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Benites-Meza JK, Malo-Castillo J, Herrera-Añazco P, Benites-Zapata VA. Atherogenic markers and 1-year amputation risk in adults with diabetic foot in a tertiary level hospital: A retrospective cohort study. J Diabetes Complications 2024; 38:108810. [PMID: 39042958 DOI: 10.1016/j.jdiacomp.2024.108810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
AIM To determine the association between atherogenic markers, such as total cholesterol/high density lipoprotein cholesterol ratio (TC/HDL-C), triglycerides/HDL-C ratio (TG/HDL-C), and triglycerides-glucose index (TyG), and the risk of 1-year amputation in adults with diabetic foot in a tertiary level hospital. METHODS Retrospective cohort study conducted in 162 adult patients with diabetic foot. The outcome was amputation, defined as "primary amputation in patients' clinical history after their first hospitalization due to foot ulcer.". The cutoff point was determined using Youden's J statistic. The relative risk (RR) was presented as an association measure. RESULTS A TyG index of >9.4 [RR: 1.64 (1.10-2.45)] was associated with a high risk of amputation after 1-year in adults with diabetic foot. However, while a TC/HDL ratio of >4.69 [RR: 1.38 (0.94-2.03)] and a TG/HDL-C ratio > 3.57 [RR: 1.35 (0.89-2.06)] did not show associations with risk of amputation after 1-year. CONCLUSIONS Only a TyG index of >9.4 was associated with an increased risk of 1-year amputation in adults with diabetic foot. Future studies with larger samples and a longitudinal design may provide more robust evidence and a better understanding of clinical implications.
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Affiliation(s)
- Jerry K Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru; Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jussara Malo-Castillo
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru; Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru
| | | | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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2
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Tang WH, Zhao YN, Cheng ZX, Xu JX, Zhang Y, Liu XM. Risk factors for diabetic foot ulcers: A systematic review and meta-analysis. Vascular 2024; 32:661-669. [PMID: 36740805 DOI: 10.1177/17085381231154805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically evaluate the risk factors for developing diabetic foot ulcers (DFU). METHODS The Cochrane Library, PubMed, Web of Science, SinoMed, CNKI, VIP, and Wanfang Data were searched for relevant studies on DFU risk factors, and the search time frame was from database creation to March 2022. Meta-analysis was performed using RevMan 5.3. RESULTS A total of 26 publications were included, including 3 cohort studies, 22 case-control studies, and one cross-sectional study. Meta-analysis showed that advanced age [MD = 6.04, 95% CI (3.92, 8.16)], male [OR = 1.84, 95% CI (1.48, 2.29)], elevated body mass index [MD = 1.58, 95% CI (0.47, 2.69)], prolonged duration of diabetes [MD = 2.72, 95% CI (2.33, 3.11)], comorbid nephropathy [OR = 3.15, 95% CI (2.68, 4.60)], comorbid neuropathy [OR = 4.80, 95% CI (2.79, 8.27)], comorbid retinopathy [OR = 3.37, 95% CI (2.26, 5.02)], elevated systolic blood pressure [OR = 8.19, 95% CI (6.33, 10.05)], elevated fasting glucose [MD = 1.60, 95% CI (0.21, 3.00)], elevated glycated hemoglobin [MD = 1.24, 95% CI (0.94, 1.54)], elevated triglycerides [MD = 0.44 (95% CI (0.15, 0.73)], elevated fibrinogen [MD = 1.35, 95% CI (0.62, 2.08)], elevated white blood cell count [MD = 2.56, 95% CI (2.24, 2.88)], elevated C-reactive protein [MD = 15.08, 95% CI (8.03, 22.13)], decreased ankle-brachial ratio [MD = -0.26, 95% CI (-0.36, -0.16)], and decreased total protein levels [MD = -4.58, 95% CI (-6.91, -2.25)] were risk factors for developing DFU (p < 0.05), and increased HDL cholesterol levels [MD = -0.22, 95% CI (-0.36, -0.08)] were protective factor for developing DFU (p < 0.05). CONCLUSION There are many risk factors for developing of ulcers in the diabetic feet, and early prevention and intervention should be performed as early as possible to assess the risk of developing diabetic foot patients.
