The scale of the problem is enormous. Recent global estimates indicate that 537 million adults were living with diabetes in 2021, a figure projected to climb to 783 million by 2045, with the steepest increases expected in low- and middle-income countries where healthcare infrastructure is often already stretched thin. Among the chronic complications of the disease, diabetic foot stands out as particularly devastating. Between 19 and 34 percent of people with diabetes will develop a foot ulcer during their lifetime, and the majority of lower limb amputations not caused by injuries are preceded by just such an ulcer. The International Working Group on the Diabetic Foot defines the condition broadly, encompassing infection, ulceration, or tissue damage in the feet of people with diabetes, typically accompanied by loss of protective sensation, foot deformities, or impaired blood flow—deficits that dramatically raise the risk of ulceration and slow healing once wounds appear.

What makes these figures so frustrating for clinicians is that diabetic foot complications are largely preventable. International guidelines consistently emphasize systematic foot examination, early identification of at-risk patients, appropriate footwear, prompt treatment of minor injuries, and structured patient education as the cornerstones of prevention. Yet translating that guidance into practice depends heavily on frontline healthcare workers—above all, nurses. In hospitals, outpatient diabetes clinics, primary care centers, and home care services, nurses are often the professionals with the most frequent and sustained contact with patients. They perform routine foot assessments, detect early signs of neuropathy and peripheral artery disease, counsel patients on self-care, and coordinate referrals to specialist services. Studies from multiple countries, however, have documented substantial gaps in nurses’ knowledge and clinical practice related to foot assessment, alongside limited access to structured training.

To determine whether educational programs can close those gaps, researchers conducted a systematic review of quasi-experimental studies published between 2015 and 2024, prospectively registered in PROSPERO and reported according to the PRISMA 2020 guidelines. The team searched Web of Science, the Cochrane Library, CINAHL via EBSCOhost, MEDLINE, and Scopus, screening 93 initial records down to nine studies that met their inclusion criteria. Each candidate study was appraised independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental research, with studies scoring five or fewer points out of nine excluded. Sample sizes across the nine included trials ranged from 30 to 110 participants, and the settings spanned five continents—from university hospitals in Egypt and Iran to community health programs in Nigeria, Brazil, Pakistan, Japan, and Saudi Arabia.

The results were strikingly consistent. Every single one of the nine studies reported statistically significant improvements in nurses’ knowledge or clinical practice following structured education, regardless of country, setting, or teaching format. The magnitude of change was often dramatic. In one Egyptian study, nurses’ practical performance of neurovascular assessment—incorporating the standardized 10-gram monofilament test, tuning forks, and reflex hammers—improved from predominantly poor at baseline to good immediately after training, with total practical scores of 93.33 percent that remained at 90 percent one month later. In Brazil, a 20-hour theoretical and practical course for primary care nurses raised mean knowledge scores from 23.8 to 41.9, with the largest gains in neurological assessment techniques that had been weakest at the outset. A 16-week program in Pakistan lifted participating nurses from uniformly weak baseline knowledge to a position where more than half achieved good knowledge ratings, while an Egyptian geriatric-care study found that the proportion of nurses demonstrating good foot care practice surged from 14 percent before training to 100 percent one month afterward.

The review also offers practical clues about how best to teach these skills. The only head-to-head comparison of delivery formats, conducted among 80 nurses in Iran, pitted a five-module e-learning course against a face-to-face interactive workshop covering identical content. Both approaches improved knowledge significantly, but post-test scores were markedly higher in the workshop group, suggesting that active, participatory, hands-on formats hold an edge for acquiring technical assessment skills. At the same time, the authors note that e-learning remains more time- and cost-efficient and more flexible, raising the possibility that blended models combining online preparation with in-person practice could deliver both accessibility and effectiveness. A Japanese study further demonstrated that a multi-component package—PowerPoint materials, videos, booklets, picture cards, and on-site coaching delivered over three to five sessions across two months—could successfully improve foot care knowledge and practice among nurses and care workers in home care settings, extending the evidence beyond hospitals.

