Impact of a three-subject, dual-track, interactive care model on hospitalized patients with diabetic foot

Diabetic foot (DF) is a severe chronic complication of diabetes, associated with high amputation risk and mortality. Conventional nursing often neglects patients' psychological needs and long-term self-management, limiting comprehensive rehabilitation. Interactive nursing has shown promise in chronic disease care, yet systematic evaluations of its multidimensional effects remain scarce. This study assessed a three-subject, dual-track, interactive care (TSDTIC) model on wound healing, psychological state, and quality of life in DF patients.

This retrospective cohort study included 150 hospitalized DF patients (June 2021 - June 2024). Patients were assigned to groups based on the nursing care model implemented during their admission period: the RC group (n=84) comprised patients admitted between June 2021 and December 2022, and the TSDTIC group (n=66) comprised patients admitted between January 2023 and June 2024. The TSDTIC model was introduced as a structured quality improvement program in January 2023; therefore, group assignment was sequential rather than randomized. Baseline demographic and clinical characteristics were comparable between groups (all P > 0.05), and ANCOVA with baseline values as covariates was performed for continuous outcomes. Outcomes included wound improvement rate (based on area reduction), fasting and postprandial glucose, Hamilton Anxiety/Depression Scale (HAMA/HAMD) scores, SF-36 quality-of-life scores, and nursing satisfaction.

The TSDTIC group showed significantly higher wound improvement rate (95.45% vs. 82.14%, P = 0.013). Post-intervention, fasting (6.29 ± 1.05 vs. 7.94 ± 1.82 mmol/L, P<0.001) and postprandial glucose (8.92 ± 1.29 vs. 10.35 ± 1.41 mmol/L, P<0.001) were markedly lower in TSDTIC. HAMA (7.21 ± 2.13 vs. 10.02 ± 2.06) and HAMD (6.88 ± 2.06 vs. 10.26 ± 2.14) scores significantly improved (both P<0.001). All eight SF-36 dimensions were higher in TSDTIC (all P<0.001 after Bonferroni correction). Satisfaction rate was higher in TSDTIC (95.45% vs. 73.81%, P<0.001).

The TSDTIC model was associated with improvements in short-term wound healing, glycemic control, mental health, and quality of life in DF patients. However, given the historical control design and lack of long-term outcomes, findings should be interpreted cautiously; prospective randomized trials are warranted.