1
|
Di Giovanni P, Scampoli P, Meo F, Cedrone F, D'Addezio M, Di Martino G, Valente A, Romano F, Staniscia T. The impact of gender on diabetes-related lower extremity amputations: An Italian regional analysis on trends and predictors. Foot Ankle Surg 2021; 27:25-29. [PMID: 31983557 DOI: 10.1016/j.fas.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Accepted: 01/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetes-related lower extremity amputations (LEAs) are a major public health issue. The aim of the study was to evaluate trends by gender and predictors of LEAs in an Italian region. METHODS Data were collected from hospital discharge records between 2006 and 2015. Gender- and age-adjusted standardised hospitalisation rates for major and minor amputations were calculated. Poisson regression model was performed to estimate trends in LEAs. RESULTS Hospitalisation rates decreased for minor amputations both among males (-30.0%) and females (-5.3%), while the major amputation rates decreased only for males (-44.7%). Males were at higher risk of undergoing major (IRR 1.41, 95%CI 1.19-1.67) and minor (IRR 1.62, 95%CI 1.45-1.82) amputations. Peripheral vascular disease was the leading predictor of major and minor amputations. CONCLUSION A significant reduction of LEAs was observed only for males. Identifying their predictable factors may help caregivers to provide higher standards of diabetes care.
Collapse
Affiliation(s)
- Pamela Di Giovanni
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Piera Scampoli
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
| | - Francesca Meo
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Fabrizio Cedrone
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Michela D'Addezio
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Giuseppe Di Martino
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Alessandra Valente
- School of Hygiene and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Ferdinando Romano
- Department of Public Health and Infectious Disease, "La Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Tommaso Staniscia
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| |
Collapse
|
2
|
Lázaro-Martínez JL, Edmonds M, Rayman G, Apelqvist J, Van Acker K, Hartemann A, Martini J, Lobmann R, Bohbot S, Kerihuel JC, Piaggesi A. Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer. J Wound Care 2019; 28:358-367. [DOI: 10.12968/jowc.2019.28.6.358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect. Method: In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location. Results: For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group. Conclusion: This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.
Collapse
Affiliation(s)
| | | | - Gerry Rayman
- The Ipswich Diabetic Foot Unit, Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | | | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jacques Martini
- Department of Endocrinology, Rangueil University Hospital, Toulouse, France
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Germany
| | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO, Paris, France
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| |
Collapse
|