Teaching foot care to reduce the "risk of impaired tissue integrity" of people with diabetes mellitus tipo 2: a randomized trial

This is a randomized, controlled, masked clinical trial with a 1:1 allocation ratio, the purpose of which was to evaluate the contribution of "foot care teaching" to reducing the "risk of impaired tissue integrity" of people with DM2, developed with a sample of 152 (GI = 73/GC=79) people registered in a Polyclinic in southern Minas Gerais. Educational interventions were based on the methodology of the Charles Maguerez Arch and carried out in the Polyclinic through three meetings, with an interval of thirty days, for three months. Evaluations were performed before the beginning of interventions (T1), at the end of interventions (T2) and three months after T2 (Tfu), at the participants' homes. Study consisted of sociodemographic, anthropometric, lifestyle, clinical, complementary information, skin integrity and appendages, sensitivity, anatomical deformities, vascular/arterial conditions, feet temperature, knowledge about self-care activities and intention to perform self-care foot activities. To analyze the sample characterization, the chi-square, paired Wilcoxon, Wilcoxon-Mann-Whitney or Fisher's exact tests were used. Regarding the intergroup comparison, the Chi-square or Wilcoxon-Mann-Whitney test was applied and for the intragroup analysis, the McNemar or Wilcoxon test, with a significance level of 5%. There was a higher frequency of females, elderly, marital status with spouse/partner, retirees, who lived with two to three people and had low/medium education and low income. It was evidenced overweight among the participants and in relation to life habits, it was highlighted a higher frequency of people who reported not being a smoker, not consuming alcohol and not practicing physical exercises. For the time of diagnosis, the groups had means of 11.71-10.72 (SD=7.75-5.47) years for GI and CG respectively. More frequently, the type of oral antidiabetic treatment and hypertension morbidity were reported. In the intergroup and intragroup capillary glucose variable, differences were observed (p<0.05). We highlight a higher frequency of participants who did not have their feet evaluated, did not receive guidance for self-care and did not perform self-care with their feet. Indicators of preserved skin integrity showed intergroup and intragroup differences, with a higher frequency of better GI means compared to CG (p<0.05). For variable sensitivity, anatomical deformities and temperature of the feet, no differences were observed (p>0.05), as well as for vascular / arterial condition indicators (p>0.05), except pulses (p<0.05). Regarding the risk classification of diabetic foot, GI presented intragroup difference between T1 and Tfu and T2 and Tfu (p<0.05). Knowledge about foot self-care activities in both groups was considered "low" at T1 and after the educational interventions, the GI presented a difference when compared to the CG at T2 and Tfu and also in the intention to take care of the feet (p<0.05). The educational interventions based on the Magueres Arch methodology were effective in improving the risk of diabetic foot, attributed mainly to indicators related to dermatological conditions, and also to the variables knowledge of self-care activities and intention to take care of the feet