Jiang C, Guan RN, Shu Y, Zhang L, Mao XP, Nie Q, Zhu HF. Impact of multidisciplinary nursing interventions and blood glucose control on diabetic foot ulcer healing, patient emotions, and satisfaction. World J Psychiatry 2025; 15(11): 106956 [DOI: 10.5498/wjp.v15.i11.106956]
Corresponding Author of This Article
Qun Nie, Chief Nurse, Department of Pancreatology, Quzhou People’s Hospital, No. 100 Minjiang Avenue, Quzhou 324000, Zhejiang Province, China. jcnq123456@126.com
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Methodology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 19, 2025 (publication date) through Nov 4, 2025
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World Journal of Psychiatry
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Jiang C, Guan RN, Shu Y, Zhang L, Mao XP, Nie Q, Zhu HF. Impact of multidisciplinary nursing interventions and blood glucose control on diabetic foot ulcer healing, patient emotions, and satisfaction. World J Psychiatry 2025; 15(11): 106956 [DOI: 10.5498/wjp.v15.i11.106956]
Author contributions: Jiang C and Zhu HF designed the research study, involved in drafting the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Guan RN, Shu Y, Zhang L, and Mao XP performed the research; Jiang C, Guan RN, Shu Y, Zhang L, Mao XP, and Zhu HF collected and analyzed the data; Nie Q participated in the investigation, supervision and verification; and all authors have been involved in revising it critically for important intellectual content, read, and approved the final version.
Supported by the Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine, No. 2025ZL594; and Municipal-Level Science and Technology Plan Project of Zhejiang Province, No. 2023ZD039.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Quzhou People’s Hospital, approval No. 2023-136.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Qun Nie jcnq123456@126.com. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qun Nie, Chief Nurse, Department of Pancreatology, Quzhou People’s Hospital, No. 100 Minjiang Avenue, Quzhou 324000, Zhejiang Province, China. jcnq123456@126.com
Received: May 23, 2025 Revised: June 26, 2025 Accepted: September 2, 2025 Published online: November 19, 2025 Processing time: 164 Days and 17.9 Hours
Abstract
BACKGROUND
Diabetic foot ulcers (DFUs) present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches. Effective management is critical for uneventful health outcomes.
AIM
To investigate the effects of multidisciplinary team (MDT) nursing interventions and blood glucose control on the negative emotions and satisfaction of DFU-healing patients.
METHODS
This retrospective cohort study included 115 patients with DFUs, divided into MDT and blood glucose control intervention group (n = 60) and standard care control group (n = 55). The comparison factors were wound area, new granulation tissue coverage area, wound healing rate, 2-hour postprandial blood glucose level, fasting plasma glucose level, Hamilton Anxiety Scale score, Hamilton Depression Scale score, and nursing satisfaction.
RESULTS
After 4 weeks, the average wound area reduced from 22.04 ± 6.48 cm2 to 11.96 ± 3.63 cm2 (P < 0.05). New granulation tissue coverage area reached 52.85 ± 18.39 cm2 for the intervention group and 28.39 ± 9.94 cm2 (P < 0.05) in the control group, respectively. The healing rate was significantly higher in the intervention group than in the control group (91.7% vs 76.4%, P < 0.05). Fasting plasma glucose decreased more sharply in the intervention group (from 8.36 ± 0.98 mmol/L to 6.91 ± 1.23 mmol/L) than in the control group (8.41 ± 1.05 mmol/L to 7.81 ± 1.27 mmol/L), with the intervention group maintaining significantly lower levels (P < 0.05). The intervention group demonstrated a significantly greater reduction in 2-hour postprandial blood glucose levels (11.35 ± 2.67 mmol/L to 7.52 ± 1.38 mmol/L) compared to the control group (11.61 ± 3.01 mmol/L to 8.72 ± 1.63 mmol/L; P < 0.05). Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in the intervention group (P < 0.05). Patient satisfaction with nursing was 93.33% and 74.55% in the intervention and control groups, respectively (P < 0.05).
CONCLUSION
MDT combined with blood glucose control enhanced healing rates and positively influenced emotional well-being and satisfaction among patients. This strategy holds potential for application in clinical practice.
Core Tip: Multidisciplinary team combined with blood glucose control significantly accelerated diabetic foot ulcer healing, with a higher healing rate (91.7% vs 76.4%) and an effective reduction in both fasting plasma glucose and 2-hour postprandial blood glucose levels. It positively affected the patients’ emotional well-being by alleviating anxiety and depression and enhancing nursing satisfaction (93.33% vs 74.55%, respectively). Therefore, multidisciplinary team combined with blood glucose control is an effective management strategy for diabetic foot ulcers and is worthy of further promotion and application in clinical practice.
