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Diabetic foot ulcers are associated with considerable morbidity, mortality and costs to the NHS. This paper describes a review of publications reporting randomised controlled trials examining the clinical effectiveness of interventions for diabetic foot ulcers for 1986–1996. Only 23 studies were identified that described randomised controlled trials and, of these, only 4 fulfilled three criteria shown to influence reliability of results: adequate description of randomisation, double blinding and description of withdrawals and drop‐outs. No cost‐effectiveness studies conducted alongside trials were identified from the searches. This shortage of rigorous trials highlights the need for more well designed research in the prevention and treatment of diabetic foot ulcers to determine clinical effectiveness as well as relative cost‐effectiveness.

Diabetes mellitus is one of the most common diseases around the world, and mainly affects the foot among the human body parts. The main causes of the diabetic foot are neuropathy, peripheral arterial disease and foot deformities; it leads to foot ulceration. Generally, sensory loss, high plantar pressure, foot deformities, inappropriate footwear, blindness, and age are the causing risk factors for developing foot ulceration in diabetic patients. Foot ulceration will result in prolonged hospitalization, high medical expenses, and serious complications with lower extremity amputation. For a long time, appropriate footwear has been recommended by physicians for reducing plantar pressure to prevent foot ulceration, the risk of amputation, and re-ulceration. A review is provided in this article towards the existing literature on the causes and prevalence of the diabetic foot, foot ulceration, off-loading pressure, footwear modification for different types of diabetic foot deformities, and types of footwear and textile materials used in footwear insoles for healing purposes.

The purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.

The prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.

The height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.

The proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.

This interview discusses a “Blue Ocean” strategy initiative: how to introduce effective change in diabetes care into Thailand given a strong reluctance in patients, and in Thai society, to see that diabetes is not a condition to be treated by doctors alone.

An interview with Dr Thep Himathongkam, the pioneer of holistic diabetes care in Thailand.

One strategic management problem he faced was the lack of suitably trained staff. Thailand had no university courses producing the multidisciplinary personnel needed for diabetes treatment such as diabetes educators, dieticians, or foot care specialists. He address the multidisciplinary personnel shortage by training the missing specialists, getting universities on board and more recently securing funding from the World Diabetes Foundation.

The result of the diabetic foot-care training for more than 2,500 personnel, mostly from community hospitals, has been markedly successful, with a reduction in annual amputations in Thailand of 80 per cent over five years.

This interview offers a look at the multi-track problem solving required to successfully implement a Blue Ocean strategy.

This paper aims to present a prototype of the diagnostic system for the examination of the distribution of the force applied by foot to substrate during usual human moving. Presented system is competitive to other currently available devices, thanks to sensors reliability, user-friendly operation manner and design based on cheap parts. The results of examinations are transmitted by radiomodem. Its recording and visualization are possible on either personal or mobile computers.

During selection of the sensors substrate, many polymeric electrets were examined. Polyvinylidene fluoride films were selected, because they have good charge uniformity across the surface, wide range of acceptable temperatures, linear relation between mechanical stress and output signal and high resistance for squeezing. The system measures the charge generated in film.

The pressures are recorded in relation to maximum value; therefore, measuring system does not require calibration. The simultaneous recording of data from all eight sensors allows tracking the signal without distortion.

An array of sensors is installed in the shoe insole. The measuring device is fixed to the outer surface of the shoe. Its weight is 75 g. The range of transmission is suitable for examination in the natural environment, outside traditional consulting room. Software is dedicated for analysis of the pressure distribution in every moment of the foot movement. The system is suitable for examination of flat feet, diabetic foot and recovery progress after injures.

Plantar force is the interface pressure existing between the foot plantar surface and the shoe sole during static or dynamic gait. Plantar force derived from gait and posture plays a critical role for rehabilitation, footwear design, clinical diagnostics and sports activities, and so on. This paper aims to review plantar force measurement technologies based on piezoelectric materials, which can make the reader understand preliminary works systematically and provide convenience for researchers to further study.

The review introduces working principle of piezoelectric sensor, structures and hardware design of plantar force measurement systems based on piezoelectric materials. The structures of sensors in plantar force measurement systems can be divided into four kinds, including monolayered sensor, multilayered sensor, tri-axial sensor and other sensor. The previous studies about plantar force measurement system based on piezoelectric technology are reviewed in detail, and their characteristics and performances are compared.

A good deal of measurement technologies have been studied by researchers to detect and analyze the plantar force. Among these measurement technologies, taking advantage of easy fabrication and high sensitivity, piezoelectric sensor is an ideal candidate sensing element. However, the number and arrangement of the sensors will influence the characteristics and performances of plantar force measurement systems. Therefore, it is necessary to further study plantar force measurement system for better performances.

