Health education in the prevention of diabetic foot: A critical review of the evidence from primary care
Keywords:
Health education; diabetic foot; diabetes mellitus; self-care; primary healthcare.Abstract
Diabetic foot represents one of the chronic complications of greatest clinical and functional impact due to its high morbidity, risk of amputation, and negative effects on patients’ quality of life. Current scientific evidence indicates that a significant proportion of these complications can be prevented through educational strategies aimed at strengthening self-care, promoting healthy behaviors, and enabling the early identification of risk factors within primary healthcare settings. This article aims to critically analyze the scientific evidence regarding the contribution of health education to the prevention of diabetic foot in primary care. During the research process, a critical review of the scientific literature was conducted through the consultation of indexed publications in international databases related to diabetes mellitus, diabetic foot, health education, self-care, and primary healthcare. Studies published mainly between 2020 and 2026 were analyzed, prioritizing systematic reviews, clinical trials, and clinical practice guidelines. The reviewed evidence shows that structured educational programs significantly improve patients’ knowledge regarding foot care, increase self-care behaviors, promote therapeutic adherence, and reduce the incidence of ulcerative lesions and preventable amputations. Therefore, it can be stated that the systematic integration of health education into care programs for people with diabetes may contribute to reducing complications, improving quality of life, and strengthening the sustainability of healthcare systems.References
American Diabetes Association. (2025). Standards of care in diabetes—2025. Diabetes Care, 48 (Suppl. 1). https://diabetesjournals.org/care
Armstrong, D. G., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 389(4), 345–356. https://www.nejm.org/doi/abs/10.1056/NEJMra1615439
Bus, S. A., Schaper, N. C., van Netten, J. J., Armstrong, D. G., Bakker, K., Hinchliffe, R. J., & International Working Group on the Diabetic Foot. (2023). IWGDF guidelines on the prevention and management of diabetic foot disease. International Working Group on the Diabetic Foot.
Dorresteijn, J. A. N., Kriegsman, D. M. W., Assendelft, W. J. J., & Valk, G. D. (2022). Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews.
International Diabetes Federation. (2022). IDF clinical practice recommendations for managing type 2 diabetes in primary care. International Diabetes Federation.
International Diabetes Federation. (2025). IDF Diabetes Atlas (11th ed.). International Diabetes Federation.
International Working Group on the Diabetic Foot. (2023). IWGDF Guidelines on the prevention and management of diabetic foot disease. IWGDF.
Moreira, M. A. (2021). Aprendizaje significativo: teoría y práctica. Editorial Universitaria.
Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42, 159–173.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372(71).
Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., Sosenko, J. M., & Ziegler, D. (2022). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess Fischl, A., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2024). Diabetes self-management education and support (DSMES). Updated consensus report.
Schaper, N. C., van Netten, J. J., Apelqvist, J., Bus, S. A., Hinchliffe, R. J., & Lipsky, B. A. (2023). Practical guidelines on the prevention and management of diabetic foot disease. Diabetes/Metabolism Research and Reviews.
Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., Bernardi, L., & Valensi, P. (2024). Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity and treatments. Diabetes Care.
World Health Organization. (2022). Health literacy development for the prevention and control of noncommunicable diseases. World Health Organization.
World Health Organization. (2023). Package of essential noncommunicable disease interventions (PEN) for primary health care. World Health Organization.
World Health Organization. (2024). Primary health care: Transforming vision into action. World Health Organization.
Published
Issue
Section
License
Copyright (c) 2026 Rachel de Jesús Marín Aragón, Lilian María Rodríguez Llorente, Ernesto Antonio Pérez Hernández, María Lucía Santos Yudi
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
CC Reconocimiento-NoComercial-SinObrasDerivadas 4.0
.jpg)
![](https://clustrmaps.com/site/1bhn8" title="Visit tracker"><img src="//www.clustrmaps.com/map_v2.png?d=2WTJsN7QOuRFRD2DOJOZtvZ6v94bxB6RU96I-iXx-_s&cl=ffffff"></a>)
