***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer . METHODS We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program . Two sessions were conducted by a nurse diabetes educator 3 months apart . Multiple educational approaches were used to teach patients foot self-examination , foot washing , proper footwear , and encouragement in enlisting proper physician foot care . Knowledge and satisfaction with care was measured before and after each visit . RESULTS The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program . After the second session , the mean improvement over baseline was 14 % . These patients also reported improved satisfaction with foot care ; mean improvement was 33 % . CONCLUSIONS An intensive education program improved the foot care knowledge and behavior of high-risk patients . Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program . Ways to improve accessibility of education sessions must be explored The purpose of this study was to evaluate the effectiveness of the activities of a podiatrist in the outpatient foot care of patients with diabetes . Patients from southwestern Finl and , ages 10 to 80 years , were selected from the national diabetes register . Those without a recent visit to a podiatrist and without any obvious need for foot care ( n=530 ) were r and omized into a podiatric care group ( individual counseling and primary prevention measures , n=267 ) and a control group ( written instructions only , n=263 ) . Knowledge of foot care and self-care habits were evaluated by means of structured interviews , and a podiatric examination  was performed at baseline and 1 and 7 years later . Compared with the baseline scores , the knowledge score was higher at the 7-year follow-up in both the podiatric and control group and similarly in men and women . Self-care score increased in men similarly in both treatment groups . The self-care score for women increased more in the podiatric group during the first year and the difference between the groups remained for up to 7 years . There were no significant differences between the groups in the podiatric findings A 10-session , self-management training program was design ed specifically for persons over 60 years of age having Type II diabetes . It targeted social learning variables , especially problem-solving skills and self-efficacy , found to be related to diabetes self-care in earlier correlational research . One hundred two adults were r and omized to immediate or delayed intervention conditions . At posttest , subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects . The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition . Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up . Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects . We conclude that a relatively short-term program can improve self-management skills of older diabetic adults , and that there is an important need for such interventions OBJECTIVE To evaluate the influence of podiatrist activities on the outpatient care of diabetic patients in terms of knowledge of diabetic foot care , self-care , and minor foot problems . RESEARCH DESIGN AND METHODS There were 733 patients , aged 10–79 years , identified from the national diabetes register . Patients without recent visits to a podiatrist and without an obvious need for foot care were r and omized into a podiatric care group ( education and primary prevention measures , n = 267 ) and a control group ( written instructions only , n = 263 ) . The patients were examined by an independent study podiatrist at baseline and after 1 year . RESULTS Patients in the podiatrist group had greater improvement in knowledge of diabetic foot care ( P = 0.004 ) and self-care ( P < 0.001 ) scores compared with control subjects . The prevalence of callosities in regions other than the calcaneal region decreased more ( P = 0.009 ) in the podiatrist group ( from 54.5 to 39.5 % ) than in the control group ( from 51.3 to 48.2 % ) , and the size of the callosities decreased more ( P < 0.001 ) in the podiatrist group than in the control group . Reduction in the prevalence of callosities was associated with younger age ( < 50 years ) . CONCLUSIONS Education and primary preventive measures provided individually by a podiatrist result in significant improvements in knowledge and foot self-care scores and in improvements in the prevalence of some minor foot problems . Long-term studies are needed to evaluate whether the intervention of podiatrists starting at an early phase would lead to a reduction in major foot problems This prospect i ve r and omized study evaluated the influence of a simple education program on the incidence of lower extremity amputation in diabetic patients . Two hundred three patients were r and omized into two groups : Group 1 , education ( 103 patients , 203 limbs ) and Group 2 ,  no education ( 100 patients , 193 limbs ) . There were no significant differences in medical management or clinical risk factors between the two groups . The amputation rate was three times higher in Group 2 ( 21 of 177 limbs versus 7 of 177 limbs ; p less than or equal to 0.025 ) , the ulceration rate was three times higher in Group 2 ( 26 of 177 limbs versus 8 of 177 limbs ; p less than or equal to 0.005 ) , and there was no difference in the overall incidence of infection ( 2 of 177 limbs ) . Overall success in Group 1 was highly significantly different from Group 2 ( 160 of 177 limbs versus 128 of 177 limbs ; p less than or equal to 0.0005 ) . This study demonstrated that a simple education program significantly reduced the incidence of ulcer or foot and limb amputation in diabetic patients BACKGROUND A cause- and -effect relation between blood glucose concentrations and microvascular complications in patients with insulin-dependent diabetes mellitus has not been established . METHODS We r and omly assigned 102 patients with insulin-dependent diabetes mellitus , nonproliferative retinopathy , normal serum creatinine concentrations , and unsatisfactory blood glucose control to intensified insulin treatment ( 48 patients ) or st and ard insulin treatment ( 54 patients ) . We then evaluated them