Abstract
Background
Diabetic foot ulcers (DFUs) are a major cause of morbidity and amputation. Professional wound care is standard, but patient self-dressing could be an alternative in resource-limited settings. Direct comparisons between self-dressing and nurse-led dressing are lacking. We compared their effects on healing outcomes in DFUs.Methods
This prospective, randomized, controlled trial enrolled 60 adults (≥18 years) with type 1 or type 2 diabetes and Wagner grade 1-2 DFUs, ankle-brachial index ≥0.7, sufficient cognitive and motor skills for self-care, and ability to attend follow-up. Patients were randomized 1:1 to either a structured self-dressing protocol after standardized training (group A, n=30) or nurse-led dressing (group B, n=30). All received standardized offloading, debridement, and a sodium hyaluronate dressing changed every 2-3 days. The primary outcome was time to complete healing (weeks). Secondary outcomes included healing rate, infection, amputation, and number of dressing days. Follow-up for healing outcomes was 14 weeks. Analysis used intention-to-treat, with post-hoc logistic regression adjusting for baseline imbalances.Results
Baseline characteristics were similar except for higher chronic kidney disease prevalence and foot infection score in the self-dressing group (PConclusions
In patients with uncomplicated DFUs, nurse-led dressing achieved faster healing, fewer infections, and fewer minor amputations compared with structured patient self-dressing. Self-dressing cannot be recommended as a substitute for professional wound care in this population.