European Association for the Study of Diabetes, Düsseldorf, Germany.
Med Clin North Am. 2013 Sep;97(5):775-90. doi: 10.1016/j.mcna.2013.03.007. Epub 2013 Apr 29.
It should now be possible to achieve a reduction in the incidence of foot ulceration and amputations as knowledge about pathways that result in both these events increases. However, despite the universal use of patient education and the hope of reducing the incidence of ulcers in high-risk patients, there are no appropriately designed large, randomized controlled trials actually confirming that education works. It has been recognized for some years that education as part of a multidisciplinary approach to care of the diabetic foot can help to reduce the incidence of amputations in certain settings. Ultimately, however, a reduction in neuropathic foot problems will only be achieved if we remember that the patients with neuropathic feet have lost their prime warning signal—pain—that ordinarily brings patients to their doctor. Very little training is offered to health care professionals as to how to deal with such patients. Much can be learned about the management of such patients from the treatment of individuals with leprosy: if we are to succeed, we must realize that with loss of pain there is also diminished motivation in the healing of and prevention of injury.
现在应该有可能减少足部溃疡和截肢的发生，因为对导致这两种情况的途径的了解增加了。然而，尽管普遍采用了患者教育，并希望减少高危患者的溃疡发生率，但实际上并没有经过精心设计的大型随机对照试验来证实教育的效果。多年来，人们已经认识到，作为糖尿病足综合护理的一部分，教育可以帮助减少某些情况下的截肢率。然而，只有当我们记住，患有神经病变的足部患者已经失去了他们的主要预警信号——疼痛，这通常会促使患者去看医生，才能真正减少神经病变性足部问题。很少有针对医疗保健专业人员的培训，以了解如何处理这些患者。我们可以从治疗麻风病患者中学到很多关于管理这些患者的方法：如果我们要成功，就必须认识到，随着疼痛的丧失，愈合和预防损伤的动力也会减弱。
