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Meta-Analysis
. 2020 Jan;63(1):49-64.
doi: 10.1007/s00125-019-05020-7. Epub 2019 Nov 27.

Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data

Fay Crawford  1   2 , Donald J Nicolson  3 , Aparna E Amanna  3 , Angela Martin  3 , Saket Gupta  3 , Graham P Leese  4 , Robert Heggie  5 , Francesca M Chappell  6 , Heather H McIntosh  7
Affiliations
Meta-Analysis

Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data

Fay Crawford et al. Diabetologia. 2020 Jan.

Abstract

Aims/hypothesis: Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.

Methods: We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.

Results: Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.

Conclusions/interpretation: Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.

Keywords: Diabetes; Evidence-based healthcare; Foot ulcer; Meta-analysis; Prevention; Systematic review.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Forest plots of foot ulcers in people receiving standard care vs (a) education alone, (b) dermal infrared thermometry, (c) complex interventions and (d) custom-made footwear and offloading
Fig. 3
Fig. 3
Subgroup analysis. Forest plot of foot ulcers in people with a history of foot ulceration receiving custom-made footwear and offloading vs standard care
See this image and copyright information in PMC

References

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