Nonadherence Predicted by Postural Instability in Type 2 Diabetes

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Off-loading adherence is associated with healing for patients with diabetic foot ulcers.
Off-loading adherence is associated with healing for patients with diabetic foot ulcers.

(HealthDay News) – For patients with diabetic foot ulcers (DFUs), off-loading adherence is associated with healing, but postural instability is a powerful predictor of nonadherence, according to a study published in Diabetes.

Ryan T. Crews, from the Rosalind Franklin University in Chicago, and colleagues conducted a prospective, multicenter study involving 79 patients (46 from the United Kingdom and 33 from the United States) with type 2 diabetes and plantar DFUs. DFUs were offloaded with a removable device, and the correlation between off-loading adherence and healing was assessed over a 6-week period.


In multivariate analyses, the researchers found that smaller baseline DFU size, U.K. study site, and better off-loading adherence were predictors of smaller DFU size at 6 weeks (P<.05). Larger and more severe baseline DFUs and more severe neuropathy and Neuropathy and Foot Ulcer Quality of Life (NeuroQoL) foot pain predicted better off-loading adherence (P<.05). Worse off-loading adherence was predicted by greater NeuroQoL postural instability (P<.001). There was no correlation for the Hospital Anxiety and Depression Scale and Revised Illness Perception Questionnaire with off-loading adherence.

"Clinicians should take this neuropathic symptom into consideration when selecting an off-loading device, as off-loading-induced postural instability may further contribute to nonadherence," the authors write.

One author disclosed financial ties to Össur Americas, which is a manufacturer of off-loading devices.


  1. Crews RT, Shen BJ, Campbell L, et al. Role and determinants of adherence to off-loading in diabetic foot ulcer healing: A prospective investigation. Diabetes Care. 2016; doi:10.2337/dc15-2373.
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