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The reported prevalence of lesions associated with diabetic foot varies greatly, depending on the country of reference, with data ranging from 1.5 to 16.6%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> among diabetics, with an estimated incidence rate of 2%, and the recurrence rate for these lesions is high</p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical impact of diabetic ulcers, in terms of morbidity and mortality, is high and well known.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Furthermore, diabetic foot syndrome carries enormous economic costs, both direct and indirect for health systems.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Another aspect, which in recent years has aroused great interest in professionals dealing with this condition, is the study of the loss of quality of life and the emotional impact on people with these ulcers.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For all these reasons, the attention given to diabetic foot in recent decades has clearly been growing, which is easy to ascertain if we quantify the published scientific production on this subject. A “simple” search in Medline, via PubMed, shows that 139 articles on diabetic foot were published in 1995 (a search performed using the MeSH term “Diabetic Foot” alone, without limits or filters), and a decade later 329 articles were found (2005). By the year 2018, this modest search yields 511 articles. This data encourages us to believe that interest in this subject will continue.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Unfortunately, this interest has not always translated as real progress in all areas associated with the care of people with diabetic foot. Recently, an interesting work by Van Natten et al. analysing the scientific production on diabetic foot,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> highlighted how the majority of published randomised clinical trials (RCTs) focussed on the area of treatment, healing and scarring of these ulcers, and other areas such as prevention were clearly undervalued. Thus, according to these authors, during the period 2010-2014 62 RCTs on treatment were published compared to only 6 RCTs on prevention.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This trend, far from changing, was accentuated in the period 2015-2019, with a result of 72 RCTs on treatment versus 2 RCTs on prevention.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Without detracting from the importance of research in the cure and treatment of diabetic foot ulcers and welcoming the excellent advances in this area (with the inclusion of new therapies and increasingly effective treatments), we consider this to be a completely inadequate proportion. Despite the fact that various bodies such as the International Working Group on the Diabetic Foot (IWGDF) establish that prevention is key in reducing the global problem of diabetic foot,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> it is not being given the importance it undoubtedly merits. This is evidenced by the oft-cited phrase “prevention is better than cure”, and financial studies conducted in the area of wounds, demonstrate this. Many of these lesions could be prevented with appropriate care and training.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Perhaps this is where part of the problem lies; it is assumed all too easily that diabetic foot lesions are inevitable. Diabetic foot is a very complex entity that poses a challenge to practitioners. Multiple variables and elements intervene in its genesis and maintenance: peripheral neuropathy, ischaemia, the state of the underlying disease, biomechanical disorders, infections, etc. it seems easier to accept the premise of the inevitability of foot ulcers in people with diabetes and that over time they are “difficult to prevent”. However, some research studies suggest that up to 75% of diabetic foot ulcers are avoidable.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is true that there are multiple knowledge gaps when addressing diabetic foot prevention. As the IWGDF highlights, the evidence to support certain preventive measures that “a priori” we could consider obvious is low and weak.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a> Although, “like a snake biting its own tail”, this is merely an endorsement of the paucity of quality research on preventive measures for diabetic foot.</p><p id="par0040" class="elsevierStylePara elsevierViewall">By way of example: there is still little evidence available on the effectiveness of self-care in preventing foot ulcers in people with diabetes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Neither are there any robust studies that assess the role that specific educational programmes could play in the prevention of ulcers and the ability of such programmes to reduce recurrence, or that assess the most effective educational approaches and interventions, the cost-effectiveness of these interventions and how to adjust them to each person's individual risk.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Therefore, we can affirm that there are multiple aspects of diabetic foot prevention that are pending quality research if we really wish to support our actions from an evidence-based practice perspective. And it is here that this “pending diabetic foot research agenda” emerges as an opportunity for nurses.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Not only do nurses regularly provide direct care to patients with diabetic ulcers together with other healthcare professionals from other disciplines, but they are also most often responsible for the control and monitoring of people with diabetes, providing advice and education, and establishing professional and personal relationships with these people that are essential in promoting self-care, ulcer prevention and treatment adherence. Often, the first professional that a patient will contact when they have a foot ulcer is their nurse; they are also often the first professional they ask for advice to prevent a foot ulcer.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Therefore, diabetic foot prevention is a field where nurses feel at home, it is an area they can call their own and it is a perfect opportunity to demonstrate the profession's strengths and value. The nursing profession is in an excellent position to bring knowledge and action to improve the lives of people with diabetes and to prevent foot ulcers.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Whether from different care settings (from primary care to hospital care, from special care units such as diabetic foot units to more general or classical departments or units), or from different professional nursing profiles (advanced practice nurses in chronic wounds or diabetes and specialist nurses in family and community health, for example) the important thing is to record our interventions appropriately, so that, based on this data, we can propose well-designed research that can finally provide that missing evidence on diabetic foot prevention. This is evidence that we take for granted, but when we evaluate it objectively, we find that it is scarce, weak and, clearly, insufficient.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Diabetic foot poses a great challenge, but it can also be a great opportunity for our profession. The challenge is there, it just remains for us to take it on and face it. Without doubt, people with diabetes will thank us for this.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This is the year of Nursing, of the “Nursing Now” movement, the year of nursing empowerment and leadership, which the National Advisory Group for the Study of Pressure Ulcers and Chronic Wounds (GNEAUPP) has made its own with the slogan “Wound Nursing Now”. Let us, therefore, be leaders in care and contribute our “grain of sand” to this field with better research that focuses on our patients and which will make us more visible to society.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-19" "fechaAceptado" => "2020-02-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torre HGdl, Soriano JV. Wound Nursing Now: liderando la prevención, cuidados e investigación del pie diabético. Enferm Clin. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.enfcli.2020.02.014">https://doi.org/10.1016/j.enfcli.2020.02.014</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (†)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Zhang" 1 => "J. Lu" 2 => "Y. Jing" 3 => "S. Tang" 4 => "D. Zhu" 5 => "Y. 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Journal Information
Vol. 30. Issue 2.
Pages 69-71 (March - April 2020)
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Vol. 30. Issue 2.
Pages 69-71 (March - April 2020)
Editorial
Wound Nursing Now: leading the prevention, care and research on diabetic foot
Wound Nursing Now: liderando la prevención, cuidados e investigación del pie diabético
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a Complejo Hospitalario Insular Materno-Infantil de Gran Canaria, Servicio Canario de Salud, Profesor asociado Universidad de La Laguna-Sede La Palma, Comité Consultivo del GNEAUPP, Spain
b Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia de la Universidad de Alicante, Comité Director del GNEAUPP, Spain
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