Plank Johannes, Haas Waltraud, Rakovac Ivo, Görzer Evelyn, Sommer Romana, Siebenhofer Andrea, Pieber Thomas R
Division of Diabetes und Metabolism, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria.
Diabetes Care. 2003 Jun;26(6):1691-5. doi: 10.2337/diacare.26.6.1691.
To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year.
Ninety-one diabetic outpatients with healed foot ulcers (age 65 +/- 11 years, 40 women and 51 men, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 +/- 4.4, diabetes duration 16 +/- 11 years, HbA(1c) 8.4 +/- 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care (n = 47) or a control group (n = 44).
Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30-1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24-0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial.
These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients.
评估足病医生定期护理对糖尿病足溃疡1年内复发率的影响。
91例足部溃疡已愈合的糖尿病门诊患者（年龄65±11岁，女性40例，男性51例，1型糖尿病6例，2型糖尿病85例，BMI 28.5±4.4，糖尿病病程16±11年，糖化血红蛋白8.4±1.6%）被随机分为两组，一组接受每月有报酬的足病医生常规护理（n = 47），另一组为对照组（n = 44）。
在中位随访386天期间，足病医生组有18例患者溃疡复发，对照组有25例患者溃疡复发（风险比[HR] 0.60；95%可信区间，0.32, 1.08；P = 0.09）。对每只脚的溃疡情况分析显示，足病医生护理组溃疡显著减少（20处溃疡对32处溃疡；Cox相对风险[Cox RR] 0.52；95%可信区间，0.30, 0.93；P = 0.03）。按照方案，对实际定期接受足病医生足部护理的患者进行分析，也表明足病医生护理有有益影响，干预组和对照组溃疡复发患者分别为13例对30例（HR，0.53；95%可信区间，0.30 - 1.01；P = 0.05），溃疡复发的足部分别为15只对37只（Cox RR，0.46；95%可信区间，0.24 - 0.90；P = 0.02）。干预组有2例患者、对照组有1例患者需要进行小截肢。对照组有4例患者、干预组有2例患者在试验期间死亡。
这些数据表明，足病医生采取的二级预防措施可能降低糖尿病患者足部溃疡的复发率。
