Effectiveness of educational interventions for diabetes‐related foot disease: A systematic review and meta‐analysis

Abstract

AbstractThis systematic review and meta‐analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes‐related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot‐care knowledge and self‐care behaviours. Meta‐analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB‐2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference −0.73; 95% CI −1.26, −0.20, I2 = 93%) without affecting all‐cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self‐care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self‐care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow‐up are needed.