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Affiliation(s)
- W H Tang
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, China
| | - Y N Zhao
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
| | - Z X Cheng
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
| | - J X Xu
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, China
| | - Y Zhang
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
| | - X M Liu
- Department of Peripheral Vascular Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
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3
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Wang K, Wang Y, Shi W, Shen K, Tao K, Ling R, Huang Y, Fu X, Hu D. Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA). Diabetes Metab Res Rev 2024; 40:e3776. [PMID: 38402455 DOI: 10.1002/dmrr.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 02/26/2024]
Abstract
Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.
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Affiliation(s)
- Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yunchuan Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wenlong Shi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Ke Tao
- Department of Wound Repair, Wound Repair and Regenerative Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yuesheng Huang
- Department of Wound Repair, Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
| | - Xiaobing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department and 4th Medical Center, PLA General Hospital and PLA Medical College, Beijing, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
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4
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Chen Y, Wang Y, Zhang T, Meng C, Li Q, Zhang B, Zhang K, Qin C. Efficacy of Chinese and Western Medical Techniques in Treating Diabetic Foot Ulcers With Necrotizing Fasciitis of the Lower Leg. INT J LOW EXTR WOUND 2024; 23:70-79. [PMID: 36648167 DOI: 10.1177/15347346221150865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To analyze and evaluate the clinical efficacy of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg and summarize the treatment experience of such patients to identify a new method of limb salvage treatment. A total of 46 patients with severe diabetic foot ulcers and necrotizing fasciitis of the lower leg were treated with such techniques as surgical debridement, bone drilling, open joint fusion, and microskin implantation. Wounds were treated with moisture-exposed burn therapy (a regenerative medical treatment for burns, wounds, and ulcers) and moisture-exposed burn ointment (a traditional Chinese medicine); underlying diseases were also treated effectively. The wound healing time, rate of high amputation, and mortality of these patients were summarized, and the clinical efficacy of such treatments was evaluated. Of the 46 patients enrolled, 38 patients were cured, with a cure rate of 82.61%. The average wound healing time was 130 ± 74.37 days. Two patients underwent high amputations, with an amputation rate of 4.35%, and 4 deaths occurred, with a mortality rate of 8.70%. The combination of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg not only effectively saved patients' lives and promoted wound healing but also greatly reduced the rates of high amputation and disability.
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Affiliation(s)
- Yongchong Chen
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Yunzhu Wang
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - TaiAn Zhang
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Chao Meng
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Qing Li
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Bohui Zhang
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Kai Zhang
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
| | - Chunfang Qin
- Department of Plastic Burns and Wounds Repair, Beijing Fengtai Hospital of Chinese Medicine (Nanyuan Hospital, Fengtai District, Beijing), Beijing, China
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5
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Peng X, Gou D, Zhang L, Wu H, Chen Y, Shao X, Li L, Tao M. Status and influencing factors of lower limb amputation in patients with diabetic foot ulcer. Int Wound J 2023. [PMID: 36651223 DOI: 10.1111/iwj.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
To investigate the influencing factors of lower limb amputation in patients with diabetic foot ulcers. Patients with diabetic foot ulcers who were hospitalised in a tertiary general hospital in Guizhou Province from January 2019 to March 2022 were retrospectively collected. Sociological information of the general population, comorbidities, laboratory-related indicators, and information on the specialty situation, using univariate analysis and multifactor analysis, compared the influencing factors of amputation and non-amputee patients. A total of 205 patients with diabetic foot and 69 ampute patients (33.7%) were enrolled. The univariate analysis found that the decrease in HDL cholesterol levels was associated with the occurrence of lower extremity amputation, and logistic stepwise regression analysis showed that HDL-C was inversely correlated with the amputation rate of patients with diabetic foot ulcers, and the risk of amputation at low levels of HDL-C was 2.452 times higher than that of high-level HDL-C (95% CI: 1.105-5.846). Decreased HDL cholesterol levels are an independent predictor of amputation in patients with diabetic foot ulcers.
