{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:25:26Z","timestamp":1763558726850,"version":"3.45.0"},"reference-count":39,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundaci\u00f3 Doc\u00e8ncia i Recerca M\u00fatua Terrassa"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To evaluate the long-term impact of a structured diabetic foot education program on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in individuals with type 1 diabetes. Methods: Retrospective cohort study including 327 adults with type 1 diabetes who participated in a structured diabetic foot education program between 1990 and 2014. The program included 10 h of education focused on diabetes self-management and foot care. Participants were encouraged to attend annual refresher sessions. The primary outcomes were the first occurrence of MALE (major amputation or lower-limb revascularization) and MACE (non-fatal stroke, non-fatal myocardial infarction, or all-cause death). Cox proportional hazards models were used to assess associations between the number of educational programs (EPs) attended (1, 2\u20133, &gt;3) and outcomes. Results: Participants attended a median of two EPs during a median follow-up of 26.3 years. Of the total number of events, 21 were MALEs (crude incidence of 1.9 per 1000 person-years) and 108 were MACEs (incidence of 12.9 per 1000 person-years). Risk of MALE was not associated with the number of EPs attended (p = 0.384). In contrast, participants who attended &gt;3 EPs had a significantly lower risk of MACE compared with those attending only one program (HR 0.48, 95% CI 0.24\u20130.99, p = 0.044), although this association was attenuated after adjusting for smoking status. Conclusions: Frequent participation in a structured diabetic foot education program was associated with fewer cardiovascular events, but this benefit was diminished by smoking. Integrating tobacco cessation into education programs may enhance their long-term impact.<\/jats:p>","DOI":"10.3390\/jcm14228149","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Effect of a Structured Educational Program on Diabetic Foot on Major Adverse Limb and Cardiovascular Events in People with Type 1 Diabetes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5846-0988","authenticated-orcid":false,"given":"N\u00faria","family":"Alonso-Carril","sequence":"first","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"},{"name":"Department of Nursing, Rovira i Virgili University, 43002 Tarragona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maite","family":"Valverde","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Anglada","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5953-7844","authenticated-orcid":false,"given":"Luis","family":"Garc\u00eda-Pascual","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2935-6521","authenticated-orcid":false,"given":"Maria-Jos\u00e9","family":"Barahona","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Rodr\u00edguez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n","family":"Berrocal","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0423-6446","authenticated-orcid":false,"given":"Carmen","family":"Quir\u00f3s","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-1327","authenticated-orcid":false,"given":"Andreu","family":"Sim\u00f3-Servat","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9466-2627","authenticated-orcid":false,"given":"Carlos","family":"Puig-Jov\u00e9","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davinia","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carme","family":"Ferr\u00e9","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"},{"name":"Department of Nursing, Rovira i Virgili University, 43002 Tarragona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9237-0903","authenticated-orcid":false,"given":"Antonio J.","family":"Amor","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, Villarroel 170, 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8104-7326","authenticated-orcid":false,"given":"Ver\u00f3nica","family":"Perea","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua Terrassa, Dr. Robert 5, 08221 Terrassa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Narres, M., Kvitkina, T., Claessen, H., Droste, S., Schuster, B., Morbach, S., R\u00fcmenapf, G., Van Acker, K., and Icks, A. 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