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Zhong J, Lin X, Zheng X, Zhou Y, Huang H, Xu L. Diminished levels of insulin-like growth factor-1 may be a risk factor for peripheral neuropathy in type 2 diabetes patients. J Diabetes Investig 2024. [PMID: 38923403 DOI: 10.1111/jdi.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS/INTRODUCTION To investigate risk factors for diabetic peripheral neuropathy (DPN) and to explore the connection between insulin-like growth factor-1 (IGF-1) and DPN in individuals with type 2 diabetes. MATERIALS AND METHODS A total of 790 patients with type 2 diabetes participated in a cross-sectional study, divided into two groups: those with DPN (DPN) and those without DPN (non-DPN). Blood samples were taken to measure IGF-1 levels and other biochemical markers. Participants underwent nerve conduction studies and quantitative sensory testing. RESULTS Patients with DPN exhibited significantly lower levels of IGF-1 compared with non-DPN patients (P < 0.001). IGF-1 was positively correlated with the average amplitude of both motor (P < 0.05) and sensory nerves (P < 0.05), but negatively correlated with the vibration perception threshold (P < 0.05). No significant difference was observed between IGF-1 and nerve conduction velocity (P > 0.05), or the temperature detection threshold (P > 0.05). Multivariate regression analysis identified diabetes duration, HbA1c, and the low levels of IGF-1 as independent risk factors (P < 0.001). Receiver operating characteristic analysis determined that at 8 years duration of diabetes, 8.5% (69.4 mmol/mol) HbA1c and 120 ng/mL IGF-1, the optimal cut-off points, indicated DPN (P < 0.001). CONCLUSIONS A reduction of IGF-1 in patients with DPN suggests a potential protective role against axon injury in large fiber nerves of type 2 diabetes patients.
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Affiliation(s)
- Jingyi Zhong
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaopu Lin
- Department of Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaobin Zheng
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanting Zhou
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Haishan Huang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Lingling Xu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Sánchez CA, De Vries E, Gil F, Niño ME. Prediction model for lower limb amputation in hospitalized diabetic foot patients using classification and regression trees. Foot Ankle Surg 2024:S1268-7731(24)00068-7. [PMID: 38575484 DOI: 10.1016/j.fas.2024.03.007] [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] [Received: 11/17/2023] [Revised: 03/01/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The decision to perform amputation of a limb in a patient with diabetic foot ulcer (DFU) is not an easy task. Prediction models aim to help the surgeon in decision making scenarios. Currently there are no prediction model to determine lower limb amputation during the first 30 days of hospitalization for patients with DFU. METHODS Classification And Regression Tree analysis was applied on data from a retrospective cohort of patients hospitalized for the management of diabetic foot ulcer, using an existing database from two Orthopaedics and Traumatology departments. The secondary analysis identified independent variables that can predict lower limb amputation (mayor or minor) during the first 30 days of hospitalization. RESULTS Of the 573 patients in the database, 290 feet underwent a lower limb amputation during the first 30 days of hospitalization. Six different models were developed using a loss matrix to evaluate the error of not detecting false negatives. The selected tree produced 13 terminal nodes and after the pruning process, only one division remained in the optimal tree (Sensitivity: 69%, Specificity: 75%, Area Under the Curve: 0.76, Complexity Parameter: 0.01, Error: 0.85). Among the studied variables, the Wagner classification with a cut-off grade of 3 exceeded others in its predicting capacity. CONCLUSIONS Wagner classification was the variable with the best capacity for predicting amputation within 30 days. Infectious state and vascular occlusion described indirectly by this classification reflects the importance of taking quick decisions in those patients with a higher compromise of these two conditions. Finally, an external validation of the model is still required. LEVEL OF EVIDENCE III.