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Affiliation(s)
- Xiaofeng Peng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Dengqun Gou
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Lu Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Hemei Wu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Yu Chen
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Xing Shao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Li Li
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Ming Tao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
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6
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Zengin B, Yuzuguldu B, Simsir IY, Cetinkalp S. An index to prevent major limb amputations in diabetic foot. Endocr Regul 2023; 57:80-91. [PMID: 37183692 DOI: 10.2478/enr-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Objective. Besides the early detection and treatment of diabetic foot ulcers, being aware of the risk factors for major amputation plays a crucial role in preventing the major lower limb amputations. Major lower limb amputations are not just mentally and physically hard for patients, but also have an effect on patient's survival and are a financial burden on both patients and healthcare systems. Subjects and Methods. We defined 37 potential risk factors for major amputation and these risk factors were investigated among 507 patients who had ulcers in their feet and were seen by the diabetic foot ulcer council at Ege University Faculty of Medicine. In our study, 106 (20.9%) patients ended up undergoing major lower limb amputation. Results. The univariate analysis showed that 24 defined risk factors were statistically significant. In the multivariate analysis using the Cox regression model, 6 risk factors remained statistically significant. Multivariate-adjusted hazard ratios were 4.172 for hyperlipidemia, 3.747 for albumin <3.365 g/dL, 3.368 for C-reactive protein (CRP) >2.185 mg/L, 2.067 for presence of gangrenous Wagner stage, 1.931 for smoking tobacco >30 pack/year, and 1.790 for hematocrit (HCT) <31.5%. Most patients with major amputation presented with a neuroischemic foot (58%). Gender and age were not found to be risk factors for major amputation. Having less than 7% of hemoglobin A1c (HbA1c) levels had a direct proportion with major amputation numbers. The mortality rates in one year, two and three years after the major amputation operations were 24.6%, 30%, and 35.9%, respectively. Conclusion. Being familiar with these risk factors for major amputation is crucial for multi-disciplinary teams to take good care of patients with diabetic foot ulcers and to lower the need for major amputations.
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Affiliation(s)
- Bugra Zengin
- 1Division of Pediatric Surgery, Department of Surgery, Chlidren's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Burak Yuzuguldu
- 2Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Ilgin Yildirim Simsir
- 3Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sevki Cetinkalp
- 3Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey
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7
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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8
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Winkler E, Schöni M, Krähenbühl N, Uçkay I, Waibel FWA. Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes. Foot Ankle Int 2022; 43:957-967. [PMID: 35582923 PMCID: PMC9260474 DOI: 10.1177/10711007221088552] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic foot osteomyelitis (DFO) often leads to amputations in the lower extremity. Data on the influence of the initial anatomical DFO localization on ultimate major amputation are limited. METHODS In this retrospective analysis, 583 amputation episodes in 344 patients (78 females, 266 males) were analyzed. All received a form of amputation in combination with antibiotic therapy. A multivariate logistic regression analysis with the primary outcome "major amputation" defined as an amputation above the ankle joint was performed. The association of risk factors including location of DFO, coronary artery disease, peripheral artery disease, neuropathy, nephropathy, and Charcot neuro-osteoarthropathy was analyzed. RESULTS Among 583 episodes, DFO was located in the forefoot in 512 (87.8%), in the midfoot in 43 (7.4%), and in the hindfoot in 28 episodes (4.8%). Overall, 53 of 63 (84.1%) major amputations were performed because of DFO in the setting of peripheral artery disease as primary indication. Overall, limb loss occurred in 6.1% (31/512) of forefoot, 20.9% (9/43) of midfoot, and 46.4% (13/28) of hindfoot DFO. Among these, 22 (41.5%) were performed as the primary treatment, whereas 31 (58.5%) followed previously failed minor amputations. Among this latter group of secondary major amputations, the DFO was localized to the forefoot in 23 of 583 (3.9%), the midfoot in 4 of 583 (0.7%) and the hindfoot in 4 of 583 (0.7%). In multivariate logistic regression analysis, initial hindfoot localization was a significant factor (P < .05), whereas peripheral artery disease, smoking, and a midfoot DFO were not found to be risk factors. CONCLUSION In our retrospective series, the frequency of limb loss in DFO increased with more proximal initial foot DFO lesions, with almost half of patients losing their limbs with a hindfoot DFO. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Elin Winkler
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland,Elin Winkler, MD, Department of
Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich, 8008,
Switzerland.
