Relationship Between Social Isolation and Health Behaviors and Ulcer Severity in Diabetic Foot Patients

LU Qiu-ping, LIN Yu-min, GAO Fang, ZOU Meng-chen, FAN Xin-zhao, QU Li-yuan, XUE Yao-ming, CAO Ying

Abstract

To explore the relationship between social isolation and health behaviors and ulcer severity in patients with diabetic foot.   Methods  A cross-sectional study was conducted with 160 patients suffering from type 2 diabetes mellitus combined with diabetic foot. The patients received treatment at the Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University between September 2020 and December 2021. Patient information was collected, including the scores for Lubben Social Network Scale and the Wagner classification of foot ulcers. Analysis was conducted to study the characteristics of the patients’ health behaviors, including whether they received information and education on diabetic foot, whether there were delays in their attempt to access medical service, the frequency of foot examinations, etc. In addition, patient demographic data were collected, including sex, age, education, and employment status. According to their scores for Lubben Social Network Scale, the patients were divided into a social isolation group (n=60) and a non-social-isolation group (n=100). The severity of the foot ulcers and the health behaviors of the two groups were compared to identify differences.   Results  The findings suggest that, compared with the non-social-isolation group, the social isolation group had a higher proportion of diabetic foot patients with Wagner grade 3-5 diabetic foot ulcers (P<0.05). Analysis of the health behaviors showed that the social isolation group had a higher proportion of diabetes foot patients who had never undergone examination of their feet and those who had delayed attempts to access medical service for their condition (P<0.05). There were no significant differences between the two groups in terms of whether the patients had received information and education concerning diabetic foot, causes of foot injury, self-treatment of wounds, smoking, and drinking. Correlational analysis suggested that the scores of Lubben Social Network Scale were negatively correlated with the delayed attempts to access medical service (r=−0.353, P=0.001), that is, the higher the degree of social isolation, the longer the delay in patients’ attempt to access medical service for their diabetic foot.   Conclusions  Social isolation is correlated to health behaviors and ulcer severity in patients with diabetic foot. Giving more attention to the problem of social isolation of diabetic foot patients and increasing their ties with the social environment and the members of their social network may have a positive effect on improving the delays in diabetic foot patients’ attempt to access medical service, which is particularly important for follow-up treatment.

 

Keywords: Diabetic foot, Social isolation, Health behaviors

 

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References


ZILIOLI S， JIANG Y. Endocrine and immunomodulatory effects of social isolation and loneliness across adulthood. Psychoneuroendocrinology， 2021， 128: 105194. https://doi.org/10.1016/j.psyneuen.2021.105194.

FUJIWARA Y， NISHI M， FUKAYA T， et al. Synergistic or independent impacts of low frequency of going outside the home and social isolation on functional decline: A 4-year prospective study of urban Japanese older adults. Geriatr Gerontol Int，2017，17(3): 500–508.

SAITO M， KONDO N， KONDO K， et al. Gender differences on the impacts of social exclusion on mortality among older Japanese: AGES cohort study. Soc Sci Med，2012，75(5): 940–945.

HOLT-LUNSTAD J， SMITH T B， LAYTON J B， et al. Social relationships and mortality risk: a meta-analytic review. PLoS Med， 2010， 7(7): e1000316. https://doi.org/10.1371/journal.pmed.1000316.

PYTER L M， YANG L， DA ROCHA J M， et al. The effects of social isolation on wound healing mechanisms in female mice. Physiol Behav， 2014，127: 64–70.

SHIOVITZ-EZRA S， LITWIN H. Social network type and health-related behaviors: evidence from an American national survey. Soc Sci Med， 2012，75(5): 901–904.

BRINKHUES S， DUKERS-MUIJRERS N H T M ， HOEBE C J P A ， et al. Social network characteristics are associated with type 2 diabetes complications: the maastricht study. Diabetes Care，2018，41(8): 1654–1662.

SAKURAI R， KAWAI H， SUZUKI H， et al. Poor social network, not living alone, is associated with incidence of adverse health outcomes in older adults. J Am Med Dir Assoc，2019，20(11): 1438–1443.

LUBBEN G. Lubben Social Network Scale (LSNS). London: Psycholocy Press， 2020.

BUS S A， VAN NETTEN J J， LAVERY L A， et al. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev，2016，32 Suppl 1: 16–24.

LUBBEN J， BLOZIK E， GILLMANN G， et al. Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist， 2006，46(4): 503–513.

THOMAS S， SRINIVASAN K， HEYLEN E， et al. Correlates of social support in individuals with a diagnosis of common mental disorders and non communicable medical diseases in rural South India. Soc Psychiatry Psychiatr Epidemiol，2021，56(9): 1623–1631.

KOETSENRUIJTER J， VAN EIKELENBOOM N， VAN LIESHOUT J， et al. Social support and self-management capabilities in diabetes patients: An international observational study. Patient Educ Couns，2016，99(4): 638–643.

STOPFORD R， WINKLEY K， ISMAIL K. Social support and glycemic control in type 2 diabetes: A systematic review of observational studies. Patient Educ Couns，2013，93(3): 549–558.

SCHLENK E A， HART L K. Relationship between health locus of control, health value, and social support and compliance of persons with diabetes mellitus. Diabetes Care，1984，7(6): 566–574.

LAOPOULOU F， KELESI M， FASOI G， et al. Perceived Social Support in Individuals With Diabetic Foot Ulcers. J Wound Ostomy Continence Nurs，2020，47(1): 65–71.

SANDERS A P， STOELDRAAIJERS L G M C， PERO M W M， et al. Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers. Diabetes Res Clin Pract，2013，102(2): 105–111.

PROMPERS L， SCHAPER N， APELQVIST J， et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia，2008，51(5): 747–755.


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