Summary: In adults with type 2 diabetes living in Karachi slums, a pictorial infographic-based foot-care education programme markedly improved foot-care knowledge and self-reported practice over standard care, though it did not measure ulcer or amputation outcomes.
PICO Summary
| Element | Detail |
|---|---|
| Population | 180 adults with type 2 diabetes in Karachi slums (160 completed; ~80% female), low foot-care awareness. |
| Intervention | Pictorial infographic-based foot-care education at primary care over three months (single-blinded). |
| Comparison | Standard diabetes care without additional foot-care education. |
| Outcome | Greater improvement in knowledge/practice scores (mean difference 3.53; 95% CI 3.11–3.96; p<0.001) versus control (0.87; 95% CI 0.34–1.40). Significant group-by-time interaction. No adverse effects. No ulcer/amputation endpoints. |
Pictorial foot-care education in T2D
RCT · type 2 diabetes · 3 months
Pictorial education produced a large improvement in foot-care knowledge and self-reported practice versus standard care. Clinical ulcer and amputation outcomes were not measured.
Expert Commentary
This is the kind of pragmatic, low-cost study I wish there were more of, because it tackles a preventable catastrophe, the diabetic foot, in exactly the population where written leaflets fail. Using pictures to bypass literacy barriers is behaviourally sound, and the effect on knowledge and self-reported practice was large and statistically clean, with tight, non-overlapping confidence intervals. My enthusiasm is real but bounded by what the trial actually measured. Knowledge and self-reported behaviour are intermediate outcomes, and the honest truth from this field, reflected in IWGDF guidance, is that education alone has never been definitively shown to cut ulceration or amputation. Self-reported practice after teaching is also prone to social-desirability bias, and three months tells me nothing about durability. Can I use this with my patients? Yes, readily, as a cheap, culturally appropriate way to teach foot care in low-literacy settings, integrated into routine visits or community health-worker programmes. But it augments rather than replaces structured foot screening, risk stratification, and podiatry referral. I would want a trial tracking actual ulcers over a longer horizon before claiming it prevents them.
References
Sharif H, Kadir M, Hashmi M, et al. Effectiveness of pictorial educational intervention on foot care among individuals having type 2 diabetes at slums of Karachi, Pakistan: a single blinded randomized control trial. BMC Public Health. 2025;25(1):3214. doi:10.1186/s12889-025-23969-6