Can a Health Literacy Intervention Reduce the Risk of Diabetic Foot Wound Complications?
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A poster presented at the Symposium on Advanced Wound Care (SAWC) Spring evaluated a multimedia educational resource platform, Health Literacy + Innovation for Positive Patient Outcomes (HIPPO), for its effect in reducing the risk of complications of diabetic foot ulcers.1
The study evaluated 27 patients in the HIPPO group, who watched 7 multilingual instructional videos lasting 5–7 minutes, and graphic illustrations during 3 separate clinical visits and had access to the same material at home.1 The control group, consisting of 31 patients, received only standard of care. The poster notes researchers assessed patients for at least 12 months post-initial clinic visit for amputation, surgical debridement, and recommendation for either procedure.
Researchers note the 3-month wound healing rates were 68% in the HIPPO group and 67% in the control group.1 The HIPPO intervention did not significantly reduce risk of lower extremity amputation, compared to standard education alone (7/27 vs. 6/31, respectively. Surgical debridement was performed in 3 participants in the HIPPO group and 2 control participants. Two participants in the control group declined amputation despite recommendation by surgeons. Wound, Ischemia, and Foot Infection score, highest education level received, internet access, and insurance type also did not significantly impact risk for amputation.
The poster concludes that HIPPO did not reduce the risk of lower extremity amputation in patients with DFUs.1 The author notes the result can be explained by a low sample size or an insufficient number of video views in the HIPPO group, advocating the study of more interventions within a larger sample of participants.
While wound debridement and pharmacotherapy play important roles in addressing diabetic foot ulcers (DFUs), poster author Shreya Jain, BA and MD candidate, says patient education can also help prevent complications from DFUs.2 As she notes, one key component in reducing risk is educating patients on offloading, which reduces mechanical stress on the foot, allowing for better healing.2 For example, Jain says one video participant in the HIPPO group explained the importance of reducing pressure on their wounds via offloading devices such as the offloading shoe, crutches, and knee scooters/wheelchairs.
Additionally, as evidence-based guidelines recommend tight glycemic control in preventing amputation, Jain stresses that educating patients on controlling their blood sugars is key.3 She notes one can do so by advising patients to follow recommendations made by their PCPs and highlighting what blood sugar ranges to look for, as happens through the HIPPO intervention.
References
1. Jain S. Evaluating the impact of a health literacy intervention on diabetic foot wound complications. Presented at Symposium on Advanced Wound Care (SAWC) Spring, April 30–May 3, 2025, Grapevine, TX.
2. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic foot ulcers: a review. JAMA. 2023;330(1):62-75. doi:10.1001/jama.2023.10578
3. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2 Suppl):3S-21S. doi:10.1016/j.jvs.2015.10.003
