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dc.contributor.authorCrawford, Fay
dc.contributor.authorNicolson, Donald
dc.contributor.authorAmanna, Aparna
dc.contributor.authorMartin, Angela
dc.contributor.authorGupta, Saket
dc.contributor.authorLeese, Graham
dc.contributor.authorHeggie, Robert
dc.contributor.authorChappell, Francesca
dc.contributor.authorMcIntosh, Heather
dc.identifier.citationCrawford , F , Nicolson , D , Amanna , A , Martin , A , Gupta , S , Leese , G , Heggie , R , Chappell , F & McIntosh , H 2020 , ' Preventing foot ulceration in diabetes : systematic review and meta-analyses of RCT data ' , Diabetologia , vol. 63 , no. 1 , pp. 49-64 .
dc.identifier.otherPURE: 265462312
dc.identifier.otherPURE UUID: 49c9856b-20b1-4221-82c2-4a3479d56fd6
dc.identifier.otherScopus: 85075878082
dc.identifier.otherORCID: /0000-0002-0473-9959/work/68281919
dc.identifier.otherWOS: 000519979600005
dc.descriptionFunding: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (HTA project: 15/171/01) as part of a wider project.en
dc.description.abstractAims/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.
dc.rights© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.en
dc.subjectEvidence-based health careen
dc.subjectFoot ulceren
dc.subjectSystematic reviewen
dc.subjectRC Internal medicineen
dc.titlePreventing foot ulceration in diabetes : systematic review and meta-analyses of RCT dataen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.description.statusPeer revieweden

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