Abstract
Giriş: Alt ekstremite amputasyonu yapılan hastaların yaklaşık %40-60’ını diyabetik hastalar oluşturmaktadır. Diyabetik ayak yaraları, diyabetik hastaların hastanede uzun süre yatışlarının en önemli nedenlerindendir. Diyabet hastası olanlarda, normal popülasyona nazaran alt ekstremite amputasyon riski 15-40 kat daha fazladır.Yara oluşmadan yapılacak profilaksi ve oluşmuş olan diyabetik ayak yaralarının tedavisi, amputasyonları ve morbiditeyi %50 azaltmakta ve maliyeti düşürmektedir. Diyabetik ayak yaralarını önlemeye yönelik yöntemler; kan şekeri regülasyonu sağlanması, uygun ayakkabılar giyilmesi, ayak bakımı, ayak tırnağı bakımı, düzenli ayak muayenesi ve hasta eğitimidir. Diyabetik ayak yarası üzerinde, diyabetik ayak hastası ve bakıcısının öğrenim düzeylerinin etkisini araştırmayı amaçladık.
Yöntem: 2009 yılında İzmir Tepecik Eğitim ve Araştırma Hastanesi Genel Cerrahi, Dahiliye ve diyabet polikliniklerine başvuran, diyabetik ayak yarası olan toplam 67 hastanın ve bu hastalara evde bakım yapan 57 bakıcının öğrenim düzeyi ile, Wagner sınıflamasına göre hastalardaki diyabetik ayak yara evresinin ilişkisi ve ayak muayenesi prospektif olarak yüz yüze anket metodu ile araştırıldı.
Bulgular: Hastaların ve bakıcılarının öğrenim durumlarının, Wagner sınıflamasına göre diyabetik ayak yarası Wagner evrelerini etkilemediği (p=0.167) fakat diyabet izlemlerini düzenli yaptıran ve daha önce diyabetik ayak yarası hakkında bilgilendirilen hastaların yara evrelerinin daha düşük olduğu saptandı (p=0.021).
Sonuç: Hastanın ve bakıcısının öğrenim seviyesinin, yara evresi üzerine etkisi olmadığı fakat düzenli klinik takip ve hastanın eğitiminin yara evresini iyi yönde etkilediği ortaya çıkmıştır. Diyabetik ayak için risk altındaki hasta grubuna, öğrenim düzeyi ne olursa olsun diyabetik ayak hastalığı hakkında bir eğitim programı uygulamak ve düzenli izlemlerinin yapılmasını sağlamak ekstremite amputasyonlarının oranlarını azaltacaktır.
References
- Powers AC. Diabetes mellitus. Eds: Braunwald E, Fauci AS, Kasper DL, Hauser SL. Harrison’s Principles of Internal Medicine. 15th edition (vol 2) McGraw-Hill Company USA 2001, pp. 2109-37.
- American Diabetes Association: Diabetes Epidemiology: Guiding Clinical and Public Health Practice. Diabetes Care 2007;30(7):1912-9.
- Eroğlu M, Barışık V. Approach to diabetes mellitus in primary care. Smyrna Med Journal 2012;2(suppl-1):54-61.
- Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Diabetes Care 2004;27(7):1598-604.
- Apelgvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev 2000;16(Suppl-1):75-83.
- Burkitt HG, Qucik CRG. Essential Surgery problems, diagnosis and management. 3'rd.ed Spain: Churchill Livingstone-harcourt puplishers limited 2002;463-8.
- Trautner C, Haastert B, Spraul M, Giani G, Berger M. Unchanged incidence of lover-limb amputations in a German City,1990-1998. Diabetes Care 2001;24(5):855-9.
- Faglia E, Favales F, Morabito A. New ulceration, new major amputation, and survival rates in diabetic subjecst hospitalized for foot ulceration from 1990 to 1993. Diabetes Care 2001;24(1):78-83.
- Ortegon MM, Redekop WK, Niessen LW. Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care 2004;27(4):901-7.
- Foster DW. Diabetes Mellitus. Braunwald E, Isselbacher KJ, Patersdorf RG, Wilson JD, Martin JB, Fauci AS, editors. In Harrison's Prenciples of Internal Medicine. 14'th ed. Hamburg: McGraw-Hill Book Company 1998; pp.2060-80.
