Psychological Interventions in Diabetic Foot Ulcers

Diabetes is a growing public health concern with a growing global incidence during the last three decades due to lifestyle changes. Diabetic foot is one of the most serious and destructive complications of diabetes mellitus (DM) with a significant impact on patients, families, and society. Around ۱۱ – ۱۴ % of worldwide patients diagnosed with diabetes will develop DFUs, which is the leading cause of lower-limb amputations in approximately ۸۰% of these patients. Even in a patient with healed ulceration, there is a tendency to suffer from recurring ulcerations (up to ۵۰% within one year). DFU management requires a multidisciplinary approach. it has been proven that physically restrictive regimes can lead to an increase in psychological stress which in turn contributes to the wound healing impairment. Stress-induced cortisol and adrenaline release has long been known as responsible to impair wound healing. On the other hand, living with diabetes and managing this condition is associated with high levels of anxiety, depression, and distress even more so when complications such as DFU develop. This condition contributes to prolonged infections, delayed wound healing, and poor quality of life (QoL), which is associated with low treatment responses and low remission rates, a major health concern. Diabetes-related distress (DRD) is a term used to characterize the emotional and behavioral changes caused by DM and its demanded lifestyle changes. Furthermore, DFUs negatively affect health-related quality of life (HRQL). Some studies have shown that patients with healed ulcers reported higher HRQL compared with patients with ongoing DFU. Since there is evidence that psychological distress affects negatively wound healing, it is expected that reducing-stress interventions have positive implications on DFU recovery. Psychological stress-reducing interventions, such as relaxation with guided imagery (visualizing positive, peaceful settings like a beautiful beach or a peaceful meadow), biofeedback-assisted relaxation (receiving information about the body, and using this information to change body functions), mindfulness-based strategies (focusing on the present moment), and hypnosis (a changed state of awareness and increased relaxation that allows for improved focus and concentration), can lead to a reduction in perceived stress and improve wound healing by reducing wound inflammation and pain while improving glycemic control. All stress reduction interventions also lead to pain relief and improved patient’s quality of life.

کلیدواژه ها:

Diabetes mellitus ، diabetic wound healing ، diabetic foot ulcer ، psychological stress ، psychological stress-reducing interventions ، hypnosis ، muscle relaxation