| | - Madlaina Schöni
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Unit for Clinical and
Applied Research and Infectiology, Balgrist University Hospital, Zurich,
Switzerland
| | - Felix W. A. Waibel
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
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9
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Yunir E, Tarigan TJE, Iswati E, Sarumpaet A, Christabel EV, Widiyanti D, Wisnu W, Purnamasari D, Kurniawan F, Rosana M, Anestherita F, Muradi A, Tahapary DL. Characteristics of Diabetic Foot Ulcer Patients Pre- and During COVID-19 Pandemic: Lessons Learnt From a National Referral Hospital in Indonesia. J Prim Care Community Health 2022; 13:21501319221089767. [PMID: 35343835 PMCID: PMC8966061 DOI: 10.1177/21501319221089767] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Diabetic foot ulcer (DFU) is one of the most terrifying diabetic complications for patients, due to the high mortality rate and risk for amputation. During the COVID-19 pandemic, many diabetic patients limited their visits to the hospital, resulting in delays for treatment especially in emergency cases. Objective: This study aimed to compare the characteristics of patients with DFU pre- and during COVID-19 pandemic period. Methods: This study was a retrospective cohort study using foot registry data. We compared our patients’ characteristics pre-COVID-19 pandemic period (1 March 2019-28 February 2020) and during COVID-19 pandemic period (1 March 2020-28 February 2021). Results: Cohorts of 84 and 71 patients with DFU pre- and during COVID-19 pandemic period, respectively, were included in this study. High infection grade (66.7% vs 83.1%, P = .032), osteomyelitis event (72.6% vs 87.3%, P = .04), leukocyte count (15 565.0/μL vs 20 280.0/μL, P = .002), neutrophil-to-lymphocyte ratio (7.7 vs 12.1, P = .008), waiting time-to-surgery (39.0 h vs 78.5 h, P = .034), and number of major amputation (20.2% vs 39.4%, P = .014) were significantly higher during the COVID-19 pandemic period. Conclusion: During the COVID-19 pandemic, patients with DFU had more severe infection, higher proportion of osteomyelitis, longer waiting time for getting surgical intervention, and higher incidence of major amputation.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Eni Iswati
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Angela Sarumpaet
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Eunike Vania Christabel
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Wismandari Wisnu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dyah Purnamasari
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Farid Kurniawan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Martha Rosana
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fitri Anestherita
- Physical Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Akhmadu Muradi
- Division of Vascular and Endovascular, Department of Surgery, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dicky L Tahapary
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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10
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Soyoye DO, Abiodun OO, Ikem RT, Kolawole BA, Akintomide AO. Diabetes and peripheral artery disease: A review. World J Diabetes 2021; 12:827-838. [PMID: 34168731 PMCID: PMC8192257 DOI: 10.4239/wjd.v12.i6.827] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.
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Affiliation(s)
- David Olubukunmi Soyoye
- Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria
| | | | - Rosemary Temidayo Ikem
- Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria
| | - Babatope Ayodeji Kolawole
- Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria
| | - Anthony Olubunmi Akintomide
- Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria
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Fan L, Wu XJ. Sex difference for the risk of amputation in diabetic patients: A systematic review and meta-analysis. PLoS One 2021; 16:e0243797. [PMID: 33705430 PMCID: PMC7951841 DOI: 10.1371/journal.pone.0243797] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
The risk of amputation is a sequelae of diabetic foot ulceration, which are significantly increased in diabetic patients and caused huge morbidly and mortality. However, whether the risk amputation in diabetic patients are differing in male and female remains inconclusive. We therefore conducted a systematic review and meta-analysis to assess the sex difference for the risk of amputation in diabetic patients. We systematically searched PubMed, EmBase, and the Cochrane library to identify eligible study from their inception up to November 2020. The diagnostic value of male patients on subsequent amputation risk were assessed by using sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC). Twenty-two studies recruited a total of 33,686,171 diabetic patients were selected for quantitative analysis. The risk of amputation in male diabetic patients was greater than female diabetic patients (DOR: 1.38; 95%CI: 1.13–1.70; P<0.001). The sensitivity and specificity for male diabetic patients on the risk of amputation were 0.72 (95%CI: 0.72–0.73), and 0.51 (95%CI: 0.51–0.51), respectively. Moreover, the PLR and NLR of male diabetic patients for predicting amputation were 1.13 (95%CI: 1.05–1.22), and 0.82 (0.72–0.94), respectively. Furthermore, the AUC for male diabetic patients on amputation risk was 0.56 (95%CI: 0.48–0.63). This study found male diabetic patients was associated with an increased risk of amputation than female diabetic patients, and the predictive value of sex difference on amputation risk in diabetic patients was mild.
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Affiliation(s)
- Lei Fan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Orthopedic Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Xue-Jian Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * E-mail:
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Wu J, Liu M, Huang H. Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity. INT J LOW EXTR WOUND 2021; 21:609-616. [PMID: 33686903 DOI: 10.1177/1534734620982233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.
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Affiliation(s)
- Jialu Wu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Min Liu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Hui Huang
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
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Peng B, Min R, Liao Y, Yu A. Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer. J Diabetes Res 2021; 2021:6621035. [PMID: 33511218 PMCID: PMC7822701 DOI: 10.1155/2021/6621035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). METHODS AND MATERIALS In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. RESULTS 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. CONCLUSION Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.
