2,46 Mb - GuÃaSalud
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11.4. Other preventive measures<br />
The most effective measure to prevent diabetic foot complications are the screening<br />
and treatment programs on the foot at risk. Other measures used are as follows:<br />
11.4.1. Education<br />
A Cochrane review (254) found nine methodologically poor RCTs on the effect<br />
education had on diabetes to prevent ulceration of the diabetic foot. Only one<br />
study which included patients at high risk presented a reduction in the incidence<br />
of ulcers [OR 0.28 (CI 95%: 0.13 to 0.59)] and in the amputation rate [OR 0.32<br />
(CI 95%: 0.14 to 0.71)] after one year. The patient’s short-term education seems<br />
to affect positively the acknowledgment on foot care and the patient’s behaviour.<br />
SR of RCT<br />
1+<br />
11.4.2. Smoking cessation<br />
Some studies have proved a direct causal relation. Case-control studies and transversal<br />
studies have proved that smoking is an amputation indicator (247).<br />
Observational<br />
studies<br />
2+/3<br />
11.4.3. Intensification of glycemic control<br />
The UKPDS 33 study proved that intensive glycemic control was effective to reduce<br />
microvascular complications and lead to the reduction of amputations (106).<br />
RCT<br />
1+<br />
11.4.4. Therapeutic footwear, orthopaedic material and measures<br />
to relieve pressure<br />
A Cochrane SR (updated in May 2000), based on four RCTs, assessed the effectiveness<br />
of the measures which reduce plantar pressure for the prevention and<br />
treatment of diabetic foot. A trial stated that therapeutic footwear reduced the incidence<br />
of ulceration [RR 0.47 (CI 95%: 0.25- 0.87), NNT 4 (CI 95%: 2-14)].<br />
Another study compared different corrective footwear with plantar padding or<br />
pads in the contact surface area without finding any differences as regards the<br />
incidence of callus or ulcers. A subsequent RCT carried out across 400 diabetic<br />
patients and with prior ulcer but no significant deformities in their feet, proved<br />
that therapeutic footwear did not reduce ulcer recurrence in comparison to conventional<br />
footwear (255). An observational study concluded that, in patients with<br />
prior ulceration, the relapse risk was lower if therapeutic footwear was used (256).<br />
RCT and<br />
observational<br />
studies<br />
1+/ 2+<br />
CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 103
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