Educational actions to reduce recurrence in the diabetic foot of patients treated with heberprot-P
RESEARCH PAPER

 

Educational actions to reduce recurrence in the diabetic foot of patients treated with heberprot-P

Acciones educativas para disminuir las recidivas en el pie diabético de pacientes tratados con heberprot-P

 

 

Irelma Permuy Torres1*
Rolando Montesino Rodríguez1
René Quintana Mugica2
Daniel Hernandez Torres3

 

1Villa Clara University of Medical Sciences. "Santa Clara" University Polyclinic. Cuba.
2Villa Clara University of Medical Sciences. Academic Vice-rectorate. Cuba.
3Villa Clara University of Medical Sciences. "Ernesto Che Guevara" Cardiological Center. Cuba.

 

*Author for correspondence. E-mail: irelmapt@infomed.sld.cu

 

 

ABSTRACT

One of the most frequent complications of diabetes mellitus is diabetic foot ulcer associated with neurological, vascular and infectious disorders. With the discovery of heberprot-P a new treatment was more effectively added against this condition. The authors intend to socialize a system of educational actions aimed at patients treated at "Santa Clara" University Polyclinic, in Villa Clara, to reduce recurrences that occur in 9 % of them, higher than the average values at a national level that range from 5 to 7 %. Among its actions are mentioned: knowledge on the subject, benefits of a healthy diet, need of physical exercises, use of footwear and glycemic control; they were taught and organized using pedagogical techniques in workshops once a week

MeSH: diabetes mellitus;strategies; health promotion; education, medical.

RESUMEN

Una de las complicaciones más frecuentes de la diabetes mellitus es la úlcera del pie diabético asociada a alteraciones neurológicas, vasculares e infecciosas. Con el descubrimiento del heberprot-P se adicionó un nuevo tratamiento con mayor efectividad contra esta afección. Los autores tienen el propósito de socializar un sistema de acciones educativas dirigidas a los pacientes tratados en el Policlínico Universitario "Santa Clara", en Villa Clara, para disminuir las recidivas que se presentan en un 9 % de ellos, cifra superior a los valores promedios a nivel nacional que oscilan entre 5-7 %. Entre sus acciones se mencionan: conocimientos sobre el tema, beneficios de una alimentación saludable, necesidad de ejercicios físicos, uso del calzado y control glucémico; impartidas en talleres una vez por semana y organizados empleando técnicas pedagógicas.

DeSC: diabetes mellitus; estrategias; promoción de la salud; educación médica.

 

 

Submitted: 15/07/2019
Accepted: 02/09/2019

 

 

Foot conditions in patients with diabetes mellitus constitute one of the main causes of morbidity and disability, and they are the main non-traumatic risk factor for lower limb amputation in approximately 15 % of diabetics. Their risk of amputation is many times higher than that of non-diabetics and the prevalence of mortality after amputation is from 39 % to 80 %.(1,2) The high rates of amputations cause a high degree of disability at a high economic and social cost.

In Cuba, the current decrease in amputations and hospital stays related to this disease is due to the creation of heberprot-P, the new Cuban drug, the only one of its kind in the world, and a medical work with a more comprehensive and multidisciplinary approach.(3) It is prescribed for the therapy of diabetic foot ulcer, based on the recombinant human growth factor (recHGF) by intralesional infiltration directly at the site of the wound. It is a product that accelerates the healing of deep, neuropathic or neuroischemic ulcers; it´s useful in advanced stages with high risk of amputation.(4,5)

An essential objective of the Cuban health system is comprehensive care for the diabetic patient to achieve metabolic control and avoid complications associated with the disease. For this it is essential to combine health education actions with systematic medical care from the operation of multidisciplinary teams that include specialists in Comprehensive General Medicine, nursing staff, podiatrists trained for the activity, dieticians, dentists and specialists in Internal Medicine, Endocrinology and Angiology, in the Primary Health Care.(6)

Therapeutic education thus becomes the cornerstone of comprehensive care for people with diabetes, and must be effectively developed in all the services of the national health system through the National Diabetes Program which has an education strategy duly structured in three main lines of action:(7)

  1. The therapeutic education of the sick person and its relatives.
  2. The training of health personnel to carry out this educational function.
  3. Health promotion and education aimed at the community and risk groups.

Several studies(1,2,3) conclude that the use of health education is essential in order to strengthen the prevention and control of risk factors, the identification of high risk foot and diabeto-logical education aimed at people adopting usual and systematic elementary rules for their care

Based on the experience accumulated in the consultations of comprehensive Patient Care with Diabetic Foot Ulcer, the use of Heberprot-p and considering the third line of action of the National Diabetes Program, the authors have considered it pertinent to design a system of educational actions to reduce the recurrence of ulcers in the diabetic foot of patients who attend the "Santa Clara" University Polyclinic of the city of the same name.

