系统评价和荟萃分析糖尿病足护理提供的可及性和质量对预防下肢截肢的影响。
A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation.
机构信息
MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
Unidade de Saúde Familiar Nova Salus, Agrupamento de Centros de Saúde Grande Porto VII, Vila Nova de Gaia, Portugal.
出版信息
J Diabetes Complications. 2021 Apr;35(4):107837. doi: 10.1016/j.jdiacomp.2020.107837. Epub 2020 Dec 31.
AIMS
To assess the impact of diabetic foot care delivery in preventing lower extremity amputation (LEA).
METHODS
We systematically searched the MEDLINE database for research evaluating the association between any aspect of diabetic foot care delivery and risk of LEA. Meta-analysis was conducted by calculating a pooled odds ratio through a random effects model.
RESULTS
Our search retrieved 5093 articles. In total, 58 articles were included: 9 addressing healthcare access, 4 educating health professionals, 2 implementing guidelines, 6 receiving chiropody/podiatry care services and 37 implementing structured diabetic foot care services (SDFC). All of these aspects of diabetic foot care seemed to have a positive impact on preventing LEA. Only SDFC literature met criteria for performing a meta-analysis. For SDFC impact on preventing overall and major LEA but not for minor LEA compelling evidence was observed [aggregated odds ratio (OR) of 0.45 (95% CI 0.37-0.57), 0.40 (95% CI 0.32-0.51), and 0.87 (95% CI 0.67-1.14), respectively]. However, high heterogeneity (superior to 60%) was observed for all outcomes.
CONCLUSIONS
Results support a reduction in diabetic LEA frequency in association with structured diabetic foot care, and, in particular, major LEA. Less evidence is available for the remaining aspects of diabetic foot care delivery.
目的
评估糖尿病足护理在预防下肢截肢（LEA）方面的效果。
方法
我们系统地检索了 MEDLINE 数据库，以评估糖尿病足护理的任何方面与 LEA 风险之间的关系。通过随机效应模型计算合并优势比进行荟萃分析。
结果
我们的检索共检索到 5093 篇文章。最终纳入 58 篇文章：9 篇探讨医疗保健获取，4 篇教育卫生专业人员，2 篇实施指南，6 篇接受手足病护理服务，37 篇实施结构化糖尿病足护理服务（SDFC）。所有这些糖尿病足护理方面似乎都对预防 LEA 有积极影响。只有 SDFC 的文献符合进行荟萃分析的标准。对于 SDFC 预防整体和主要 LEA 的影响，但对于次要 LEA 的影响则没有，观察到了强有力的证据[总体和主要 LEA 的汇总优势比（OR）分别为 0.45（95%CI 0.37-0.57）、0.40（95%CI 0.32-0.51）和 0.87（95%CI 0.67-1.14）]。然而，所有结果的异质性都很高（超过 60%）。
结论
结果支持结构化糖尿病足护理与糖尿病性 LEA 频率降低相关，特别是与主要 LEA 降低相关。对于糖尿病足护理提供的其余方面，证据较少。
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