INTRODUCTION:Patients with high-risk feet and diabetes are prone to develop diabetes-related foot ulcers (DFUs). To prevent DFUs and their costs and impacts on diabetes mellitus (DM) patients' productivity and quality of life, patients' foot self-care (FSC) practices are essential to screen for DFUs. Our study aimed to assess the self-efficacy and outcome expectations about FSC and evaluate the knowledge about DFUs among patients with DM in Jordan. METHODS:A cross-sectional study was conducted with DM patients who attended two diabetes clinical centers in Jordan in the period from October 2022 to April 2023 in which data were collected through a self-administered questionnaire developed to assess patients' understanding of DFUs, foot care outcomes expectations (FCOE), and self-efficacy about FSC. RESULTS AND DISCUSSION:The final sample included data from 107 patients. Patient awareness of DFUs and FCOE was good, and the level of self-efficacy for FSC was moderate to high. Multiple linear regression revealed that age was negatively associated with lower self-efficacy for FSC (β = -0.22, p = 0.03) and both confidence (self-efficacy) in FSC and living arrangements (i.e., living with family) were positively associated with higher FCOE (β = 0.19, p = 0.04 and β = 0.39, p <0.001, respectively). Diagnosis of renal failure, diagnosis of retinopathy, elevated levels of glycated hemoglobin, and the settings in which the patient is receiving care for DM were positively associated with an understanding of DFUs. Both age and history of heart attacks and coronary artery disease were negatively associated with realizing DFUs (β = -0.26, p = 0.007, and β = -0.18, p = 0.045, respectively). CONCLUSION:Patients with diabetes mellitus in Jordan have good FCOE, good awareness of DFUs, and a moderate degree of self-efficacy to execute FSC. Health education and self-efficacy programs should focus on older adults with a history of heart attacks to boost their understanding of DFUs and raise their sense of self-efficacy around FSC.

This study aimed to investigate the levels of adherence to wearing therapeutic footwear, and the factors associated, among people at high-risk of diabetes-related foot ulcers (DFUs) in Jordan. This was a secondary analysis of data from a multi-centre cross-sectional study of participants at high-risk of DFU in Jordan who had therapeutic footwear. Participants had socio-demographic, health, limb, and psychosocial variables collected, plus self-reported their proportion of adherence time wearing therapeutic footwear on an average day (excluding sleeping time) using a visual analogue scale. Participants were categorized into high (≥60%) or low (<60%) adherence levels, plus users (1%-100% adherence) or non-users (0% adherence) of therapeutic footwear. Of 104 included participants (mean age 58 ± 13 years, 68% males), 65 (62.5%) self-reported low adherence levels and 44 (42.3%) as non-users. No variables were independently associated with low adherence levels (P > .05). Whereas participants with lower self-reported foot care outcome expectation scores were independently associated with non-use of therapeutic footwear (P = .05). Most people at high-risk of DFUs in Jordan self-reported low adherence or total non-use of their therapeutic footwear. Perceived low footcare outcome expectations was the only factor found associated with non-use of therapeutic footwear and further research is needed to explore other potential factors.

BACKGROUND:Diabetic foot osteomyelitis affecting the toes is associated with several complications including amputation. Management is variable and include medical therapy alone or coupled with surgery. Removal of infected tissues is a common therapeutic option. However, limited source data are available. This study determines the outcome and complications of percutaneous partial bone excision (PPBE) of infected bone among diabetic patients with toe osteomyelitis.METHODS:This is an uncontrolled experimental prospective study in diabetic patients who underwent PPBE of infected pieces of bone for toe osteomyelitis in the outpatient setting at a single foot clinic. All participants were followed up until the occurrence of wound healing or amputation.RESULTS:Forty-seven patients (mean ± SD age was 62.8 ± 11.6 years) participated. Forty-four patients (93.6%) had complete healing and 3 (6.4%) required toe amputation. The mean (±SD) wound healing time was 11 (±4.6) (range, 7-22) weeks. Diabetes mellitus type 1 and younger age were significantly associated with increased risk for amputation.CONCLUSION:PPBE of infected toes in diabetic patients can be performed successfully and safely in the outpatient clinic. It can also improve healing and avoids inpatient stay.LEVEL OF EVIDENCE:Level II, prospective cohort study.

Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (β = .30, P < .01) and reporting higher scores of patients’ interpretations about neuropathy physical causes of foot ulcers (β = “.22,” P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.

Background and aims: To determine and analyze the factors related to anxiety and depression in patients having diabetic foot ulcer (DFU). Methods: This two-center, cross-sectional study was conducted among 250 patients with DFU, who were receiving treatment in the outpatient diabetes foot care clinic at Prince Sultan Military Medical City, Saudi Arabia and National Center for Diabetes, Endocrinology and Genetics, Jordan. Employing the Hospital Anxiety and Depression Scale (HADS), the anxiety and depression levels of the study population were measured. The demographic variables were also recorded. Results: Females displayed significantly higher anxiety (p = 0.032) and depression levels (p = 0.043); and those who were unmarried showed higher anxiety (p = 0.042). School educated patients showed reduced degrees of anxiety (p - 0.023) and depression (p - 0.003) and college educated showed reduced anxiety (p = 0.047) compared to uneducated. Compared to patients on treatment with diet, a significant decline was found in depression (p = 0.034) levels among orally treated patients. Compared to patients on oral medication, patients with oral and insulin treatments revealed higher depression (p = 0.026). Higher-income patients showed a significant decline for anxiety (p = 0.004). Patients who were past smokers had higher anxiety (p = 0.046) than current and never had been smokers. Higher anxiety (p = 0.017) was observed in patients having higher HbA1c levels, similarly, patients with three diabete-srelated complications showed higher levels of anxiety (p = 0.001) and depression (p = 0.001). Conclusion: Female gender, lower education levels, patients on oral and insulin treatments, low income, high HbA1c levels and patients experiencing a higher number of diabetes-related complications showed either higher anxiety or depression levels. (C) 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.

This study aims to screen patients with type 2 diabetes mellitus for peripheral arterial disease (PAD) and to determine the agreement between ankle brachial index (ABI) and toe brachial index (TBI). A total of 182 diabetic patients at 40 years of age or older were assessed using both ABI and TBI. Mean age was 60.5 (SD ±8.1) years. PAD was present in 28.9% and 5.4% of patients according to TBI and ABI definitions respectively. The prevalence of high ABI (ABI > 1.3) was 16.5%. The agreement between TBI and ABI results was fair. Current smoking was associated with low ABI whereas age was inversely associated with TBI. We strongly suggest using both the ABI and TBI as screening tests for PAD because the agreement between these tests was fair, they complement each other in most instances and they detect PAD at different anatomical levels.