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糖尿病患者的足部溃疡可以继发感染,导致截肢,其医疗费用昂贵,因而预防糖尿病足成为美国糖尿病协会(ADA)的重要目标。为了评价各种干预对糖尿病足的预防作用,我们回顾了所有预防糖尿病足部溃疡的随机临床试验(RCT),并通过现有的评价体系对各项试验的有效性及科学性进行评价。仅检索到13项RCT。所有RCT都纳入二级预防,或者混合纳入一级以及二级预防。大部分试验的样本量较小,科学性差,且阴性结果试验的科学性多优于阳性结果的试验。在所有预防糖尿病足的干预方法中,只有足部温度指导下的回避治疗(avoidance therapy)在RCT中获得有益证据,尽管此法还需要在不同人群中进一步验证。目前所有的观察仅在高危人群中进行,上述干预对普通糖尿病人群的益处不详。
Foot ulcers in people with diabetes can be secondary to infection, leading to amputation, which can be costly to treat and thus preventing diabetic foot becoming an important goal of the American Diabetes Association (ADA). To evaluate the preventive effect of various interventions on diabetic foot, we reviewed all randomized clinical trials (RCTs) to prevent diabetic foot ulcers and evaluated the effectiveness and scientificness of each trial through the existing evaluation system. Only 13 RCTs were retrieved. All RCTs include secondary prevention, or a combination of primary and secondary prevention. Most trials have small samples, poor science, and negative results are scientifically better than positive ones. Of all interventions to prevent diabetic foot, only avoidance therapy guided by foot temperature has yielded beneficial evidence in RCT, although this method still needs to be further validated in different populations. All current observations are made only in high-risk groups, and the benefits of these interventions for the general population are unknown.