The more I read about the psychological impact of diabetic foot ulceration, the more I appreciate how difficult it is for our patients to follow the advice we give them, and how demotivation and social factors frequently compromise outcomes. While we typically cite infection and vascular disease as the causes of amputations, non-adherence is one of the primary reasons for delayed closure of ulceration, which is itself a risk factor for amputation.
The two lead articles in this quarter’s lower limb complications section focus on these rarely discussed areas of diabetes foot care.
Fejfarová et al (their study summarised alongside) compared a selected list of psychological and social characteristics among 104 people with diabetes and diabetic foot ulcers, and 48 people with diabetes without ulceration. They found that participants with a history of ulceration had a more extensive list of adverse social factors compared to those without a history of ulceration, including lower levels of achieved education, greater prevalence of disability pensions and benefits, and greater levels of perceived depression. However, objective scores of depression were similar between those with and without diabetes ulceration, except for people who had undergone a major amputation, in whom depression scores were higher.
The second article to study this topic in this issue is by McDonald et al, and is summarised on the following page. The authors found that diabetes-related amputations altered body image, but depression and other adverse psychosocial health measures were related to other underlying comorbidities. However, people with a diabetes-related amputation were more likely to have other diabetes complications, including renal, retinal and cardiac problems, which might account for the differences in depression scores reported by Fejfarová et al.
The problems of delayed healing and amputations continue to be a major issue for people with diabetic foot complications. However, until we pay as much attention to how our patients are ‘feeling’ and how they live their lives, there will be a limit to how much we can achieve with dressings and offloading alone.
To read the article summaries, please download the PDF from the article options link at right.