Yet the researchers are careful to temper enthusiasm with methodological caution. Applying the GRADE framework, they rated the overall certainty of evidence as very low for both knowledge and practice outcomes. All nine studies used quasi-experimental designs without randomization, most lacked concurrent control groups, and serious concerns about inconsistency and imprecision arose from heterogeneous interventions, varied measurement instruments, small samples, and short follow-up periods. Improvements measured immediately or one month after training cannot be assumed to persist, and none of the studies tracked whether better-trained nurses actually reduced ulcer incidence, amputation rates, or hospital admissions among their patients—arguably the outcomes that matter most.

The review also uncovers structural barriers that training alone cannot overcome. Even after completing education, nurses in many settings lacked access to basic diagnostic equipment such as monofilaments, tuning forks, and reflex hammers, forcing them to improvise with inappropriate tools or skip parts of the examination altogether. The authors argue that educational programs must therefore be paired with organizational support: adequate supplies, clinical protocols aligned with international guidelines, formal authorization for nurses to conduct regular foot examinations, and protected time for both training and systematic screening. They further recommend tailoring content to nurses’ prior experience, progressing from basic pathophysiology for novices to complex case management in specialized clinics, and extending training to community nurses, geriatric specialists, and home care workers as diabetes care increasingly shifts out of hospitals.

For researchers, the roadmap is clear. The authors call for randomized and cluster-randomized controlled trials comparing e-learning, workshops, blended learning, and mentoring models; longitudinal studies assessing skill retention at six to twelve months and beyond; standardized measurement instruments to enable meaningful comparisons across settings; and, critically, research linking nurse training to patient-level outcomes such as ulcer recurrence and amputation. Until such evidence accumulates, the review concludes that integrating competency-based diabetic foot care training into nursing professional development is a reasonable interim strategy—one supported by consistently positive, if methodologically limited, findings across five continents.

Subject of Research: Effectiveness of educational programs in improving nurses' knowledge and practice related to diabetic foot care

Article Title: Effectiveness of Educational Programmes on Knowledge and Practice Related to Diabetic Foot Care Among Nurses: A Systematic Review

Article References: Al‐Me'ani, M., Alqaisi, O., Dibas, M., Al‐Aaraj, H., & Rubbai, Y. (2026). Effectiveness of Educational Programmes on Knowledge and Practice Related to Diabetic Foot Care Among Nurses: A Systematic Review. Endocrinology, Diabetes & Metabolism, 9(5), Article e70324. https://doi.org/10.1002/edm2.70324

Image Credits: AI Generated

DOI: 10.1002/edm2.70324

Keywords: diabetic foot care, nursing education, systematic review, diabetes complications, foot ulcer prevention, quasi-experimental studies, GRADE assessment, monofilament testing, nurse training, health policy, patient safety, continuing professional development

This groundbreaking study, conducted by a team of researchers led by Gong et al., brings an unprecedented level of scrutiny to the available nursing interventions for diabetic foot ulcers. The research systematically evaluates and synthesizes data from multiple studies to develop a robust understanding of what methods work best in promoting ulcer healing and ensuring patient safety. The importance of such research lies not only in improving clinical outcomes but also in enhancing the quality of life for patients burdened with these chronic wounds.

The methodology employed in this systematic review is noteworthy for its rigor and comprehensiveness. The researchers meticulously gathered data from numerous databases, ensuring a wide-ranging collection of relevant studies. This holistic approach allows for a thorough comparison of different nursing interventions, encompassing both established practices and innovative techniques that may be on the cutting edge of wound care. By using a network meta-analysis, the study provides a comparative efficacy assessment of interventions that may not have been directly tested against each other in prior research.

Among the non-pharmacological interventions that were scrutinized in the study, several stand out due to their promising results. Techniques such as patient education, meticulous foot care routines, and the application of advanced dressing materials exemplify the proactive approaches that nursing staff can employ. These interventions not only address the immediate needs of ulcer care but also empower patients with the knowledge and skills necessary to manage their condition effectively. The significance of these findings resonates with nursing practitioners, as it highlights the essential role they play in patient-centered care.