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Affiliation(s)
- C A Sánchez
- Department of Orthopedics and Traumatology, Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Hospital de la Samaritana, Bogotá, Colombia; Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - E De Vries
- Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - F Gil
- Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M E Niño
- Department of Orthopedics and Traumatology, Pontificia Universidad Javeriana, Foot and Ankle Surgery, Clínica del Country and Hospital Militar Central, Bogotá, Colombia
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Xu JW, Xu X, Ling Y, Wang YC, Huang YJ, Yang JZ, Wang JY, Shen X. Vincamine as an agonist of G-protein-coupled receptor 40 effectively ameliorates diabetic peripheral neuropathy in mice. Acta Pharmacol Sin 2023; 44:2388-2403. [PMID: 37580494 PMCID: PMC10692181 DOI: 10.1038/s41401-023-01135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/09/2023] [Indexed: 08/16/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, which has yet no curable medication. Neuroinflammation and mitochondrial dysfunction are tightly linked to DPN pathology. G-protein-coupled receptor 40 (GPR40) is predominantly expressed in pancreatic β-cells, but also in spinal dorsal horn and dorsal root ganglion (DRG) neurons, regulating neuropathic pain. We previously have reported that vincamine (Vin), a monoterpenoid indole alkaloid extracted from Madagascar periwinkle, is a GPR40 agonist. In this study, we evaluated the therapeutic potential of Vin in ameliorating the DPN-like pathology in diabetic mice. Both STZ-induced type 1 (T1DM) and db/db type 2 diabetic (T2DM) mice were used to establish late-stage DPN model (DPN mice), which were administered Vin (30 mg·kg-1·d-1, i.p.) for 4 weeks. We showed that Vin administration did not lower blood glucose levels, but significantly ameliorated neurological dysfunctions in DPN mice. Vin administration improved the blood flow velocities and blood perfusion areas of foot pads and sciatic nerve tissues in DPN mice. We demonstrated that Vin administration protected against sciatic nerve myelin sheath injury and ameliorated foot skin intraepidermal nerve fiber (IENF) density impairment in DPN mice. Moreover, Vin suppressed NLRP3 inflammasome activation through either β-Arrestin2 or β-Arrestin2/IκBα/NF-κB signaling, improved mitochondrial dysfunction through CaMKKβ/AMPK/SIRT1/PGC-1α signaling and alleviated oxidative stress through Nrf2 signaling in the sciatic nerve tissues of DPN mice and LPS/ATP-treated RSC96 cells. All the above-mentioned beneficial effects of Vin were abolished by GPR40-specific knockdown in dorsal root ganglia and sciatic nerve tissues. Together, these results support that pharmacological activation of GPR40 as a promising therapeutic strategy for DPN and highlight the potential of Vin in the treatment of this disease.
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Affiliation(s)
- Jia-Wen Xu
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Xu Xu
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yun Ling
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yan-Chun Wang
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yu-Jie Huang
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Juan-Zhen Yang
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jia-Ying Wang
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Xu Shen
- Jiangsu Key Laboratory of Drug Target and Drug for Degenerative Diseases, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Nanjing, 210023, China.
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Tang F, Abdul Razak SNB, Tan JX, Choke ETC, Zainudin SB. Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231196464. [PMID: 37786405 PMCID: PMC10541744 DOI: 10.1177/11795514231196464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/13/2023] [Indexed: 10/04/2023] Open
Abstract
Background Diabetic foot ulcers (DFUs) are debilitating to the patient and costly for the healthcare system. We set up the Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic with the aim of providing early directed specialist care to patients with DFUs. With early management, we hope to treat DFUs in its early stages, reducing the need for and associated morbidity of major and minor lower limb amputations. Objectives We evaluated the outcomes of the fast-access DREAM clinic with multi-disciplinary evaluation for patients with DFUs. Outcomes include time from the point of referral to DREAM clinic evaluation, amputation rates and wound healing rates. Design Patients presenting with DFU to the DREAM clinic were enrolled. A podiatrist made the first assessment, followed by immediate specialist consultation with Endocrinologists, Vascular surgeons or Orthopaedic surgeons as required. Methods Data on baseline demographics and DFU characteristics were collected. Outcomes evaluated were wound healing at 12 weeks, wound salvage rates, time to DREAM clinic access and time to specialist referral. Results Sixty-eight patients were enrolled, with 57.3% males, and mean age of 63 ± 13.0 years. Majority of ulcers were classified as neuropathic (41.3%) and located at the digits (40%). At 12-weeks follow-up, 1 had undergone major amputation, 9 minor amputations and 4 surgical debridements. The median time to DREAM clinic evaluation from first presentation was 3 days (IQR 7). Eleven (16.2%) required >1 specialist consult. Twenty (29.4%) were hospitalised for treatment. Twelve underwent revascularisation within 4 days (IQR 3.5). Twenty-four patients (35.3%) continued podiatry follow-up, having 28 DFUs in which 20 (71.4%) healed within 12 weeks. Conclusion The fast-access multidisciplinary DREAM clinic shows promising outcomes with lower major amputation rates and exemplary DFU healing outcomes.
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Affiliation(s)
- Fengjie Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Sueziani Binte Zainudin
- Department of Endocrinology, Department of General Medicine, Sengkang General Hospital, Singapore
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Khan S, Mohammadnezhad M, Ratu A, Ghosh A, Ali W, Nand D, Mangum T. Patterns and risk factors associated with index Lower Extremity Amputations (LEA) among Type 2 Diabetes Mellitus (T2DM) patients in Fiji. Prim Care Diabetes 2021; 15:1012-1018. [PMID: 34284950 DOI: 10.1016/j.pcd.2021.07.007] [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: 06/05/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
AIM To describe patterns of index (first ever) Lower Extremity Amputations (LEA) and to determine factors associated with their occurrence amongst Type 2 Diabetes Mellitus (T2DM) patients in Fiji. METHODS This cross-sectional study was conducted that adheres to the STROBE check lists for observational research among T2DM patients who experienced index LEA at the Colonial War Memorial Hospital (CWMH) in Fiji between 2011 and 2015. Demographic and clinical variables were extracted from patient folders. Univariate and multivariate logistic regression were used to determine factors associated with Major LEA. A p-value < 0.05 was considered significant. RESULTS A total of 649 study participants were studied with the average age of index amputation was 58.4 years (±9.6 years, range 30-91 years). The average duration of T2DM was 9.5 ± 5.7 years. LEAs were more common amongst males (55%) and indigenous Fijians (71.8%). One-third of index LEA (33%) were major amputations. Factors associated with occurrence of Major LEA were poor Random Blood Sugar (RBS) levels (OR = 1.68, 95% CI: 1.01, 2.81), midfoot lesion (OR = 9.38 95% CI: 4.95, 19.52), septicaemia (OR = 2.42, 95% CI: 1.28, 4.57), low haemoglobin level (OR = 0.78 95% CI: 0.72, 0.86), and history of hypertension (OR = 0.58, 95% CI: 0.40, 0. 84). CONCLUSIONS Results indicate that diabetic patients with foot infections present late to tertiary level care. Our findings also show an urgent need to strengthen primary care interventions and surveillance of both diabetes and diabetic LEA.