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Affiliation(s)
- Bocheng Peng
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Rui Min
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, China
| | - Aixi Yu
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Wu T, Xie D, Zhao X, Xu M, Luo L, Deng D, Chen M. Enhanced Expression of miR-34c in Peripheral Plasma Associated with Diabetic Foot Ulcer in Type 2 Diabetes Patients. Diabetes Metab Syndr Obes 2021; 14:4263-4273. [PMID: 34703259 PMCID: PMC8526515 DOI: 10.2147/dmso.s326066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To explore the correlation between the expression of miR-34c in peripheral blood of patients with type 2 diabetes mellitus (T2DM) and the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO). METHODS Sixty newly diagnosed patients with T2DM without DFU (T2DM group), 112 T2DM patients with DFU (DFU group) and 60 controls with normal glucose tolerance (NC group). The DFU group patients were subdivided into DFO (n=64) and NDFO (n=48) groups. Quantitative real-time PCR (qRT-PCR) method was used to determine miR-34c expression levels in the peripheral blood of subjects to analyze the clinical characteristics of DFU and DFO risk factors. RESULTS MiR-34c expression level in the T2DM group was marked higher than the NC group [2.99 (1.45-6.22) vs 1.01 (0.89-1.52)] (P < 0.05). However, the expression level of miR-34c in the DFU group was significantly higher than the T2DM group [9.65 (6.15-18.63) vs 2.99 (1.45-6.22)] (P < 0.01). Compared with the NDFO group, the expression level of miR-34c in the DFO group was also obviously increased [13.46 (8.89-19.11) vs 6.02 (5.93-14.72)] (P < 0.01). The expression level of miR-34c in DFU patients was positively correlated with the amputation rate of foot ulcers (P=0.030) and was negatively correlated with the healing rate of foot ulcers after eight weeks (P=0.025). Multifactorial logistic regression analysis showed that increased expression of miR-34c was an independent risk factor for DFU and DFO (ORDFU=3.47, ORDFO=4.25, P < 0.01). Meanwhile, the ROC curve analysis indicated that the AUC of miR-34c for the diagnosis of DFU and DFO was 0.803 and 0.904, the optimum sensitivity being was 100% and 98.7%, the optimum specificity was 98.4% and 98.4%, respectively. CONCLUSION The increased expression of miR-34c in peripheral blood of T2DM patients is closely related to the occurrence, development and prognosis of DFU and DFO.
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Affiliation(s)
- Tingting Wu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Dandan Xie
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Xiaotong Zhao
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Murong Xu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Li Luo
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Datong Deng
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
- Correspondence: Mingwei Chen Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, 230032, People’s Republic of China Email
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Li XY, Qi X, Tian SH, He R, Jiang S, Li HJ. Impact of dedicated infectious disease teamwork on the treatment and prognosis of patients with diabetic foot infection. Int J Infect Dis 2020; 100:133-138. [PMID: 32916250 DOI: 10.1016/j.ijid.2020.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/10/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The aim was to develop and evaluate the impact of a new model in which the infectious disease (ID) physician and pharmacist work together to treat diabetic foot infections (DFIs). METHODS A quasi-experimental before-after study was conducted. The medical charts of inpatients with DFI admitted between April 1, 2017 and March 31, 2018 were reviewed retrospectively (control group, n = 30). Inpatients diagnosed with DFI between April 1, 2018 and March 31, 2019 were enrolled prospectively as the intervention group and received treatment through dedicated ID teamwork (intervention group, n = 35). RESULTS The distribution of infection severity and levels of metabolic criteria were similar in the two groups. Compared with the control group, the intervention group received adequate initial empirical treatment more frequently (96.8% vs 43.5%, p < 0.001) and had a shorter median duration of fever (1 day vs 7.5 days, p < 0.001). Rates of healing and relapse within 6 months were similar in the two groups, although the intervention group showed more sites of osteomyelitis (p = 0.036) and a higher percentage of polymicrobial infections (48.6% vs 10.0%, p = 0.001). CONCLUSION The early and full participation of ID physicians and pharmacists in the treatment of DFI facilitated targeted antimicrobial treatment and improved patient outcomes.
