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The strengths of study are; it is a community based study to report the prevalence of DFS while many studies reported prevalence based on hospital patients and we have ensured an adequate sample size and use of validated questionnaire coupled with thorough clinical examination for comprehensive foot evaluation. Limitations of the study include HbA1c not being done for the entire study population due to financial constraints, though we used subset drawn from all DFS risk categories which gives ample evidence about attributes of DFS.
Besides DM the study could not assess other co-existing factors which might have led to peripheral neuropathy like autoimmune diseases and nutritional deficiencies as study is done among diabetic patients only. However other causes of neuropathy are considerably less.
The overall prevalence of diabetic foot syndrome was high among the study population and significantly associated with advancing age, low socio-economic status, sedentary physical activity and longer duration of DM. It can therefore be concluded that the screening for foot complications should start at the time of diagnosis of diabetes and integrated with sustainable patient education at primary care level by training of health care providers at primary care level. Diabetes Atlas. International Diabetes Federation, Brussels.
Accessed 10 Sept Top 10 causes of death. Alexiadou K, Doupis J.
Management of Diabetic Foot Ulcers. Diabetes Ther. Forlee M. What is the diabetic foot? The rising prevalence of diabetes worldwide will mean an increasing prevalence of complications such as those of the extremities. Continuing Medical Education.
Int Surg J. Atlas of the diabetic foot. Diabetes and Foot Care: Time to act. Netherlands: Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India. J Fam Med Primary Care. Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India.
Tobacco use among adults in a rural area of coastal Karnataka. Indian Journal of Preventative Medicine. World Health Organization. Waist circumference and waist-hip ratio.
Geneva: Report of a WHO expert consultation; The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. University of Michigan. Accessed on 18 th Sept IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. Use and Utility of ankle brachial index in patients with diabetic. Eur J Vasc Endovasc Surg. Categories of foot at risk in patients of diabetes at a tertiary care center: insights into need for foot care.
Indian J Endocrinol Metab. Evaluation the prevalence and incidence of foot pathology in Mexican-Americans and Nonhispanic whites from a diabetes disease management cohort. Diabetes Care. Effectiveness of the diabetic foot risk classification system of the international working group on the diabetic foot.
A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy.
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Clin Neurol Neurosurg. A study of risk factors and foot care behavior among diabetics. J Family Med Prim Care. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort. J Peripher Nerv Syst. Peripheral sensory neuropathy and associated factors among adult diabetes mellitus patients in Bahr Dar, Ethiopia. J Diabetes Metab Disord. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting.
J Diabetes Investig. Prevalence of diabetic peripheral neuropathy and associated risk factors in type 2 diabetes patients attending a diabetes care Centre in Maharashtra. International journal of recent trends in. Sci Technol. Diabetic peripheral neuropathy and its determinants among patients attending a tertiary health care Centre in Mangalore, India.
J Public Health Res. Burden of foot problems in diabetic subjects-a community-based study among urban poor in Bangalore. India Education. Prevalence of diabetic complications in rural Goa, India. Indian J Community Med. Prevalence and risk factors for severity of diabetic neuropathy in type 2 diabetes mellitus. Indian J Med Sci. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. Urban-rural differences in the prevalence of foot complications in south-Indian diabetic patients.
Incidence, risk factors for amputation among patients with diabetic foot ulcer in a north Indian tertiary care hospital. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for diabetes in youth follow-up cohort. Prevalence and determinants of peripheral neuropathy in patients with type 2 diabetes attending a tertiary care center in the United Arab Emirates. Prevalence of micro and macrovascular complications and their risk factors in type-2 diabetes mellitus.
J Assoc Physicians India. Risk factors for foot ulcers in patients with diabetes mellitus-a short report from Vellore, South India. Download references. The authors also thank the support of laboratory technicians and health workers in the smooth conduct of the study. The co-operation from all study participants is also appreciated.
MMK conceived the idea for the research, wrote the framework and drafted the manuscript. The choice of the revised material does not specifically focus on the scientific quality of the research but on the importance of the texts included in the study for the purpose of the research. The experience of the authors of this study in the care of diabetic people helped in the development of this stage. The extracted data were archived in a file suitable for this purpose. Also, in this step, the illustrations were selected the images inserted in the manual resulted from searches performed using Google Image and from photographs provided by a volunteer.
The criteria for selecting the images included figures that were easy to understand, didactic, attractive and, preferably, self-explanatory. For the presentation in the manual, each image was numbered and the list of images was elaborated to make its sources available. The images included in the manual included: attention gifs, pancreatic anatomy images, diabetic complications, illustrative photos of the guidelines, didactic schemes for insulin action, right and wrong gifs, and types of shoe.
In the 5th step, the layout was defined. The attractiveness and easy handling by the reader was prioritized once again. The size mm x mm and the format of the manual rectangular , number of pages 31 , type and size of the letter used in the construction of the texts Bookman Old Style, size 20 titles Bookman Old Style, bold, size 28 and illustrations 56 images were defined. With the choice of illustrations, care was taken to set up dialogues between the exposed contents and the actions themselves, which involve self-care practices, as well as the relationship between organic functions and hormones.
Thus, the aim was to use a playful way of transmitting as many orientations as possible without tiring the reader.
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In order to be included in the study, the experts needed to have a year or more of experience in the care of diabetic people with diabetic foot and to be active in the scenario institution of that study. Diabetic people had to be hospitalized at the surgical clinic during the data collection period and have diabetic foot the selection of diabetic people was performed by random choice and the companions had to be present at the time of data collection.
It is recorded that the consultation with diabetic people was performed to verify the intelligibility of the content. In order to consult the contents, the Delphi technique was applied, a tool that provides the judgment of the information in a systematized way, in the search of the consensus of experts in a given topic for validation, in this case, specialists in DM. In the Delphi technique it is common to give up the participation of experts, which may require new inclusion of study participants. This fact did not occur in this study. A form was created via Google Drive in order for the consultation with the experts, which is a tool available online by Microsoft that allows files to be shared with more people through their emails.
In this way, invited participants were able to edit the shared document online and contribute how they want. Thus, the electronic address was exclusively created for this study. In addition to the form submitted online, each expert received a printed version of the manual. In this form, questions were also included to characterize the profile of the experts, such as: age, professional training, year of graduation, higher degree, year of completion and professional acting position. Data collection with the experts occurred between September 15 th and November 30 th , The consultation with diabeticpeople and their companions involved the delivery of the educational manual in printed format, along with an evaluation form containing the Likert scale for the evaluation of content and appearance, as well as a space for suggestions and changes.
The form contained closed questions that evaluated the opinion of diabetic people regarding: understanding the contents of the manual, images and format of the manual; if the language adopted was clear and easy to read and if they would like to add or remove some of the contents. In addition, three descriptive questions were included that evaluated the perception of diabetics and family members regarding the manual, the need for content changes, the difficulty of understanding the information and the new learning achieved. Data collection with diabetic people and their companions was performed between October 20 th and November 10 th , These participants were identified by the code P1, P2 and P3.
The experts were identified by the code E1 through E Minor percentages needed to be revised or eliminated, i. The results obtained in the data collection with the patients and companions were grouped by similarity.