Citation: Jiang C, Guan RN, Shu Y, Zhang L, Mao XP, Nie Q, Zhu HF. Impact of multidisciplinary nursing interventions and blood glucose control on diabetic foot ulcer healing, patient emotions, and satisfaction. World J Psychiatry 2025; 15(11): 106956
Diabetes mellitus affects 537 million adults globally in 2021. Diabetic foot ulcers (DFUs) are common complications in patients with diabetes, developing in up to 34% of these patients during their lifetime[1,2]. Its universality and severity have a far-reaching impact on the quality of life of patients, imposing economic burden on the medical system and posing amputation risk[3]. These ulcers affect health and often lead to the social and emotional isolation of patients[4]. Due to the increasing prevalence of diabetes worldwide, the incidence of DFUs is increasing, particularly in patients with poor blood sugar control[5,6]. In recent years, the burden of diabetes in China has increased substantially[7]. In individuals with diabetes mellitus, foot infections contribute significantly to increased morbidity, mortality, hospital costs, and reduced quality of life[8].
China has a significant prevalence of both diabetes and prediabetes[9]. Therefore, the challenges faced by DFUs are particularly prominent. Traditional DFU management usually relies on the nursing care of a single patient; however, this method often fails to fully consider the complex relationship between wound healing and metabolic control[10]. Appropriate primary care is essential to maintain high-quality care for patients with chronic diseases[11]. Individuals with chronic conditions typically require continuous care management rather than isolated, focused interventions[12]. Fluctuations in blood sugar levels directly affect the healing speed of DFUs, and a significant correlation exists between high levels of glycosylated hemoglobin and low wound healing rates. The standard care for DFU often involves an initial comprehensive evaluation of infection, vascular compromise, and neuropathy[13]. In addition, the presence of DFU places a significant psychological burden on patients. A study of 260 patients with diabetic foot showed a prevalence of depression of 39.6%[14]. Patients with DFU durations of more than a year had a three-fold higher risk of moderate-to-major depression than other patients (P = 0.049)[15,16]. Chronic wound management is challenging owing to persistent inflammation that is often difficult to contain[17]. Frequent consultation with a team of professionals is necessary to manage chronic wounds[18]. Furthermore, the expenses associated with managing DFUs and surgical wounds are significantly higher than those associated with managing other chronic wounds[19]. Depression and anxiety are frequently observed in patients with DFU and might play a role in cognitive deficits; these mental health problems further worsen the wound healing process and form a vicious cycle[20]. Therefore, bringing mental health into holistic management strategies, and helping patients cope with the psychological stress caused by chronic illness is vital for treatment effectiveness.
This study evaluated the effects of a multidisciplinary team (MDT) (endocrinology, wound care, nutrition, and psychology) combined with blood sugar control on the wound healing rates of DFUs and patients’ negative emotions and satisfaction[21]. This comprehensive nursing model focuses not only on wound healing but also on the emotional and psychological needs of patients[22]. Through this comprehensive nursing strategy, we expect to provide higher-quality nursing methods for patients with diabetes and provide data support for the clinical selection of diabetes care.
MATERIALS AND METHODS
Study design
This was a retrospective study that analyzed consecutive cases without identifying patient information. Case inclusion was managed in a unified manner using the hospital’s electronic medical record system and a follow-up database.
This study included 115 patients with DFUs divided into an intervention group that received MDT combined with blood glucose control (n = 60) and a control group (n = 55) that received standard care according to the nursing methods adopted. Data were collected from the electronic medical records of the hospital between December 2023 and January 2025. This study was approved by the Medical Ethics Committee, approval No. 2023-136 of Quzhou People’s Hospital.
Inclusion and exclusion criteria
The inclusion criteria for patients were as follows: (1) Diagnosed with DFUs; (2) Aged 18 years and older; (3) Without critical limb ischemia; and (4) Hemoglobin A1c 5.7%-6.5%. The exclusion criteria were as follows: (1) Malignancy; (2) Pregnancy; (3) Cognitive impairment; and (4) Loss to follow-up.
