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Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus

Diabetes mellitus is a common condition that leads to high blood glucose concentrations, with around 2.8 million people affected in the UK (approximately 4.3% of the population). Some people with diabetes can develop ulcers on their feet. These wounds can take a long time to heal, be painful and become infected. Ulceration of the foot in people with diabetes can also lead to a higher risk of amputation of parts of the foot or leg. Generally, people with diabetes are at a higher risk of lower‐limb amputation than people without diabetes. Negative pressure wound therapy is a wound treatment which involves applying suction to a wound; it is used increasingly around the world but it is not clear how effective it is. It also expensive compared with treatments such as dressings. We found five randomised controlled trials that compared negative pressure wound therapy with other treatments. We found some preliminary evidence that negative pressure wound therapy increases the healing of foot wounds on people with diabetes compared with other treatments. However, the findings are not conclusive and more, better quality randomised controlled trials are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Educating people with diabetes about foot care to help reduce foot ulcers and amputations

Foot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease (PVD)), or both. People with ulcers due to diabetes sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring. This review of high‐level studies found that educating people with diabetes about the need to look after their feet seems to improve people's foot care knowledge and behaviour in the short term. There is insufficient evidence that education alone, without any additional preventive measures, will effectively reduce the occurrence of ulcers and amputations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Behavioral Programs for Type 2 Diabetes Mellitus: Current State of the Evidence

This is a summary of a systematic review evaluating the evidence about factors that contribute to the effectiveness of behavioral programs for type 2 diabetes mellitus (T2DM). The systematic review included 132 studies of T2DM published between January 1, 1993, and January 2015. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/diabetes-behavioral-programs. This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 29, 2016

Ozone therapy as a treatment for foot ulcers in people with diabetes

Diabetes mellitus (DM) is a common condition that leads to high sugar concentrations in the blood. People who have had diabetes for a long time often suffer from foot ulcers. Nearly 35% of all hospital admissions from diabetes clinics are due to them, as are nearly 80% of all non‐traumatic amputations of the leg and foot.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Diabetic Diets for Frail Elderly Long-Term Care Residents with Type II Diabetes Mellitus: A Review of Guidelines [Internet]

People with type 2 diabetes, also known as non-insulin-dependent diabetes or adult onset diabetes, produce less insulin and are often overweight. The prevalence of type 2 diabetes increases with age as more people live longer. The prevalence of diabetes among Canadian seniors was 21.3% between 2006 and 2007. In the US, one in three residents of long-term care facilities have diabetes, of which 95% are type 2 diabetes. Older people with diabetes are at an increased risk for urinary tract infections, skin infections, foot ulcers, and pneumonia or flu. Treatment goals vary depending on the overall health of the residents. Usual goals for non-institutionalized adults include HbA1c <7.0%, before meal blood glucose levels 70–130 mg/dl, after meal (2 hours) blood glucose levels <180 mg/dl, blood pressure < 130/80 mmHg, and LDL cholesterol <100 mg/dl. Oral medications or injectable insulin are used to manage high blood sugar, while other agents may be used to control cardiovascular risk factors such as high blood pressure or cholesterol. However, good nutrition plays an important part of diabetes care, since undernutrition is common in frail older people, who often live in the long term care facilities and are dependent on the help of others to perform daily activities due to decreasing in strength, endurance and physiological function, the level of which can be characterized by using a clinical frailty scale. It is therefore important to know whether or not dietary restrictions such as “diabetic diets” should be used in such population. “Diabetic diets” are generally healthy diets that are individualized based on preferences, abilities and treatment goals using the advantages and disadvantages of dietary interventions listed in the chapter of Nutrition Therapy of the Canadian Diabetes Association Clinical Practice Guidelines.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 15, 2015
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Behavioral Programs for Type 1 Diabetes Mellitus: Current State of the Evidence

This is a summary of a systematic review evaluating the evidence about the effectiveness of behavioral programs for type 1 diabetes mellitus (T1DM). The systematic review included 34 studies of T1DM published between January 1, 1993, and January 2015. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/diabetes-behavioral-programs. This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 29, 2016

Systematic guideline search and appraisal, as well as extraction of new and relevant recommendations, for the DMP “diabetes mellitus type 2”: Executive summary of final report: V09-04, Version 1.0

The aim of this study was to specify a potential need for updating and supplementation of the existing DMP “diabetes mellitus type 2” by systematically searching for new, topic-relevant, evidence-based guidelines and by synthesizing the guideline recommendations.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 7, 2011

Combined strategies to avoid foot ulcers in patients with diabetes

Foot ulcers (open sores) are common in people with diabetes mellitus (type 1 and type 2), especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease) or both. People with ulcers due to diabetes will sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life, but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring, for example, by showing patients with diabetes how to look after their feet or by prompting doctors to check their patients' feet more often. The results of single prevention strategies alone have so far been disappointing, therefore in clinical practice, preventive interventions directed at patients, healthcare providers and/or the structure of health care are often combined. In this review of trials of complex, preventive interventions, we found insufficient evidence that these combined approaches can be effective in reducing foot problems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Dressings to treat foot ulcers in people with diabetes