- Pinzur MS, Slovenkai MP, Trepman E, Shields NN. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int 2005;26(1):113-9.
- Nesbitt JA. Approach to managing diabetic foot ulcers. Can Fam Physician 2004;50:561-7.
- Ragnarson Tenvall G, Apelqvist J. Health-Economic Consequences of Diabetic Foot Lesions. Clin Infect Dis 2004;39:132-9.
- Younes NA, Albsoul AM, Awad H. Diabetic hell ulcers: a major risk factor for lower extremity amputation. Ostomy Wound Manage 2004;50(6):50-60.
- Pollock RD, Unwin NC, Connolly V. Knowledge and practice of foot care in people with diabetes. Diabetes Res Clin Pract 2004;64(2):117-22.
- Batista F, Pinzur MS. Disease knowledge in patients attending a diabetic foot clinic. Foot Ankle Int 2005;26(1):38-41.
- Bolzoni O, Milan P, Perari D, Mollo F, Monesi G. Educational activities for the prevention of diabetic foot: foot complications at the Center for Diabetes of Rovigo. Assist Inferm Ric 2004;23(1):21-5.
- Beem SE, Machala M, Holman C, Wraalstad R, Bybee A. Aiming at “de feet” and diabetes: a rural model to increase annual foot examinations. Am J Public Health 2004;94(10):1664-6.
- Yetzer EA. Incorporating foot care education into diabetic foot screening. Rehabil Nurs 2004;29(3):80-4.
- Neder S, Nadash P. Individualized education can improve foot care for patients with diabetes. Home Healthc Nurse 2003;21(12):837-40.
- Özkan Y, Çolak R, Demirdağ K, Yıldırım M, Özalp G. Diyabetik ayak sendromlu 142 olgunun retrospektif değerlendirilmesi. Turkiye Klinikleri J Endocrin 2004;2(3):191-5.
- Akçay S, Harman E, Satoğlu IS, Kurtulmuş A. Rates and Risk Factors of Diabetic Foot Reamputations. Medicine Science 2012;1(4):283-91.
- Ramachandran A. Specific problems of the diabetic foot in developing countries. Diabetes Metab Res Rev 2004;20(Suppl 1):19-22.
- Peters EJ, Lavery LA, Armstrong DG. Diabetic lower extremity infection: influence of physical, psychological, and social factors. J Diabetes Complications 2005;19(2):107-12.
- De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Physician attitudes toward foot care education and foot examination and their correlation with patient practice. Diabetes Care 2004;27(1):286-7.
- Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293(2):217-28.
- Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration. A systematic review. Endocrinol Metab Clin North Am 2002;31(3):633-58.
Abstract
ABSTRACT
Introduction: Diabetic foot wounds are one of the most important causes of long duration hospitalizations regarding diabetic patients. Lower extremity amputation risk is 15 to 40 times higher in diabetics compared to normal population. Methods for preventing diabetic foot wounds are providing good blood glucose regulation, appropriate shoe wearing, foot care, toe-nail care, regular foot examinations and patient education. We aimed to investigate the effects of education level of the patients and the caregivers on the diabetic foot wound.
Methods: 67 patients having diabetic foot wound applying to General Surgery, Internal Medicine and Diabetes outpatient clinics of Izmir Tepecik Education and Research Hospital in 2009 and 57 caregiver caring for these patients were analyzed prospectively with a face to face questionnaire for a correlation between education levels of patients and caregivers and Wagner staging of patients’ diabetic foot wounds and foot examination findings.
Results: It was found that education levels of patients and caregivers did not affect Wagner staging of the wounds (p=0.167), but patients with regular follow-up and previously educated for diabetic foot wounds had a lower stage of wound (p=0.021).
Conclusion: Education level of patients and caregivers was not found to be effective on the stage of the wound, but regular clinical follow-up and patient education had an decreasing effect on the stage of wound. Whatever the patients’ education levels are, educations on diabetic foot care and providing regular follow up of patients at risk for diabetic foot will decrease the rates of extremity amputations.
References
- Powers AC. Diabetes mellitus. Eds: Braunwald E, Fauci AS, Kasper DL, Hauser SL. Harrison’s Principles of Internal Medicine. 15th edition (vol 2) McGraw-Hill Company USA 2001, pp. 2109-37.
