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Sloan G, Dela Pena P, Andag-Silva A, Cunanan E, Jimeno C, Robles JJ, Tesfaye S. Sheffield One-Stop Service: A potential model to improve the screening uptake of diabetic peripheral neuropathy and other microvascular complications of diabetes. J Diabetes Investig 2024; 15:1355-1362. [PMID: 39037334 DOI: 10.1111/jdi.14268] [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: 06/14/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight-threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10-g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low- to middle-income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One-Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One-Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource-limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world.
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Affiliation(s)
- Gordon Sloan
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pepito Dela Pena
- Section of Endocrinology, Diabetes and Metabolism, East Avenue Medical Center, Quezon City, Philippines
| | - Aimee Andag-Silva
- Section of Endocrinology and Diabetes, De La Salle University Medical Center, Cavite, Philippines
| | - Elaine Cunanan
- Section of Endocrinology, Diabetes and Metabolism, University of St. Tomas Hospital, Manila, Philippines
| | - Cecilia Jimeno
- Section of Endocrinology, Diabetes and Metabolism, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Jeremy Jones Robles
- Section of Endocrinology, Diabetes and Metabolism, Chong Hua Hospital, Cebu, Philippines
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Al-Ajlouni YA, Abouzid M, Tanashat M, Basheer AA, Al Ta'ani O, Bilgin-Badur N, Islam M. Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019. Int J Equity Health 2024; 23:178. [PMID: 39227932 PMCID: PMC11370275 DOI: 10.1186/s12939-024-02264-7] [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] [Received: 05/21/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.
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Affiliation(s)
- Yazan A Al-Ajlouni
- Department of Rehabilitation, Montefiore Medical Center, Bronx, NY, USA.
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA.
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St, Poznan, 60-806, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, 60-812, Poland
| | | | - Ahmed Ahmed Basheer
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Beni Suef University, Beni Suef Governorate, Egypt
| | | | | | - Mohammad Islam
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
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AlQahtani NJ, Al-Naib I, Althobaiti M. Recent progress on smart lower prosthetic limbs: a comprehensive review on using EEG and fNIRS devices in rehabilitation. Front Bioeng Biotechnol 2024; 12:1454262. [PMID: 39253705 PMCID: PMC11381415 DOI: 10.3389/fbioe.2024.1454262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/11/2024] Open
Abstract
The global rise in lower limb amputation cases necessitates advancements in prosthetic limb technology to enhance the quality of life for affected patients. This review paper explores recent advancements in the integration of EEG and fNIRS modalities for smart lower prosthetic limbs for rehabilitation applications. The paper synthesizes current research progress, focusing on the synergy between brain-computer interfaces and neuroimaging technologies to enhance the functionality and user experience of lower limb prosthetics. The review discusses the potential of EEG and fNIRS in decoding neural signals, enabling more intuitive and responsive control of prosthetic devices. Additionally, the paper highlights the challenges, innovations, and prospects associated with the incorporation of these neurotechnologies in the field of rehabilitation. The insights provided in this review contribute to a deeper understanding of the evolving landscape of smart lower prosthetic limbs and pave the way for more effective and user-friendly solutions in the realm of neurorehabilitation.
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Affiliation(s)
- Nouf Jubran AlQahtani
- Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibraheem Al-Naib
- Bioengineering Department, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
- Interdisciplinary Research Center for Communication Systems and Sensing, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
| | - Murad Althobaiti
- Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Sheng B, Pushpanathan K, Guan Z, Lim QH, Lim ZW, Yew SME, Goh JHL, Bee YM, Sabanayagam C, Sevdalis N, Lim CC, Lim CT, Shaw J, Jia W, Ekinci EI, Simó R, Lim LL, Li H, Tham YC. Artificial intelligence for diabetes care: current and future prospects. Lancet Diabetes Endocrinol 2024; 12:569-595. [PMID: 39054035 DOI: 10.1016/s2213-8587(24)00154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 05/16/2024] [Indexed: 07/27/2024]
Abstract
Artificial intelligence (AI) use in diabetes care is increasingly being explored to personalise care for people with diabetes and adapt treatments for complex presentations. However, the rapid advancement of AI also introduces challenges such as potential biases, ethical considerations, and implementation challenges in ensuring that its deployment is equitable. Ensuring inclusive and ethical developments of AI technology can empower both health-care providers and people with diabetes in managing the condition. In this Review, we explore and summarise the current and future prospects of AI across the diabetes care continuum, from enhancing screening and diagnosis to optimising treatment and predicting and managing complications.