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Affiliation(s)
- Xiang-Yan Li
- Department of Anti-infection, Institute of Clinical Pharmacology, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Xin Qi
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shuo-Han Tian
- Department of Pharmacy, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Rui He
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shan Jiang
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Hui-Juan Li
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
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Li X, Tang Y, Jia Z, Zhao X, Chen M. Decreased expression of miR-24 in peripheral plasma of type 2 diabetes mellitus patients associated with diabetic foot ulcer. Wound Repair Regen 2020; 28:728-738. [PMID: 32710681 DOI: 10.1111/wrr.12850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/19/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
To examine the correlations of miR-24 expression in peripheral plasma with the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO) in type 2 diabetes mellitus (T2DM) patients and explore the clinical value of miR-24 as a potential biomarker for the diagnosis and treatment outcomes of DFU and DFO, a total of 60 newly diagnosed T2DM patients without DFU (T2DM group), 112 T2DM patients with DFU (DFU group), and 60 healthy controls (NC group) were included. DFU group were further divided into DFO group (n = 64) and non-DFO group (n = 48). MiR-24 levels were determined by quantitative real-time PCR, while clinical features and risk factors of DFU and DFO were explored. The expression level of miR-24 in T2DM and DFU group was significantly lower than in NC group (P < .05), and that in DFU group was significantly lower than in T2DM group (P < .01). Additionally, the level of miR-24 significantly decreased in DFO group compared to non-DFO group (P < .01). Moreover, it was negatively correlated with the amputation rate in DFU group (P = .043) and positively correlated with healing rate after 8 weeks (P = .036). The multivariate logistic regression analysis confirmed that a low expression of miR-24 was an independent risk factor for DFU and DFO. The ROC curve analysis indicated that the AUC of miR-24 for the diagnosis of DFU and DFO was 0.849 (95% CI, 0.618-0.879, P < .001) and 0.782 (95% CI, 0.595-0.813, P < .001). Thus, a decreased expression of miR-24 of T2DM patients was closely related to the occurrence, development and prognosis of DFU and DFO, suggesting the use of miR-24 as a potential biomarker for the prediction of DFU and DFO.
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Affiliation(s)
- Xueting Li
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Ying Tang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Zeguo Jia
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Xiaotong Zhao
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China.,Institute of Traditional Chinese Medicine for the Prevention and Control of Diabetes, Anhui Academy of Chinese Medicine, Hefei, PR China
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Costa MSA, Machado JC, Pereira MG. Longitudinal changes on the quality of life in caregivers of type 2 diabetes amputee patients. Scand J Caring Sci 2020; 34:979-988. [PMID: 31985865 DOI: 10.1111/scs.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/17/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE To explore changes in the quality of life of caregivers of amputees due to type 2 diabetes ten months after amputation. METHODS This is a longitudinal study with three moments of evaluation (T1: one month after surgery, T2: 7 months, T3: 10 months). The sample comprised 110, 101, and 84 caregivers of amputated patients with type 2 diabetes. Caregivers answered a Socio-demographic questionnaire; the Self-Assessment Caregiver; the Family Disruption from Illness Scale; and the Short Form Health Survey (SF36). RESULTS Stress levels were not significantly reflected in changes on mental quality of life over time, except in the caregivers who presented less stress, emphasizing the adverse role of stress when experienced on a continuous basis for ten months on the caregivers' mental well-being. Caregivers presented greater number of physical symptoms at T2 that decreased at T3. CONCLUSIONS According to the results, in order to promote caregivers' physical and mental quality of life, it would be important to evaluate stress levels especially in patients who presented somatic complaints.
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Affiliation(s)
| | - José C Machado
- Institute of Social Sciences, University of Minho, Braga, Portugal
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Sørensen MLB, Jansen RB, Wilbek Fabricius T, Jørgensen B, Svendsen OL. Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012. J Diabetes Res 2019; 2019:6429575. [PMID: 31583251 PMCID: PMC6754878 DOI: 10.1155/2019/6429575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/28/2019] [Accepted: 07/02/2019] [Indexed: 12/15/2022] Open
Abstract
AIM To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. METHODS A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. RESULTS Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p = 0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p = 0.6), 14% were amputated (p = 0.2), and 12.8% were dead within one year in 2011/2012 (p < 0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. CONCLUSION The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.
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Affiliation(s)
- Marie Louise Buhl Sørensen
- Department of Endocrinology I, Copenhagen Diabetes Foot Center, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Rasmus Bo Jansen
- Department of Endocrinology I, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
| | | | - Bo Jørgensen
- Copenhagen Diabetes Foot Center, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
| | - Ole Lander Svendsen
- Department of Endocrinology I, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
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