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REDUCE

Development of the REDUCE intervention

Current treatments for Diabetic foot ulcers (DFUs) focus on wound care, but there is a need to address the psychological and behavioural factors which play a major role in ulcer recurrence and healing.

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, affecting up to one in four diabetics during their lifetime. They are difficult to heal, often come back, and can lead to loss of limbs. DFUs can also cause emotional distress and make day-to-day self-care challenging.

The REDUCE program was created to help people change behaviours to reduce their ulcer risk and improve recovery. Researchers worked closely with patients, carers and family members to design and refine the REDUCE program. They used interviews, website testing and feedback sessions and a pilot trial to understand what worked and what needed improvement.

Methodology

The REDUCE program is made up of eight one-to-one sessions (by phone or video), plus ongoing support via the website and printed handbooks. An initial trial over 10 months was completed at two NHS sites with 20 people who had recently recovered from a DFU. Participation was for up to 4 months with data collected via questionnaires at the start, at 6 weeks, and at 3 months, and during one-to-one interviews.

Findings

Participants valued the one-to-one sessions and being able to engage from home, reporting improvements in their psychological well‐being, footcare behaviours and mood. However, there was limited use of the website by the participants during this initial trial due to digital literacy, barriers accessing or using the website or finding the website did not offer additional information. These findings informed improvements to the REDUCE program ahead of a Main Trial with 544 participants.

Patient, Carer and Family Member contributions

Patients, carers and their family members – 10 in total – were all involved in the development of the REDUCE program.

Read the publication

Vedhara K, Brewin D, Game F, Sheehan C, Ayling K, Bradbury K, Slodkowska-Barabasz J, Joseph J, Hart R, Mitchell N, Lawton J, Chalder T. The REDUCE Intervention: The Development of a Person-Centred Cognitive Behavioural Intervention to Improve Ulcer Outcomes in People at Risk of Diabetic Foot Ulceration. Health Expect. 2025 Oct;28(5):e70434. https://doi.org/10.1111/hex.70434. PMID: 40965821; PMCID: PMC12445198.