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Affiliation(s)
- Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China; Key Laboratory of Artificial Intelligence, Ministry of Education, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Krithi Pushpanathan
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Quan Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhi Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Samantha Min Er Yew
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore; SingHealth Duke-National University of Singapore Diabetes Centre, Singapore Health Services, Singapore
| | - Charumathi Sabanayagam
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nick Sevdalis
- Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore
| | | | - Chwee Teck Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore; Institute for Health Innovation and Technology, National University of Singapore, Singapore; Mechanobiology Institute, National University of Singapore, Singapore
| | - Jonathan Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Elif Ilhan Ekinci
- Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School and Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
| | - Yih-Chung Tham
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
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Chen H, Wang Y, Ge S, Li W, Li J, Chen W. The effects of major dietary patterns on patients with type 2 diabetes: Protocol for a systematic review and network meta-analysis. PLoS One 2024; 19:e0306336. [PMID: 38941329 PMCID: PMC11213329 DOI: 10.1371/journal.pone.0306336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/12/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) represents a significant worldwide health issue, experiencing an increasing incidence rate. Effective dietary strategies are vital for T2DM management, but the optimal dietary patterns remain debated due to inconsistent research outcomes and single-outcome reporting. Network Meta-Analysis (NMA) provides a powerful approach for integrating data from randomized controlled trials (RCTs), enabling a detailed evaluation of the impact of different dietary patterns. This document presents our strategy for a systematic review and network meta-analysis, aimed at assessing the influence of key dietary patterns on glycemic control, lipid profiles, and weight management in individuals with Type 2 Diabetes Mellitus (T2DM). MATERIALS AND METHODS Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and network meta-analyses guidelines, we conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library, without language or date restrictions. Our objective is to assess the efficacy of various dietary interventions in managing Type 2 Diabetes Mellitus (T2DM). We used standardized mean differences for pairwise comparisons and a Bayesian framework for ranking interventions via Surface Under the Cumulative Ranking Curve (SUCRA). Key analyses include heterogeneity, transitivity, and sensitivity assessments, along with quality and risk evaluations using the Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. ETHICS AND DISSEMINATION This systematic review and network meta-analysis involve aggregate data from previous trials, obviating the need for additional ethical approval. The search strategy will be executed starting October 2023, with all searches completed by December 2023, to encompass the most current studies available. Findings will be shared through academic conferences and peer-reviewed journals focused on diabetes care and nutrition. TRIAL REGISTRATION PROSPERO registration number CRD42023465791.
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Affiliation(s)
- Hongyu Chen
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yuanyuan Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, Texas, United States of America
| | - Wanyang Li
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
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Abdo AI, Kopecki Z. Comparing Redox and Intracellular Signalling Responses to Cold Plasma in Wound Healing and Cancer. Curr Issues Mol Biol 2024; 46:4885-4923. [PMID: 38785562 PMCID: PMC11120013 DOI: 10.3390/cimb46050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Cold plasma (CP) is an ionised gas containing excited molecules and ions, radicals, and free electrons, and which emits electric fields and UV radiation. CP is potently antimicrobial, and can be applied safely to biological tissue, birthing the field of plasma medicine. Reactive oxygen and nitrogen species (RONS) produced by CP affect biological processes directly or indirectly via the modification of cellular lipids, proteins, DNA, and intracellular signalling pathways. CP can be applied at lower levels for oxidative eustress to activate cell proliferation, motility, migration, and antioxidant production in normal cells, mainly potentiated by the unfolded protein response, the nuclear factor-erythroid factor 2-related factor 2 (Nrf2)-activated antioxidant response element, and the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway, which also activates nuclear factor-kappa B (NFκB). At higher CP exposures, inactivation, apoptosis, and autophagy of malignant cells can occur via the degradation of the PI3K/Akt and mitogen-activated protein kinase (MAPK)-dependent and -independent activation of the master tumour suppressor p53, leading to caspase-mediated cell death. These opposing responses validate a hormesis approach to plasma medicine. Clinical applications of CP are becoming increasingly realised in wound healing, while clinical effectiveness in tumours is currently coming to light. This review will outline advances in plasma medicine and compare the main redox and intracellular signalling responses to CP in wound healing and cancer.
