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A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta\u2010analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non\u2010controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta\u2010analysis (using Mantel\u2010Haenszel's statistical method and random effect models) was done when &gt;1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non\u2010controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31\u20130.84) and pressure\u2010optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26\u20131.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37\u20131.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24\u20131.17), flexor tenotomy (1 RCT, 7 non\u2010controlled studies, no meta\u2010analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58\u20131.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure\u2010optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high\u2010quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low\u2010to\u2010moderate risk of ulceration.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.3652","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T13:35:16Z","timestamp":1685194516000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences Program Rehabilitation  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Raspovic","sequence":"additional","affiliation":[{"name":"Discipline of Podiatry School of Allied Health Human Services and Sport La Trobe University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence A.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"additional","affiliation":[{"name":"Portuguese Red Cross School of Health \u2013 Lisbon  Lisbon Portugal"},{"name":"MEDCIDS \u2013 Departamento de Medicina da Comunidade Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade Faculty of Medicine University of Porto  Porto Portugal"},{"name":"RISE@CINTESIS Faculty of Medicine Oporto University  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Paton","sequence":"additional","affiliation":[{"name":"School of Health Professions Faculty of Health University of Plymouth  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel C. 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