PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

Prevalence Of Diabetic Foot Ulcer

Problem statement

A diabetic foot ulcer is a poorly healing wound around the feet. It is the most common complication of diabetes mellitus in the United States of America. It has significantly contributed to mortalities and morbidities. Globally, around 26 million people are affected by diabetic leg ulcers. Diabetes is a chronic metabolic syndrome characterized by persistently elevated blood sugar levels. The most common cause of diabetes in modern society is poor lifestyle habits such as consuming highly processed calories and physical inactivity (Tilg,et al, 2017). Therefore, it causes insulin resistance and insufficient production of insulin.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

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 A diabetic foot ulcer is the most common cause of non-traumatic amputations of the lower extremities. They are the leading cause of prolonged hospitalization compared to other complications of diabetes mellitus. Causes of diabetic foot ulcers are poor glycemic control, peripheral vascular disease, poor foot care, and neuropathy (Armstrong,et al, 2017). Development of the diabetic foot ulcer occurs in three stages; callus neuropathy, motor neuropathy, and autonomic neuropathy. Continuous trauma to the callus causes a subcutaneous hemorrhage and eventually an ulcer. Slow healing of a diabetic leg ulcer is usually due to atherosclerosis of the small peripheral blood vessels that lead to vascular compromise. Other causes of slow healing of diabetic ulcers are poor wound cleaning and dressing techniques and uncontrolled hyperglycemia.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

Interventions

Due to the increased rate of diabetic foot ulcers and their associated complications, healthcare providers have strategized on the policies that curb disease occurrence. The main strategy was to create awareness to the public about diabetes mellitus and its complications through community programs, media houses, and posters. Mass education is the first preventive measure since the individuals take their personal initiative to prevent disease occurrence. The care providers did a diabetes mass screening for the population to find out the new cases of diabetes or the existing undiagnosed cases. The diagnosed patients were given follow-up clinics where the primary care physicians screened for diabetic leg ulcers. Patients at risk of developing diabetic leg ulcers were educated on the needfor foot care and controlling glycemic levels. Patients with diabetic leg ulcers were pot on effective treatment care according to the grade of the ulcers.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

Grade one diabetic foot ulcer is a superficial lesion with partial or full-thickness. It is treated by optimum glycemic control, proper foot care, and antibiotics. Grade two leg ulcers extend to the ligaments, tendons, and deep fascia without abscess and osteomyelitis. It is managed by proper foot care, aseptic wound cleaning and dressing, antibiotics, and glycemic control. Grade three diabetic leg ulcer is characterized by an abscess or osteomyelitis that needs incision and drainage, intravenous antibiotics, and strict glycemic control. Grade four is characterized by gangrene of the foot that needs debridement (Rayman,et al, 2020). Of note is the complication associated with wound cleaning and dressing. According to Armstrong,et al, (2017), an ideal diabetic foot ulcer wound cleaning and dressing should allow gaseous exchange from the wound, protects from bacterial exposure, should absorb the would exudate without drying the wound and reduce pain and itchiness.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

Comparison

During the cross-section study, diabetic patients at risk of developing diabetic leg ulcers were divided into two groups, group A and group B. The criterion for selecting the participants was any diabetic patient above 30 years old. Group A patients were under strict glycemic control, follow-up clinics, educated on the risk factors of diabetes mellitus, signs of leg ulcers, and proper foot care. Group B was not put only on oral anti-diabetics (Mariam,et al, 2017). They were neither educated on foot care practices nor other complications of diabetes. These groups were observed for one year.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

Outcome

Group A.patients were reviewed after one year of proper glycemic control, proper foot care, and patient education, and regular monitoring of the patient’s vitals to assess the risk of diabetic foot ulcer. 94% of the patient turned out with controlled glycemic levels and did not have diabetic leg ulcers. 6% of the patients had grade one leg ulcers which developed due to non-compliance to medication and foot care. Group B. patients were reviewed after one year of anti-diabetic treatment. 10% of the patients had well-controlled glycemic levels and no leg ulcers while 90% had poorly controlled glycemic levels and chronic diabetic leg ulcers that resulted from septic wound cleaning and dressing technique (Mariam,et al, 2017).PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

From the study, the prevalence of diabetic foot ulcers is due to a lack of awareness of diabetes mellitus and its complication, lack of effective foot care practices, and non-compliance to diabetic medications. The complication of the leg ulcers was due to septic dressing techniques by the nurses and septic debridement, incision, and drainage procedures by the attending doctors. Other factors that contributed to the complication of foot ulcers are other comorbidities such as vascular diseases and anemia (Rayman,et al, 2020). The patient’s social factors are smoking tobacco, drinking alcohol, and physical inactivity.PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.

References

Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376(24), 2367-2375.

Mariam, T. G., Alemayehu, A., Tesfaye, E., Mequannt, W., Temesgen, K., Yetwale, F., & Limenih, M. A. (2017). Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients who attend the diabetic follow-up clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-based cross-sectional study. Journal of diabetes research, 2017.

Rayman, G., Vas, P., Dhatariya, K., Driver, V., Hartemann, A., Londahl, M., … & International Working Group on the Diabetic Foot (IWGDF). (2020). Guidelines on the use of interventions to enhance the healing of chronic foot ulcers in diabetes (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36, e3283.

Tilg, H., Moschen, A. R., & Roden, M. (2017). NAFLD and diabetes mellitus. Nature reviews Gastroenterology & hepatology, 14(1), 32-42.

PICO(T) Study-Prevalence Of Diabetic Foot Ulcers Among Diabetic Patients Essay.