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Affiliation(s)
- Adrian I. Abdo
- Richter Lab, Surgical Specialties, Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Department of Surgery, The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Zlatko Kopecki
- Future Industries Institute, STEM Academic Unit, University of South Australia, Mawson Lakes, SA 5095, Australia
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Siddiqui NA, Khaliq MA, Pirzada MA, Rehman Z, Shaikh F, Riaz A, Khan S. Development and content validation of a financial and functional outcomes tool for diabetes-related foot disease in patients undergoing major lower limb amputation: a prospective observational study from Pakistan. BMJ Open 2024; 14:e080853. [PMID: 38553052 PMCID: PMC10982708 DOI: 10.1136/bmjopen-2023-080853] [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: 10/12/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To develop and content validate a questionnaire to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease. DESIGN Prospective observational study. SETTING This study was conducted at a tertiary care centre in Pakistan. PARTICIPANTS We conducted a thorough literature review and a group interview with 10 participants, resulting in domain identification and item generation. The group included seven patients with diabetes-related foot disease who underwent major lower limb amputation and three caregivers. Subsequently, a focused group discussion was held to assess overlap and duplication among the items, and two rounds of content validation were carried out by five content and five lay experts in both English and Urdu. Question items with a Content Validity Index (CVI) score of >0.79 were retained, items with a CVI score between 0.70 and 0.79 were revised and items with a CVI score of <0.70 were excluded. RESULTS The initial literature review and group interview resulted in 61 items in the financial and functional domains. After the focused group discussion, the questionnaire was reduced to 37 items. Following two rounds of content validation, the English questionnaire achieved the Scale-Content Validity Index/Average (S-CVI/Ave) of 0.92 and 0.89 on relevance and clarity, respectively. Similarly, the Urdu questionnaire achieved the S-CVI-Ave of 0.92 and 0.95, respectively. CONCLUSION A 37-item multidimensional questionnaire was developed and rigorously content-validated to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease. The questionnaire used in this study has shown robust content validity specifically for our population.
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Affiliation(s)
| | | | | | - Ziaur Rehman
- Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Fareed Shaikh
- Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Amna Riaz
- Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sadaf Khan
- Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
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Ge L, Zhao J, Tan M, Tan E, Liew H, Yong E, Hoe J, Shi C, Chan DYS, Ang GY, Molina JA, Sun Y, Hoi WH, Chandraskear S, Lo ZJ. Multi-disciplinary diabetic limb salvage programme in octogenarians with diabetic foot ulcers is not futile: An observational study with historical controls. Int Wound J 2024; 21:e14801. [PMID: 38426365 PMCID: PMC10905330 DOI: 10.1111/iwj.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/02/2024] Open
Abstract
