A study to assess the effectiveness of adjuvant therapies in home care management of diabetic foot ulcer to reduce healing time and amputation rate among the diabetic patients residing in rural areas of Nellore, Andhra Pradesh

Need for study: Diabetes mellitus (DM) is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. According to epidemiological studies, the number of patients with DM increased from about 30 million cases in 1985, 177 million in 2000, 285 million in 2010, and estimated if the situation continues, more than 360 million people by 2030 will have DM. The International Diabetes Federation (IDF) have estimated that 451 million adults live with diabetes worldwide in 2017 with a projected increase to 693 million by 2045 if no effective prevention methods are adopted. The prevalence of both type 1 and type 2 diabetes among children and adolescents has also increased, and the estimates of children and adolescents below age 20 with type 1 diabetes now exceed one million. Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals during their lifetime. It is now appreciated that 15 – 20% of patients with such foot ulcers go on to need an amputation. Almost 85% of the amputations are preceded by diabetic foot ulcers. Adjuvant therapies in addition to standard practices in DFU care, there are a wide range of agents available or currently being studied as adjuvant therapies. Hydrogel dressings are a great way to provide hydration to wound. The benefits of using hydrogel-based dressings for wound care are vast by providing excellent source for providing moisture to a dry lesion, hydrogel dressings act fast to help cool down a wound, as well as provide temporary relief from pain for up to six hoursObjectives: To assess the effectiveness of adjuvant therapy in home care management of diabetic foot ulcer and to reduce healing time and amputation rate. To find out the association between healing process of diabetic foot ulcer and selected demographic variables among both experimental and control groups Materials and Methods: A quantitative research approach was adopted. True experimental study was conducted in selected rural areas of Nellore. The sample of 100 diabetic patients having diabetic foot ulcer were selected using simple random method, out of which 50 were in the experimental group and 50 were in control group. The severity of wound was assessed by Bates-Jenson wound assessment scale. On the first day the demographic variables of the samples were collected by interview method then the Pretest was done to assess the state of the wound by using BWAT scale for both experimental and control groups. For the experimental group intervention that is wound dressing was done with adjuvant therapies by using hydrogel to have debride mentation and honey was applied on the wound and dressing was done with gauze pads. It was continued for 30 days with the help of local health workers. For control group regular dressing procedure was followed. For both the groups health education was given regarding diet, exercises medications to control the confounding variables. The post test was done on 15th and 30thday by using BWAT scale in experimental group and control group. Data obtained was analyzed by using descriptive and inferential statistics and the effectiveness was assessed and tabulated. Result: For the experimental group Post hoc multiple comparison of Bonferroni t-test shows the reduction of wound score from pre-test to post-test-I (36.34±5.37 vs 28.10±5.44, respectively mean difference is 8.24), which was statistically significant (p≤.001). After post-test2, intervention further reduces the wound score (36.34±5.37 vs 28.10±5.44, respectively mean difference is 14.58), which was statistically significant reduction from pre-test to post test-II score (p≤.001). Therefore, we can conclude that an adjuvant therapy in home care management reduces the wound score significantly. In the control group Post hoc multiple comparison of Bonferroni t-test shows the reduction of Wound assessment score from pre-test to post-test-I (36.84±4.73 vs 34.08±5.03, respectively mean difference is 2.76), which was statistically significant (p≤.01). After post-test2, routine care reduces the wound score (36.84±4.73vs 32.54±5.81, respectively mean difference is 4.30), which was statistically significant reduction from pre-test to post test-II score (p>.05). Therefore, we can conclude that routine care not reduces the wound score significantly compared to experimental group. Conclusion: So adjuvant therapy can be implemented at community, home set up and sub centers especially in rural areas to treat the patients, because it is cost effective and cost beneficial.in rural areas where health care services are not much available and accessible to treat diabetic foot ulcers