One of the key insights gleaned from the analysis is the variation in efficacy among different nursing intervention strategies. While some approaches yielded more significant healing rates, others demonstrated improved safety profiles, suggesting that the choice of intervention may depend on individual patient circumstances. This nuanced understanding underscores the importance of personalized care plans tailored to the unique needs of each person with diabetes. Consequently, the findings are poised to inform clinical practice guidelines and enhance the decision-making process for healthcare providers.

Safety is equally paramount in the context of diabetic foot ulcer care, and the systematic review addresses this pivotal aspect comprehensively. By analyzing the safety outcomes associated with various interventions, the authors provide invaluable insights that can guide nurses and healthcare teams toward safer practices. This focus on safety is critical, particularly in populations with chronic conditions such as diabetes, where complications can arise swiftly if care is not managed appropriately.

As healthcare systems around the world are increasingly embracing evidence-based practices, the implications of this study extend beyond academic circles. The findings are likely to influence policy changes and resource allocation, as healthcare leaders recognize the necessity of investing in effective, evidence-based nursing interventions. The potential for improved patient outcomes can lead to significant reductions in healthcare costs associated with the treatment of diabetic foot ulcers.

Furthermore, the study’s emphasis on non-pharmacological strategies encourages a multidisciplinary approach to care. Collaboration among nursing, dietary, podiatric, and medical professionals is essential to comprehensively address the multifactorial nature of diabetic foot ulcers. By fostering cooperation among various disciplines, healthcare providers can create a holistic care environment that supports patients at every step of their healing journey.

The world of nursing is continuously evolving, and research such as that conducted by Gong et al. is vital for propelling the field forward. The meticulous analysis of non-pharmacological interventions not only enhances existing knowledge but also prompts further inquiry into new and emerging techniques. As future research builds upon these findings, nursing professionals will be better equipped to confront the challenges posed by diabetic foot ulcers.

In addition to clinical implications, the societal impact of this research cannot be overstated. The burden of diabetic foot ulcers is felt not merely by those suffering from them but also by families, communities, and healthcare systems. By promoting interventions that effectively reduce ulcer incidence and enhance healing, this research contributes to a broader narrative of improving public health and patient welfare.

While the study highlights the efficacy of specific nursing interventions, it also calls attention to gaps in the literature that future studies must address. For instance, further investigation into the longitudinal impacts of these interventions could yield insights into the long-term health trajectories of patients. Additionally, exploring the psychological dimensions of living with diabetic foot ulcers and how nursing interventions can address these needs remains an important avenue for future research.

Ultimately, Gong et al.’s study provides a critical stepping stone toward advancing nursing practices related to diabetic foot ulcers. By meticulously evaluating the efficacy and safety of non-pharmacological interventions, the research opens the door for innovative care strategies that can transform patient experiences. As healthcare continues to evolve, the integration of such evidence-based approaches will be vital in ensuring that individuals with diabetes receive the highest standard of care and support.

The future of diabetic foot ulcer management looks promising, thanks in part to the diligent efforts of researchers and nursing professionals committed to enhancing patient outcomes. By harnessing the power of systematic reviews and meta-analyses, the healthcare community is better prepared to meet the challenges posed by this common yet debilitating condition.

While ongoing research will undoubtedly continue to unearth new methodologies and discoveries, the principles established in the current study hold the potential for profound impacts in the realm of nursing care for diabetic foot ulcers. Embracing these evidence-based practices can pave the way for improved healing, better patient safety, and, above all, a brighter future for individuals grappling with diabetes-related complications.

Subject of Research: Non-pharmacological nursing interventions for diabetic foot ulcers.

Article Title: Comparative efficacy and safety of non-pharmacological nursing interventions for diabetic foot ulcers: a systematic review and network meta-analysis.

Article References:

Gong, J., Sun, X., Fu, H. et al. Comparative efficacy and safety of non-pharmacological nursing interventions for diabetic foot ulcers: a systematic review and network meta-analysis.
BMC Nurs 24, 1445 (2025). https://doi.org/10.1186/s12912-025-04065-x

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12912-025-04065-x

Keywords: Diabetic foot ulcers, non-pharmacological interventions, nursing care, systematic review, network meta-analysis, patient safety, wound healing.