This study evaluated the effectiveness of a multi-disciplinary diabetic limb salvage programme in improving clinical outcomes and optimising healthcare utilisation in 406 patients aged ≥80 years with diabetic foot ulcers (DFUs), compared to 2392 younger patients enrolled from June 2020 to June 2021 and against 1716 historical controls using one-to-one propensity score matching. Results showed that elderly programme patients had lower odds of amputation-free survival (odds ratio: 0.64, 95% CI: 0.47, 0.88) and shorter cumulative length of stay (LOS) compared to younger programme patients (incidence rate ratio: 0.45, 95% CI: 0.29, 0.69). Compared to the matched controls, participating in the programme was associated with 5% higher probability of minor lower extremity amputation, reduced inpatient admissions and emergency visits, shorter LOS but increased specialist and primary care visits (all p-values <0.05). The findings suggest that the programme yielded favourable impacts on the clinical outcomes of patients aged≥80 years with DFUs. Further research is needed to develop specific interventions tailoring to the needs of the elderly population and to determine their effectiveness on patient outcomes while accounting for potential confounding factors.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes ResearchNational Healthcare GroupSingaporeSingapore
| | - Jiashen Zhao
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Matthew Tan
- Section of Vascular Surgery, Department of Surgery and CancerImperial College LondonLondonUK
| | - Elaine Tan
- Medical DepartmentNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Huiling Liew
- Department of EndocrinologyTan Tock Seng HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Jeremy Hoe
- Department of EndocrinologyKhoo Teck Puat HospitalSingaporeSingapore
| | - Claris Shi
- Department of Orthopaedics SurgeryKhoo Teck Puat HospitalSingaporeSingapore
| | - Dexter Yak Seng Chan
- Vascular Surgery Service, Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
| | - Gary Yee Ang
- Health Services and Outcomes ResearchNational Healthcare GroupSingaporeSingapore
| | | | - Yan Sun
- Health Services and Outcomes ResearchNational Healthcare GroupSingaporeSingapore
| | - Wai Han Hoi
- Department of EndocrinologyWoodlands HealthSingaporeSingapore
| | - Sadhana Chandraskear
- Vascular Surgery Service, Department of SurgeryWoodlands HealthSingaporeSingapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of SurgeryWoodlands HealthSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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Darwis P, Syaifudin A, Suhartono R, Muradi A, Pratama D, Dewi DK, Hamzah A. Associations Between Systolic Pressure, Vascular Waveform, and Volume Flow with Debridement or Amputation Treatment Decisions in Diabetic Foot Ulcer Patients. INT J LOW EXTR WOUND 2024:15347346241233364. [PMID: 38389316 DOI: 10.1177/15347346241233364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Diabetic foot ulcer disease, affecting 6.3% of the global population, necessitates crucial decisions regarding debridement and amputation, with substantial cost, morbidity, and mortality implications. This study's primary goal is to determine effective vascular examination modalities, including systolic blood pressure, vascular waveforms, and blood volume flow to guide optimal treatments for diabetic foot patients. METHOD This cross-sectional study at Cipto Mangunkusumo General Hospital aimed to identify effective vascular examination modalities, such as systolic blood pressure, vascular waveforms, and blood volume flow, to guide treatment choices for diabetic foot patients. The study included 38 subjects, equally split between debridement and amputation groups. RESULTS Notably, the presence of a biphasic pattern in popliteal artery vascular examinations was associated with the decision for amputation in diabetic foot patients (p < 0.05). The Chi-square test revealed that a biphasic ultrasound pattern served as a predictive factor for amputation among diabetic foot patients, with three times more biphasic patients choosing amputation over debridement. Conversely, assessments of popliteal artery systolic pressure, common femoral artery waveform, popliteal artery volume flow, and common femoral artery volume flow showed no significant correlations with the choice of debridement or amputation treatment for diabetic foot patients. CONCLUSION In summary, ultrasound assessment of vascular waveform in the popliteal artery emerges as a predictive factor for amputation or debridement in diabetic foot patients.