Nursing methods
The control group received standard care, which primarily included trained nurses regularly performing wound debridement to remove necrotic tissue and pus to promote wound healing and established reasonable dressing change frequencies based on wound healing. Typically, dressing changes were performed twice a week or were adjusted according to the level of wound exudate. Basic wound dressings were used to maintain a moist environment for the wound and facilitate healing. The patients were also provided with basic health education on diabetes management, including blood glucose monitoring, dietary control, and foot care. Through the distribution of educational materials and face-to-face instructions, patients were assisted in acquiring self-management skills.
The intervention group received MDT combined with blood glucose control that included the following aspects: This intervention comprised weekly MDT consultations, which included endocrinologists, wound care specialists, clinical dieticians, and psychologists, and were approximately 60-90 minutes long. The division of labor in each discipline is clear.
Endocrinologist: Responsible for assessing the patient’s glycemic control and adjusting the glucose-lowering drug or insulin regimen based on real-time glucose monitoring data (four fingerstick blood glucose tests daily and one glycosylated hemoglobin test once a week). The glycemic control goals were set as follows: For patients without severe comorbidities, the target values were fasting plasma glucose (FPG) < 7.0 mmol/L and 2-hour postprandial blood glucose (2hPG) < 10.0 mmol/L; for older patients or those with complications, a more moderate goal of FPG 7.0-8.3 mmol/L and 2hPG 8.0-11.1 mmol/L was adopted. The treatment plan was adjusted to ensure that goals were met. If the patient’s blood glucose deviated from the target values or showed significant fluctuations (defined as FPG > 10% above or below the target or 2hPG > 15% above the target), the endocrinologist adjusted the treatment plan within 24 hours. Adjustments included modifying the dosage of oral hypoglycemic agents and insulin injection regimens or recommending dietary and exercise changes. The MDT team reviewed these adjustments weekly to evaluate their effectiveness and further optimize them, as needed.
Wound care specialist: Systematically assesses ulcer wounds, including measuring wound size and depth, observing granulation tissue growth, and developing a personalized wound care plan, such as debridement, dressing selection, and frequency of replacement.
Clinical dietitian: According to the patient’s nutritional status, blood glucose level, and body mass index, formulate a personalized diet plan, focus on adjusting protein intake (0.8-1.2 g/kg/day), and guide the patient to implement it correctly.
Psychologist: Psychological assessment of patients was conducted using the Hamilton Anxiety (HAM-A)/Hamilton Depression (HAM-D) scales, and individual psychological interventions were conducted for anxiety and depression, such as cognitive behavioral therapy and relaxation training, to improve patients’ treatment compliance.
Observed indicators
Primary outcome: The wound healing status, including wound area, new granulation tissue coverage area, and wound healing rate, was classified into several categories: Complete recovery (wound healed entirely and scab fell off), significant improvement (wound not fully healed but reduced in size, without secretion and healthy granulation tissue), effectiveness (reduced secretion and exudation without significant wound expansion), and ineffectiveness (poor wound healing with pale granulation tissue). Wounds were scored using the Pressure Ulcer Scale for Healing both before and after treatment, and the areas of the wound and granulation tissue were measured using a ruler during each dressing to ensure the accuracy and reliability of the results[23]. The healing rate was calculated as follows: (number of significant improvements + number of effective cases)/(total number of cases) × 100. Blood glucose levels were assessed before and after the intervention using a fully automated biochemical analyzer. FPG and 2hPG levels were recorded and compared between the groups.
Secondary outcomes: Psychological status[24]: Before the intervention, psychological scores were measured separately at 4 weeks after the intervention. The HAM-A scale consists of 14 items, with each item scored on a scale of 0 to 4, with higher scores reflecting greater levels of anxiety. The HAM-D includes 17 items and uses a hierarchical scoring system. For specific items (1, 2, 3, 7, 8, 9, 10, 11, 15, and 17), the scores ranged from 0 to 4, whereas the scores for other items (4, 5, 6, 12, 13, 14, and 16) ranged from 0 to 2. A higher total score on the HAM-D scale indicates a more severe degree of depression.
Nursing satisfaction: Nursing satisfaction was assessed using a custom-designed questionnaire focused on five areas: Basic nursing care, nursing knowledge, nursing attitude, operational skills, and skin care. Satisfaction levels were expressed as percentages (0-100), with higher scores indicating greater satisfaction. The criteria were as follows: Scores below 60 indicated dissatisfaction; scores between 60 and 80 indicated satisfaction; and scores above 80 indicated high satisfaction. The overall satisfaction rate was calculated as follows: (very satisfied + satisfied)/(total number of cases) × 100.
Statistical analysis
Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, United States). Continuous data were analyzed with t-tests or rank sum tests, whereas categorical data were assessed using χ2 tests. Statistical significance was set at P < 0.05 all analyses.
