Psychosocial and Educational Implications of Diabetic Foot Complications

The psychosocial and behavioral impacts of diabetic leg and foot wounds are well-known. People with foot complications experience higher rates of depression, anxiety, and diabetes distress among others. Depression also increases the risk for amputation and doubles the risk for 5-year mortality after an initial diabetic foot ulcer. Furthermore, quality of life is diminished for those affected by foot complications and their caregivers. Thus, screening and treating psychosocial issues is critical to improve diabetic foot outcomes. Despite recent efforts to address the psychosocial and behavioral impacts of foot complications, evidence to support patient education interventions has been mixed. Systematic reviews and meta-analyses of these interventions have identified no clear effects in the prevention of diabetic foot complications or the treatment of leg and foot wounds. More well-done interventions are needed to prevent and treat diabetic foot complications. These interventions need to be sufficiently powered, include proper controls, incorporate long-term follow-up, and assess complete wound healing. Additionally, these interventions should acknowledge the four phases a person with diabetes experiences throughout the course of their condition: onset of diabetes, health maintenance and prevention, early onset of complications, and the stage of illness where complications dominate.