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Affiliation(s)
- Patrianef Darwis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Syaifudin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Raden Suhartono
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Akhmadu Muradi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dedy Pratama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dian Kusuma Dewi
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Alif Hamzah
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Li X, Wen S, Dong M, Yuan Y, Gong M, Wang C, Yuan X, Jin J, Zhou M, Zhou L. The Metabolic Characteristics of Patients at the Risk for Diabetic Foot Ulcer: A Comparative Study of Diabetic Patients with and without Diabetic Foot. Diabetes Metab Syndr Obes 2023; 16:3197-3211. [PMID: 37867628 PMCID: PMC10590077 DOI: 10.2147/dmso.s430426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Backgrounds and Objective Diabetic foot is a relatively severe complication in patients with type 2 diabetes (T2D), with peripheral neuropathy and angiopathy frequently serving as risk factors. However, it is unknown how the other major systemic metabolic factors impacted the profile of these patients, besides glucose management. Thus, we investigated the distinct characteristics of patients with diabetic foot ulcers and their relationships with angiopathy. Materials and Methods We obtained the laboratory data of 334 diabetic patients at Shanghai Pudong Hospital from 2020 to 2023. The comparisons were performed between the groups with or without diabetic foot, including glucose metabolism, lipids profile, liver and kidney function, thyroid function, and serum iron. The association between metabolic factors and lower extremity computed tomography angiography (CTA) was analyzed. Results We found significant disparities between groups in relation to age, serum protein content, liver transferase, serum creatinine, estimated glomerular filtration rate (eGFR), serum uric acid (UA), small dense low-density lipoprotein (sdLDL), lipoprotein A (LP(a)), apolipoprotein A1 (APOA1), thyroid function, serum iron, and hemoglobin (Hb) (p<0.05). The Spearman correlational analyses showed that the severity of CTA, categorized by the unilateral or bilateral plaque or occlusion, was positively significantly correlated with UA (r=0.499), triglyceride (TG) (r=0.751), whereas inversely correlated with serum albumin (r=-0.510), alanine aminotransferase (r=-0.523), direct bilirubin (DBil) (r=-0.494), total bilirubin (TBil) (r=-0.550), Hb (r=-0.646). Conclusion This cross-section investigation showed that compared to T2D only, the patients with diabetic foot ulcer (DFU) might display similar glucose metabolic control context but adverse metabolic profiles, and this profile is associated with macrovascular angiopathy characteristics and their severity.
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Affiliation(s)
- Xiucai Li
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Meiyuan Dong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
| | - Yue Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Min Gong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Congcong Wang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Xinlu Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Jianlan Jin
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Mingyue Zhou
- Clinical Research OB/GYN REI Division, University of California, San Francisco, CA, USA
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, 201399, People’s Republic of China
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Al-Quwaidhi AJ, AlSaleh EM. Future Projections of Diabetes-Related Amputations in Eastern Saudi Arabia During 2022-2045 Using a Validated Epidemiological Model. Cureus 2023; 15:e45972. [PMID: 37900427 PMCID: PMC10600592 DOI: 10.7759/cureus.45972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Diabetes-related amputations (DRA) are associated with significant morbidity and mortality. There are limited studies on the burden of this condition and its future projections in Saudi Arabia. OBJECTIVES To estimate future forecasts in the burden of DRA (number of cases and mortalities) among adult diabetics (aged ≥20 years) in Al-Ahsa, Eastern Region of Saudi Arabia from 2022 to 2045. METHODS A simulation epidemiological model was designed and validated. It is a simple discrete-state model composed of multiple states, in which diabetics make annual transitions to either 'Major Amputations', 'Minor Amputations', or 'No Amputations' states, and then to two states of mortalities. The data inputs required are minimal, including the total diagnosed cases of diabetes for 2022 and transition parameters obtained from recent published literature. The model used some reasonable assumptions and scenarios for testing potential uncertainties around the model outputs. Model validation was conducted by comparing its estimates with the observed local data from two main hospitals in Al-Ahsa for 2022. RESULTS The model projected that the total number of DRA among diabetics in Al-Ahsa will increase from 129 (uncertainty interval (UI): 103-154) in 2022 to 169 (UI: 136-203) in 2030 and 227 (UI: 182-272) in 2045, assuming that the incidence rates of major and minor amputations among diabetics will remain constant. However, assuming that these incidence rates will show a gradual decline of 20% every three years, the model predicted the total number of DRA to decrease from 103 (UI: 82-124) in 2022 to 91 (UI: 73-110) in 2030 and 61 (UI: 49-74) in 2045. CONCLUSION DRA impose a considerable burden on patients and the healthcare system, despite the possibility of a potential decrease in incidence rates.
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Affiliation(s)
| | - Essa M AlSaleh
- Infection Control, Al-Ahsa Directorate of Health Affairs, Ministry of Health, Hofuf, SAU
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