Diabetes mellitus (generally known as 'diabetes'), when untreated, causes a rise in the sugar (glucose) levels in the blood. It is a serious health issue that affects millions of people around the world (e.g., almost two million people in the UK and 24 million people in the USA). Foot ulcers are a common problem for people with diabetes; at least 15% of people with diabetes have foot ulcers at some time during their lives. Wound dressings are used extensively in the care of these ulcers. There are many different types of dressings available, from basic wound contact dressings to more advanced gels, films, and specialist dressings that may be saturated with ingredients that exhibit particular properties (e.g. antimicrobial activity). Given this wide choice, a clear and up‐to‐date overview of the available research evidence is needed to help clinicians/practitioners to decide which type of dressing to use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Systematic guideline search and appraisal, as well as extraction of new and relevant recommendations, for the DMP “diabetes mellitus type 1”: Executive summary of final report V09-03, Version 1.0

The aim of this study was to specify a potential need for updating and supplementation of the existing DMP “diabetes mellitus type 1” by systematically searching for new, topic-relevant, evidence-based guidelines and by synthesizing the guideline recommendations.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 24, 2011

Behavioral Programs for Diabetes Mellitus

To conduct a systematic review focusing on the effectiveness of behavioral programs for type 1 diabetes (T1DM) and identifying factors contributing to program effectiveness for type 2 diabetes (T2DM).

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2015
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Delivery of Podiatry Care for Adults with Diabetes or Chronic Foot Conditions: A Review of the Clinical Effectiveness [Internet]

Foot problems such as foot ulcers are common complications of diabetes, with close to 85% of lower limb amputations due to diabetes in the US originating with foot ulcerations. Successful treatment of diabetic foot issues include a combination of approaches such as optimal diabetes control, effective local wound care, infection control, pressure relieving strategies and blood flow recovery that usually require a multidisciplinary team approach, including podiatric care. Routine foot care may be provided by specialist physicians (podiatrists), non-specialists such as family physicians, or nurses or other allied health professionals. Nurses may receive additional foot care training, however there is currently no certification process for nursing foot care in Canada.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: November 6, 2013
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Non-Pharmacological Interventions to Reduce the Risk of Diabetes in People with Impaired Glucose Regulation: A Systematic Review and Economic Evaluation

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the UK and worldwide. Before the onset of T2DM, there are two conditions characterised by blood glucose levels that are above normal but below the threshold for diabetes. If screening for T2DM in introduced, many people with impaired glucose tolerance (IGT) will be found and it is necessary to consider how they should be treated. The number would depend on what screening test was used and what cut-offs were chosen.

Health Technology Assessment - NIHR Journals Library.

Version: August 2012
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Controlling blood glucose in treating diabetic foot ulcers (sores)

Background: People with diabetes can develop foot ulcers (sores) for a number of reasons. This includes nerve damage and reduced blood flow to the feet and legs. Having high blood glucose may affect the ability of foot ulcers to heal and therefore intensively controlling blood glucose may be beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Granulocyte‐colony stimulating factor, a growth factor, which can be added to usual therapy for treating foot infections in people with diabetes

People with diabetes can develop foot infections which can be difficult to treat, and treatment failure can result in lower extremity amputation. We found five trials which included a total of 167 people. The trials showed that adding G‐CSF to usual therapy did not significantly affect the likelihood of the infection resolving or the improved healing of foot wounds, nor did it reduce the period of treatment with oral antibiotics. However, G‐CSF does appear to reduce the need for surgical interventions, especially amputations, and the number of days spent in hospital. There are limitations to this analysis related to the variations in the people included in the studies (e.g. the severity of infection, the timing of the clinical assessment, the use of different G‐CSF preparations, and for different lengths of time). Therefore caution is required in the interpretation of the findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Growth factors for treating diabetic foot ulcers

People who suffer from diabetes mellitus (usually referred to as ‘diabetes’) can develop wounds (ulcers) on their feet and ankles. These diabetic foot ulcers can take a long time to heal, and affect quality of life for people with diabetes. In some people, failure of these ulcers to heal can contribute to the need for some level of amputation on the foot. Any treatments that encourage diabetic foot ulcers to heal will be valuable.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

Foot ulceration is a major problem in people with diabetes and is the leading cause of hospital admissions and limb amputations. Despite the current variety of strategies available for the treatment of foot ulcers in people with diabetes, not all ulcers heal completely. Additional treatments with skin grafts and tissue replacement products have been developed to help complete wound closure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Canagliflozin (Invokana) for Type 2 Diabetes Mellitus [Internet]

Canagliflozin is the first sodium-glucose cotransporter-2 (SGLT2) inhibitor to be approved for use in Canada. Canagliflozin is indicated for patients with type 2 diabetes to improve glycemic control as monotherapy or in combination with metformin; a sulfonylurea; metformin and a sulfonylurea; metformin and pioglitazone; or insulin (with or without metformin) when these drugs do not provide adequate glycemic control. The recommended starting dose is 100 mg once daily. A dose of 300 mg once daily may be considered for patients who have tolerated a dose of 100 mg once daily and who need tighter glycemic control, provided they have an estimated glomerular filtration rate (eGFR) of ≥ 60 mL/min/1.73 m2 and have a low risk of adverse reactions associated with reduced intravascular volume. Canagliflozin is contraindicated in renally impaired patients who have an eGFR of less than 45 mL/min/1.73 m2, have end-stage renal disease, or are on dialysis.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: September 2015

Antibiotics to treat foot infections in people with diabetes

We reviewed the effects on resolution of infection and safety of antibiotics given orally or intravenously (directly into the blood system) in people with diabetes that have a foot infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic Review of Self-Management Support for long-term conditions

Study found that supporting self-management is inseparable from the high-quality care for long-term conditions. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care.

Health Services and Delivery Research - NIHR Journals Library.

Version: December 2014
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