for microvascular complications after 18 months and 3 , 5 , and 7.5 years . RESULTS Mean ( + /- SD ) glycosylated hemoglobin values were reduced from 9.5 + /- 1.3 percent to 7.1 + /- 0.7 percent in the group receiving intensified treatment and from 9.4 + /- 1.4 percent to 8.5 + /- 0.7 percent in the group receiving st and ard treatment ( P = 0.001 ) . In 12 of the patients receiving intensified treatment ( 27 percent of those included in the analysis ) and 27 of those receiving st and ard treatment ( 52 percent ) , serious retinopathy requiring photocoagulation developed ( P = 0.01 ) . Visual acuity decreased in 6 patients receiving intensified treatment ( 14 percent ) and in 18 receiving st and ard treatment ( 35 percent ) ( P = 0.02 ) . Nephropathy ( urinary albumin excretion , > 200 micrograms per minute ) developed in one patient in the group receiving intensified treatment , as compared with nine patients in the group receiving st and ard treatment ( P = 0.01 ) . No patient in the intensified-treatment group had nephropathy with subnormal glomerular filtration rates , as compared with six patients in the st and ard-treatment group ( P = 0.02 ) . The conduction velocities of the ulnar , tibial , peroneal , and sural nerves decreased significantly more in the st and ard-treatment group than in the intensified-treatment group . The odds ratio for serious retinopathy was 0.4 ( 95 percent confidence interval , 0.2 to 1.0 ; P = 0.04 ) in the intensified-treatment group as compared with the st and ard-treatment group . The corresponding odds ratio for nephropathy was 0.1 ( 95 percent confidence interval , 0 to 0.8 ; P = 0.04 ) . CONCLUSIONS Long-term intensified insulin treatment , as compared with st and ard treatment , retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus OBJECTIVE To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers  within 1 year . RESEARCH DESIGN AND METHODS Ninety-one diabetic out patients with healed foot ulcers ( age 65 + /- 11 years , 40 women and 51 men , diabetes type 1 ( n = 6 ) or 2 ( n = 85 ) , BMI 28.5 + /- 4.4 , diabetes duration 16 + /- 11 years , HbA(1c ) 8.4 + /- 1.6 % ) were r and omized to a group that received monthly remunerated routine chiropodist care ( n = 47 ) or a control group ( n = 44 ) . RESULTS Within a median follow-up of 386 days , ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group ( hazard ratio [ HR ] 0.60 ; 95 % CI , 0.32 , 1.08 ; P = 0.09 ) . Analysis of ulceration per foot demonstrated a significant reduction ( 20 vs. 32 ulcerations ; Cox relative risk [ Cox RR ] 0.52 ; 95 % CI , 0.30 , 0.93 ; P = 0.03 ) in favor of chiropodist care . Per protocol , analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients ( HR , 0.53 ; 95 % CI , 0.30 - 1.01 ; P = 0.05 ) and in 15 vs. 37 feet ( Cox RR , 0.46 ; 95 % CI , 0.24 - 0.90 ; P = 0.02 ) for the intervention and control groups , respectively . Minor amputation was required in two patients in the intervention group and one patient in the control group . Four patients in the control group and two patients in the intervention group died during the trial . CONCLUSIONS These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients OBJECTIVES Every year about 38,000 elderly people with diabetes have a  lower extremity amputation .  Therapeutic shoes are prescribed by clinicians specializing in foot care to prevent foot ulcerations and amputations among at-risk patients with diabetes . Medicare ran a 3-year demonstration of a therapeutic-shoe benefit for beneficiaries with diabetes . Medicare added the benefit nationwide in May 1993 . METHODS This paper describes the benefit and its implementation in the demonstration based on demonstration records , a patient survey , and discussion s with clinicians and shoe suppliers before and during the demonstration . RESULTS During the demonstration , far fewer beneficiaries applied for the therapeutic shoes than were eligible for them . The paper discusses reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes . CONCLUSIONS The benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are educated in the role therapeutic shoes can play in diabetic foot disease , they prescribe the shoes for their patients , and they increase their patients ' awareness of the shoes ' value Despite the established role of foot care education in diabetes management , reports evaluating such interventions are rare . The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes . The intensive group showed significantly greater improvements than the conventional group in foot care knowledge ( p less than 0.001 ) , compliance with the recommended foot care routine ( p = 0.012 ) , and compliance with the initial advice to consult  a podiatrist ( other than the project podiatrist ) for further treatment ( p = 0.008 ) . At the first follow-up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group OBJECTIVE To evaluate the recurrence of foot ulcers as well as the cumulative amputation and mortality rates in diabetic patients with previous foot ulcers . DESIGN A prospect i ve study of consecutively presenting diabetic patients admitted to the Department of Internal Medicine because of foot ulcer with a median follow-up of 4 years . SETTING A multidisciplinary foot-care team . POPULATION Five-hundred- and -fifty-eight consecutive diabetic patients with foot ulcers treated between 1 July 1983 and 31 December 1990 were followed to final outcome . Out of these patients , 468 healed either primarily ( n = 345 ) or after minor or major amputations ( n = 123 ) and 90 died before healing had occurred . Those 468 patients who healed were included in this prospect i ve study from the time of healing . MAIN OUTCOME MEASURES Patients were followed according to a st and ardized protocol with registration of foot lesions , amputation , morbidity and mortality . Clinical examination was performed twice yearly . RESULTS After  
    Output:
    
Existing data suggests that patient education may reduce foot ulceration and amputations , especially in high-risk patients .
Foot care knowledge and behaviour of patients seem positively influenced by patient education in the short term .