- American Diabetes Association: Diabetes Epidemiology: Guiding Clinical and Public Health Practice. Diabetes Care 2007;30(7):1912-9.
- Eroğlu M, Barışık V. Approach to diabetes mellitus in primary care. Smyrna Med Journal 2012;2(suppl-1):54-61.
- Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Diabetes Care 2004;27(7):1598-604.
- Apelgvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev 2000;16(Suppl-1):75-83.
- Burkitt HG, Qucik CRG. Essential Surgery problems, diagnosis and management. 3'rd.ed Spain: Churchill Livingstone-harcourt puplishers limited 2002;463-8.
- Trautner C, Haastert B, Spraul M, Giani G, Berger M. Unchanged incidence of lover-limb amputations in a German City,1990-1998. Diabetes Care 2001;24(5):855-9.
- Faglia E, Favales F, Morabito A. New ulceration, new major amputation, and survival rates in diabetic subjecst hospitalized for foot ulceration from 1990 to 1993. Diabetes Care 2001;24(1):78-83.
- Ortegon MM, Redekop WK, Niessen LW. Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care 2004;27(4):901-7.
- Foster DW. Diabetes Mellitus. Braunwald E, Isselbacher KJ, Patersdorf RG, Wilson JD, Martin JB, Fauci AS, editors. In Harrison's Prenciples of Internal Medicine. 14'th ed. Hamburg: McGraw-Hill Book Company 1998; pp.2060-80.
- Pinzur MS, Slovenkai MP, Trepman E, Shields NN. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int 2005;26(1):113-9.
- Nesbitt JA. Approach to managing diabetic foot ulcers. Can Fam Physician 2004;50:561-7.
- Ragnarson Tenvall G, Apelqvist J. Health-Economic Consequences of Diabetic Foot Lesions. Clin Infect Dis 2004;39:132-9.
- Younes NA, Albsoul AM, Awad H. Diabetic hell ulcers: a major risk factor for lower extremity amputation. Ostomy Wound Manage 2004;50(6):50-60.
- Pollock RD, Unwin NC, Connolly V. Knowledge and practice of foot care in people with diabetes. Diabetes Res Clin Pract 2004;64(2):117-22.
- Batista F, Pinzur MS. Disease knowledge in patients attending a diabetic foot clinic. Foot Ankle Int 2005;26(1):38-41.
- Bolzoni O, Milan P, Perari D, Mollo F, Monesi G. Educational activities for the prevention of diabetic foot: foot complications at the Center for Diabetes of Rovigo. Assist Inferm Ric 2004;23(1):21-5.
- Beem SE, Machala M, Holman C, Wraalstad R, Bybee A. Aiming at “de feet” and diabetes: a rural model to increase annual foot examinations. Am J Public Health 2004;94(10):1664-6.
- Yetzer EA. Incorporating foot care education into diabetic foot screening. Rehabil Nurs 2004;29(3):80-4.
- Neder S, Nadash P. Individualized education can improve foot care for patients with diabetes. Home Healthc Nurse 2003;21(12):837-40.
- Özkan Y, Çolak R, Demirdağ K, Yıldırım M, Özalp G. Diyabetik ayak sendromlu 142 olgunun retrospektif değerlendirilmesi. Turkiye Klinikleri J Endocrin 2004;2(3):191-5.
- Akçay S, Harman E, Satoğlu IS, Kurtulmuş A. Rates and Risk Factors of Diabetic Foot Reamputations. Medicine Science 2012;1(4):283-91.
- Ramachandran A. Specific problems of the diabetic foot in developing countries. Diabetes Metab Res Rev 2004;20(Suppl 1):19-22.
- Peters EJ, Lavery LA, Armstrong DG. Diabetic lower extremity infection: influence of physical, psychological, and social factors. J Diabetes Complications 2005;19(2):107-12.
- De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Physician attitudes toward foot care education and foot examination and their correlation with patient practice. Diabetes Care 2004;27(1):286-7.
- Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293(2):217-28.
- Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration. A systematic review. Endocrinol Metab Clin North Am 2002;31(3):633-58.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | March 5, 2016 |
| Submission Date | March 5, 2016 |
| Acceptance Date | April 20, 2016 |
| Published in Issue | Year 2016Volume: 1 Issue: 1 |