The actions consist of a group of educational activities distributed in workshops as follows:

Workshop 1. Knowing is power
Workshop 2. No injury, worry outside
Workshop 3. Diseases diagnosed and treated, guaranteed health
Workshop 4. Benefits of physical activity
Workshop 5. Healthy eating, quality health
Workshop 6. Ideal footwear, safe walking

Methodological requirements for the development of the workshops:

  • To achieve meaningful learning about the content, an educational process will be developed with several individual and group sessions. The methodology is characterized by being flexible, participatory, practical and experiential.
  • As a starting point, the critical analysis of the participants is taken about their experiences, knowledge, successes and mistakes in relation to diabetes mellitus and diabetic foot ulcer (DFU).
  • Different active pedagogical techniques will be used, such as: problem analysis, group discussions, public debate, video debate, operational simulation, demonstration with training, situation analysis and decision making.
  • The working groups will be organized with around 20 patients to be able to develop activities with creativity and participatory techniques that enable reflection, dialogue and a critical analysis of reality.
  • The actions will be weekly carried out, with no more than one hour duration, in pleasant and comfortable areas.
  • The teaching aids will be designed according to the objective and its topic.

The authors consider that the designed actions are relevant, correspond to the logical criteria of the treatment, are feasible to be applied and contribute to increase knowledge for the achievement of the proposed general objective. The contents are very precise and updated and the methodology for their use is adequately supported.

 

BIBLIOGRAPHIC REFERENCES

1. Bustillo Santandreu M, Feito Castex T, García Seco F, Álvarez López Y, Guerra Durán B. Resultados del tratamiento con heberprot-P a pacientes con diagnóstico de pie diabético en el Municipio de Ranchuelo. Acta Med del Centro [Internet]. 2014 [citado 05/01/2019];8(2):[aprox. 7 p.]. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/115/89

2. Gómez Hoyos E, Levy E, Díaz Pérez A, Cuesta Hernández M, Montañez Zorrilla C, Calle Pascual AL. Pie diabético. Semin Fund Esp Reumatol [Internet]. 2012 [citado 12/01/2019];13(4):[aprox. 11 p.]. Disponible en: https://www.elsevier.es/index.php?p=revista&pRevista=pdf-simple&pii=S1577356612000309

3. Mass Basulto G, Cabrera Rodríguez T, Torres Torres F, Vidal Cabrera G, Moya Ávila A, Alonso Abad J. Efectividad del heberprot P en la úlcera de pie diabético en un área de salud. Rev Finlay [Internet]. 2014 [citado 19/01/2019];4(2):[aprox. 7 p.]. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/view/255/1277

4. Fernández Montequín JI. Una victoria de la Medicina Cubana en Angiología y Cirugía Vascular. Rev Cuba Angiol Cir Vasc [Internet]. 2013 [citado 21/01/2019];14(1):[aprox. 2 p]. Disponible en: https://www.medigraphic.com/pdfs/revcubangcirvas/cac-2013/cac131a.pdf

5. Machado Novell K, Leyva Mora AM, Alonso Salceda K, Hernández Pérez JR, Labarta Rodríguez DM. Eficacia del tratamiento del heberprotP en un paciente con pie diabético neuroinfeccioso. CCM [Internet]. 2013 [citado 18/01/2019];17(3):[aprox. 5 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1560-43812013000300020

6. Proenza Fernández L, Figueredo Remón R, Fernández Odicio S, Baldorillanas Y. Factores epidemiológicos asociados al pie diabético en pacientes atendidos en el Hospital "Celia Sánchez Manduley". Multimed [Internet]. 2016 [citado 12/01/2019];20(3):[aprox. 17 p.]. Disponible en: http://www.revmultimed.sld.cu/index.php/mtm/article/view/199/244

7. García R, Suárez R. Programa Cubano de Educación en Diabetes [informe]. Infomed. [Internet]. 2009 [citado 20/01/2019]. Disponible en: http://www.sld.cu/galerias/pdf/sitios/diabetes/programa_cubano_de_educacion_en_diabetes.pdf

 

 

Declaration of interests

The authors declare no conflict of interest.

 

 

Contribution of the authors

Irelma Permuy Torres: diagnosis of the main problems that affect patients with (DFU), design and implementation of actions.
Rolando Montesino Rodríguez: data management, design and implementation of actions.
René Quintana Mugica and Daniel Hernandez Torres: review of bibliography and creation of auxiliary resources for the workshops.

 

 

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