vascular changes, poses a significant threat to affected individuals’ quality of life [3]. Our findings underscore the critical need for continuous healthcare and guidance post-discharge to mitigate the risk of adverse outcomes and maintain optimal glycemic control among DM patients [4].
The efficacy of continuous nursing interventions in DF management hinges on their ability to address the multifaceted nature of glycemic control [5]. Effective management aims to rectify short-term metabolic imbalances and prevent and delay the onset of chronic complications associated with DM [6]. This underscores the importance of continuous nursing interventions in enriching the spectrum of DF care. By providing ongoing medication self-management guidance, tailored dietary adjustments, emotional support, and mindset adjustments, these interventions facilitate patient compliance and contribute to effective glycemic control [7].
Our study’s emphasis on glycemic control indicators, such as fasting and 2-hour postprandial blood glucose and glycated haemoglobin, highlights their significance in monitoring and managing diabetic foot incidence and prognosis [8]. While fasting and 2-hour postprandial blood glucose levels offer insights into short-term metabolic fluctuations, glycated haemoglobin comprehensively assesses average blood glucose levels over an extended period [9]. The significant reduction in these indicators among DF patients receiving continuous nursing interventions underscores the effectiveness of such approaches in improving glycemic control and reducing DF incidence.
Moreover, our findings shed light on the critical role of patient education and empowerment in diabetic foot management [10]. By fostering an understanding of the importance of foot care practices and providing tailored guidance, continuous nursing interventions empower patients to take an active role in their self-care regimen. This proactive approach enhances patient compliance and fosters a sense of autonomy and self-efficacy, contributing to improved long-term outcomes [11].
In conclusion, continuous nursing interventions are pivotal in optimizing diabetic foot management by addressing the multifaceted aspects of glycemic control and empowering patients to take charge of their health. By providing comprehensive care and guidance, these interventions have the potential to significantly reduce DF incidence and improve overall patient outcomes in individuals with diabetes mellitus [12].
LIMITATIONS
- Language Bias:
- The literature search was confined to Chinese and English sources, with a predominance of Chinese literature included after screening.
- This limitation raises concerns regarding publication bias and incomplete coverage of the literature, potentially influencing the generalizability of the study findings.
- Limited Number of Studies:
- The study’s reliance on a few included studies underscores the need for additional support from high-quality research.
- The limited pool of studies may restrict the breadth and depth of the analysis, potentially impacting the robustness of the conclusions drawn.
- Generalizability to Other Populations:
- While the study focused on Chinese diabetic foot (DF) patient studies, extrapolating conclusions to other populations may not be straightforward.
- Further validation is necessary to ascertain the applicability of the findings to diverse demographic groups and healthcare settings beyond the scope of the current study.
Addressing these limitations is essential for enhancing the credibility and applicability of the study findings. Future research endeavours should overcome these challenges by employing more comprehensive literature search strategies, increasing the sample size, and conducting cross-cultural validation studies to ensure the generalizability of the findings to diverse populations.
CONCLUSION
In summary, the findings of this study underscore the significant clinical value of continuous nursing interventions in managing high-risk diabetic foot (DF) patients. By effectively controlling blood glucose levels and reducing diabetic foot incidence, these interventions contribute to improved patient outcomes and enhance overall quality of life. The study highlights the pivotal role of continuous nursing care in addressing the multifaceted challenges associated with DF management, emphasizing its importance in comprehensive healthcare strategies for individuals with diabetes mellitus. These conclusions affirm the critical need for integrating continuous nursing interventions into clinical practice to optimize patient care and mitigate the burdens of DF-related complications.
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