RESULTS
Baseline data
In total, 115 patients with DFUs were included in this study, with 60 patients and 55 patients in the intervention and control groups, respectively. No significant differences were observed between the two groups with respect to age, sex, or body mass index at baseline (P > 0.05). The demographic characteristics of the participants are summarized in Table 1.
Table 1 Comparison of general data between the two groups, n (%).
In the intervention group, the incidence rates of ulcer were 20.0% in the calcaneus region, 23.3% in the metatarsus, and 25.0% in the midfoot, with a relatively even distribution in other locations. In the control group, the incidence rate of ulcers in the calcaneus region was 18.2%, and the ulcer rates in the metatarsus and midfoot were 23.6% and 21.8%, respectively. The results indicate a similar distribution of ulcers across locations compared with the intervention group (P > 0.05). The distribution of ulcer locations in the two groups is shown in Table 2.
Table 2 Comparison of ulcer location distribution between the two groups, n (%).
After 4 weeks of nursing intervention, the wound areas in the intervention group were significantly reduced, with an average reduction of 22.04 ± 6.48 cm2, whereas those in the control group only decreased by 11.96 ± 3.63 cm2 (P < 0.05) (Figure 1A).
Figure 1 Comparison of reduced wound area and new granulation tissue coverage area between the two groups after 4 weeks of nursing.aP < 0.001 vs control; bP < 0.001 vs control. A: Comparison of reduced wound area between the two groups after 4 weeks of nursing; B: New granulation tissue coverage area between the two groups after 4 weeks of nursing.
New granulation tissue coverage area
After 4 weeks of nursing intervention, the average new granulation tissue coverage area of the intervention group reached 52.85 ± 18.39 cm2; that for the control group was 28.39 ± 9.94 cm2 (P < 0.05) (Figure 1B).
Wound healing rate
After four weeks of nursing intervention, the intervention group wound healing rate was 91.7% (55/60) compared to 76.4% (42/55) in the control group, and this difference was significant (P < 0.05) (Table 3).
Table 3 Comparison of wound healing rates between the two groups.
Prior to the intervention, there was no significant difference in blood glucose index between the two groups (P > 0.05). After 4 weeks of nursing, both groups experienced significant reductions in FPG and 2hPG levels, with the intervention group demonstrating lower values than the control group, which was significant (P < 0.05) (Figure 2).
Figure 2 Comparison of blood glucose indexes between the two groups before and after intervention.cP < 0.05 vs control; dP < 0.05 vs control. A: Comparison of fasting plasma glucose between the two groups before and after intervention; B: 2-hour postprandial blood glucose comparison between the two groups before and after intervention. FPG: Fasting plasma glucose; 2hPG: 2-hour postprandial blood glucose.
Comparison of HAM-A and HAM-D scores
There were no significant differences in the HAM-A and HAM-D scores between the two groups before nursing (P > 0.05). The HAM-A and HAM-D scores of the two groups after nursing were significantly lower than those before nursing, and those of the intervention group were significantly lower than those of the control group (P < 0.05) (Table 4).
Table 4 Comparison of Hamilton Anxiety and Hamilton Depression scores between the two groups.
Differences in nursing satisfaction between the two groups
Patient satisfaction with nursing in the intervention group was 93.33% (56/60), which was higher than the 74.55% (41/55) in the control group, and the difference was significant (P < 0.05) (Figure 3).
Figure 3 Comparison of nursing satisfaction between the two groups.eP < 0.05 vs control.
DISCUSSION
This study evaluated the effect of an MDT nursing intervention combined with glycemic control on wound healing rates and patients’ psychological burden and satisfaction. The results demonstrated that the intervention group had significantly improved wound healing rates, improved blood sugar control, reduced anxiety and depression scores, and higher patient satisfaction than the control group. These findings are consistent with existing literature, and highlight the importance of integrated care in chronic disease management[25-30].
