Nurse-Led Dual-Domain Neurovascular Screening and Escalation Pathway for Adults with Type 2 Diabetes at High Foot Risk: A Randomized Controlled Trial
Keywords:
diabetes mellitus, diabetic foot, diabetic neuropathies, nursing assessment, peripheral arterial disease, randomized controlled trialAbstract
Background: Diabetes-related foot disease is a major neurovascular complication of type 2 diabetes, and high-risk patients often experience delayed recognition of neuropathy and ischemia. Nurse-led pathways that combine screening with escalation may strengthen prevention, but trial evidence in routine hospital care remains limited.
Aim: To evaluate whether a nurse-led dual-domain neurovascular pathway improves outcomes in adults with type 2 diabetes at high foot risk.
Approach: In this single-center randomized clinical trial, 60 of 80 screened adults with type 2 diabetes at high foot risk were consecutively enrolled and randomly assigned 1:1 to intervention or usual care. Outcomes were measured at baseline, 12 weeks, and 24 weeks. Repeated-measures ANOVA was used for longitudinal comparisons.
Results: Mean age was 58.0 (8.2) years, and 33 participants (55.0%) were women. Compared with usual care, the intervention improved healthcare-seeking intention at 12 weeks (mean difference, 5.5 points; 95% CI, 0.7-10.3; P = .0257), with a significant group-by-time interaction (P = .0265). Foot self-care behavior also improved (mean difference, 5.2 points; P = .0412), while MNSI examination score and ankle-brachial index changed favorably (P = .0451 and P = .0460, respectively).
Conclusions: A nurse-led dual-domain neurovascular pathway was associated with modest short-term improvement in help-seeking, self-care, and selected neurovascular indicators in adults with type 2 diabetes at high foot risk
Implication for Nursing Practice: Nursing practice may benefit from integrating concurrent neuropathy and vascular screening with predefined escalation pathways to support earlier risk recognition, structured referral, and preventive foot-care reinforcement in high-risk diabetes care
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Copyright (c) 2026 Andre Priyanto, Nova Aprialini, Putri Vilotenda, Asmat Burhan
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