So far, many plantar force measurement systems have been proposed, and several reviews already introduced plantar force measurement systems in the aspect of types of pressure sensors, experimental setups for foot pressure measurement analysis and the technologies used in plantar shear stress measurements. However, this paper reviews plantar force measurement systems based on piezoelectric materials. The structures of piezoelectric sensors in the measurement systems are discussed. Hardware design applied to measurement system is summarized. Moreover, the main point of further study is presented in this paper.

This study aims to design to assess the traditional, complementary and alternate medicine (TCAM) usage and its association with the quality of life (QOL) of Type 2 diabetic patients in a tertiary hospital (Hospital Universiti Sains Malaysia) in Malaysia.

A total of 300 respondents included in this study were divided into the following two major categories: TCAM (34.33% of respondents) and non-TCAM users (65.67% of the respondents), respectively. The mean ages of the respondents were 59.3 ± 10.2 for the TCAM users and 57.7 ± 12.0 for the non-TCAM users.

A greater percentage of non-TCAM users reported poor control of diabetes (14.7%) and blood glucose (55.8%) compared with the TCAM users (9.7% and 48.5%, respectively). Further, the diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Additionally, the diabetic patients with TCAM usage had a significantly better physical (p = 0.02) and overall (p = 0.03) qualities of life compared to the non-TCAM users. However, psychological, social and environmental health did not show any significant difference.

The prevalence of TCAM usage among diabetic patients was lower than in other comparable studies. Diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Further, diabetes patients on TCAM reported better QOL compared to non-TCAM users especially in terms of physical health.

Reports on a study that focuses on the specific roles of the nurse within the interdisciplinary team as an example of how nursing contributes to developing clinical effectiveness in wound healing. The multidisciplinary team approach used here builds on recommendations by Edmonds as the most effective method of delivering care to patients with diabetic foot ulceration. In particular, monitors the evolution of the service provided and patient outcomes by measuring the number of ulcers treated, the level of service provided, record keeping and patient outcome. The contribution of the wound care nurse includes the assessment of the status and progress of ulcers presented at the clinic. Argues that, as research in wound care has evolved, so the contribution of the nurse has grown (in line with NHS recommendations) with a broader range of wound features assessed and documented. In evaluating improvements in recording information, three indicators were used. Ulcer size and type were recorded in 1993 on 2.2 per cent and 17.8 per cent of occasions respectively. By 1999 these had progressed to being recorded on 100 per cent of occasions. Assessments of ulcer edge also showed an improvement, being recorded on 11.1 per cent of occasions in 1993 and 50.6 per cent of occasions in 1999. The detail of record keeping allowed the data collection.

This papers aims to study lattice structures in terms of geometric variables, manufacturing variables and material-based variants and their correlation with compressive behaviour for their application in a methodology for the design and development of personalized elastic therapeutic products.

Lattice samples were designed and manufactured using extrusion-based additive manufacturing technologies. Mechanical tests were carried out on lattice samples for elasticity characterization purposes. The relationships between sample stiffness and key geometric and manufacturing variables were subsequently used in the case study on the design of a pressure cushion model for validation purposes. Differentiated areas were established according to patient’s pressure map to subsequently make a correlation between the patient’s pressure needs and lattice samples stiffness.

A substantial and wide variation in lattice compressive behaviour was found depending on the key study variables. The proposed methodology made it possible to efficiently identify and adjust the pressure of the different areas of the product to adapt them to the elastic needs of the patient. In this sense, the characterization lattice samples turned out to provide an effective and flexible response to the pressure requirements.

This study provides a generalized foundation of lattice structural design and adjustable stiffness in application of pressure cushions, which can be equally applied to other designs with similar purposes. The relevance and contribution of this work lie in the proposed methodology for the design of personalized therapeutic products based on the use of individual lattice structures that function as independent customizable cells.

In 2002 the Singapore Ministry of Health (MOH) audited doctors' compliance with diabetes clinical practice guidelines in public healthcare institutions and attempted to postulate factors that influenced the degree of conformity. This study aims to address this issue

A retrospective cross‐sectional chart review of diabetes patient records sampled from hospital specialist outpatient clinics (SOCs) and polyclinics was performed. Childhood, gestational and secondary diabetes cases were excluded. The nine audit parameters used were process measures concerning the assessment of HbA1c, weight, blood pressure, urinary protein, serum creatinine, serum lipids, electrocardiography, retina and feet. Age‐standardised prevalence rate ratios of parameter adherence were calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases, 94 per cent were analysed.

Adherence to ECG and foot assessment parameters was poor among SOC cases, while poor adherence to weight and foot assessment parameters was seen in the polyclinics. There was poorer adherence to blood pressure and ECG parameters in the SOCs, but better adherence was seen for weight assessment. Among the SOC cases, Cluster A fared better than Cluster B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment parameters.

Based on pre‐existing information on local diabetes care, certain system, physician, patient and guideline factors are postulated to explain clinical practice guideline non‐compliance among doctors.