Blood glucose control is a critical factor in the management of DFUs. Studies show that early and intensive blood glucose control can significantly enhance the healing process of DFUs[31]. MDT has many benefits, such as the integration of different areas of expertise (endocrinology, wound care, nutrition, and psychology) and further optimization of nursing methods. In this study, the nutritionists in the intervention group played an important role in regulating dietary protein intake to promote granulation tissue formation, whereas endocrine experts focused on controlling blood sugar, which is crucial for wound healing. MDT combined with blood glucose control can more effectively reduce patients’ blood glucose fluctuations and improve their overall health and quality of life. This comprehensive care approach not only aids wound healing, but also reduces the risk of amputation and enhances patients’ quality of life[32]. The possible reason for the finding is that the intervention group may promote wound healing through two mechanisms: First, stable blood glucose levels reduce the release of pro-inflammatory cytokines (e.g., tumor necrosis factor-α, interleukin-6). Acute blood glucose spikes exacerbate endothelial dysfunction and activate the nuclear factor kappa B signaling pathway[33,34], while smooth glycemic control effectively inhibits the inflammatory response. Second, good glycemic management can improve microvascular perfusion by reducing the production of advanced glycation end products. Advanced glycation end products disrupt the capillary basement membrane and impede oxygen delivery to tissues[35,36], whereas stabilizing blood glucose with MDT helps maintain the structural and functional integrity of micro vessels, thereby further promoting wound healing. Previous studies have shown that hyperglycemia is associated with an enhanced inflammatory response and impaired collagen synthesis[37,38], further confirming the need for strict blood sugar control during healing. Previous studies also reported that improved blood sugar management is closely related to improved healing among patients with DFUs[27,39], which is essentially consistent with our study.
This study used MDT combined with precise blood sugar management, which helped resolve both the physiological and psychological aspects of the patients. A significant association between psychological intervention and wound healing was observed. Furthermore, the HAM-A and HAM-D scores decreased in both groups after care, but the reduction was more significant in the intervention group (P < 0.05). This improvement in psychological state is likely to be a key mediator in the wound healing process. Previous studies have reported that anxiety relief can improve patient adherence to treatment regimens. One study examined the impact of an enhanced education program on anxiety and depression in patients with DFUs[40]. The study found that patients who received the patient education program showed significant improvements in their anxiety and depression scores and an overall improvement in their Patient Global Assessment score[36]. Another study examined the predictive role of psychological factors, such as anxiety and depression, on the quality of life of patients with foot ulcers. These findings indicate that anxiety and depressive symptoms are significant predictors of psychological quality of life, while pain and functional issues are key predictors of physical quality of life[41]. This underscores the importance of mental health in the management of DFUs. Studies have also shown that family empowerment education interventions can effectively control hemoglobin A1c levels and accelerate the healing of DFUs[42]. The patients’ psychological burden may be reduced with family support and participation, thereby improving treatment compliance and effectiveness.
In addition, this study demonstrated that after 4 weeks of nursing intervention, the satisfaction of the intervention group was 93.33%, whereas that of the control group was only 74.55%. A possible reason for these results is that the comprehensive nursing model can not only significantly improve the patient’s wound healing but also promote a good psychological response. Similar to our findings, previous studies have shown that patient participation can improve health outcomes[43,44]. Future research should explore the long-term benefits of this comprehensive approach and its applicability to other chronic diseases to advance clinical practice and optimize the quality of patient care.
Limitations
This study has a few limitations. First, as this was a single-center retrospective study, inherent bias may have affected the reliability of the results, including potential selection bias, and extrapolated limitations to a wider population. Owing to the small sample size, representativeness cannot be extrapolated to other contexts. Secondly, the long-term recurrence rate of DFUs was not evaluated, and the absence of this important indicator limits our understanding of the durability of intervention effects. Future research should focus on assessing the persistence of the intervention effects to determine their effectiveness in long-term management. In addition, the lack of an in-depth analysis of the patients’ baseline characteristics (such as comorbidities and lifestyle factors) may have affected the comprehensive understanding of the effects of the intervention. Future studies should incorporate larger and more diverse populations and assess the follow-up results to better understand the long-term benefits of this multidisciplinary approach. Simultaneously, the possibility of optimizing MDT interventions in outpatient settings should be explored to improve DFU management effectiveness. In the future, a multicenter, large-sample, prospective, longitudinal research design should be adopted to further verify the results of this study, provide a solid evidence base for clinical practice, and promote the continuous improvement of DFU management.
CONCLUSION
In summary, this study showed that the use of MDT combined with intensive glycemic management could significantly improve the clinical outcomes and psychological status of patients with DFU. Therefore, in future clinical practice, it is recommended to form an MDT team composed of wound, endocrinology and psychological experts, implement a personalized glycemic control plan, and incorporate mental health assessment into routine follow-up in order to improve the prognosis of patients.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Giannouli V, PhD, Assistant Professor, Greece; Wiatr M, PhD, Poland S-Editor: Bai Y L-Editor: A P-Editor: Yu HG
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