Long-Term Effect of a Structured Educational Program on Diabetic Foot on Major Adverse Limb and Cardiovascular Events...

Background/Objectives: To evaluate the long-term impact of a structured diabetic foot education program on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in individuals with type 1 diabetes. Methods: Retrospective cohort study including 327 adults with type 1 diabetes who participated in a structured diabetic foot education program between 1990 and 2014. The program included 10 h of education focused on diabetes self-management and foot care. Participants were encouraged to attend annual refresher sessions. The primary outcomes were the first occurrence of MALE (major amputation or lower-limb revascularization) and MACE (non-fatal stroke, non-fatal myocardial infarction, or all-cause death). Cox proportional hazards models were used to assess associations between the number of educational programs (EPs) attended (1, 2-3, >3) and outcomes. Results: Participants attended a median of two EPs during a median follow-up of 26.3 years. Of the total number of events, 21 were MALEs (crude incidence of 1.9 per 1000 person-years) and 108 were MACEs (incidence of 12.9 per 1000 person-years). Risk of MALE was not associated with the number of EPs attended (p = 0.384). In contrast, participants who attended >3 EPs had a significantly lower risk of MACE compared with those attending only one program (HR 0.48, 95% CI 0.24-0.99, p = 0.044), although this association was attenuated after adjusting for smoking status. Conclusions: Frequent participation in a structured diabetic foot education program was associated with fewer cardiovascular events, but this benefit was diminished by smoking. Integrating tobacco cessation into education programs may enhance their long-term impact.