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Affiliation(s)
- Sabiha Khan
- School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
| | - Masoud Mohammadnezhad
- School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Anaseini Ratu
- School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Anamica Ghosh
- School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Wahed Ali
- School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Devina Nand
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Tamara Mangum
- University of Health Sciences Antigua, Antigua and Barbuda
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Rossboth S, Rossboth B, Schoenherr H, Lechleitner M, Oberaigner W. Risk factors for diabetic foot complications among patients with type 2 diabetes in Austria-A registry-based retrospective cohort study. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00286. [PMID: 34505418 PMCID: PMC8502226 DOI: 10.1002/edm2.286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/29/2022]
Abstract
Aims Diabetic foot complications, a serious consequence of diabetes mellitus, are associated with a tremendous burden on both individual patients and health care systems. Since prevention strategies may reduce the incidence of this complication, identification of risk factors in large longitudinal studies is essential to optimize early detection and personalized screening of patients at increased risk. Materials and methods We conducted a registry‐based retrospective cohort study using data from 10,688 patients with type 2 diabetes mellitus aged ≥18 years. Cox regression models were used to identify risk factors for foot complications while adjusting for potential confounders. Results We observed 140 diabetic foot complications in our patient cohort. The multivariate Cox regression model revealed neuropathy, peripheral arterial disease and male gender as being positively associated with foot complications. The same effect was detected for nephropathy in the time >10 years after T2DM diagnosis. For higher age at diagnosis and use of insulin, however, a negative association was retrieved. Conclusion Male gender and several diabetes‐related comorbidities were identified as risk factors for subsequent initial foot complications in patients with type 2 diabetes mellitus. These findings suggest that personalized early detection of patients at increased risk might be feasible by using information on demographics, medical history and comorbidities.
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Affiliation(s)
- Sophia Rossboth
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria
| | | | - Hans Schoenherr
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria.,Department of Internal Medicine, St. Vinzenz Hospital Zams, Zams, Austria
| | | | - Willi Oberaigner
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria
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Khodaie SA, Khalilzadeh SH, Emadi F, Kamalinejad M, Jafari Hajati R, Naseri M. Management of a diabetic foot ulcer with a Myrtle (M. communis) gel based on Persian medicine: A case report. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elgzyri T, Apelqvist J, Lindholm E, Örneholm H, Annersten Gershater M. Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene. SAGE Open Med 2021; 9:20503121211029180. [PMID: 34262765 PMCID: PMC8246462 DOI: 10.1177/20503121211029180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3-234) weeks. Results Four hundred and seventy-six patients were included. The median age was 73 (35-95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3-234) weeks; for auto-amputated, 48 (10-228) weeks; for minor amputated, 48 (6-234) weeks; and for major amputation, 32 (3-116) weeks. Conclusion Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.
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Affiliation(s)
- Targ Elgzyri
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Eero Lindholm
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Hedvig Örneholm
- Department of Orthopaedic Surgery, Skåne University Hospital, Malmö, Sweden
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Rossboth S, Rossboth B, Schoenherr H, Ciardi C, Lechleitner M, Oberaigner W. Diabetic foot complications-lessons learned from real-world data derived from a specialized Austrian hospital. Wien Klin Wochenschr 2021; 134:7-17. [PMID: 33938984 DOI: 10.1007/s00508-021-01864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diabetic foot complications, one of the most severe late complications of type 2 diabetes mellitus, are associated with a tremendous personal and financial burden. In order to drive the prevention of diabetic foot complications forward and facilitate early detection and personalized screening of high-risk patients, longitudinal studies are needed to identify risk factors associated with diabetic foot complications in large patient datasets. METHODS This is a retrospective cohort study on 3002 patients with type 2 diabetes mellitus aged ≥ 18 years without prior foot complications. The data were collected between 2006 and 2017 in an Austrian hospital department specialized for diabetic patients. In addition to a univariate Cox regression analysis, multivariate Cox regression models were established to identify independent risk factors associated with diabetic foot complications and adjust for potential confounders. RESULTS We observed a total of 61 diabetic foot complications in 3002 patients. In the multivariate Cox regression model, significant risk factors (hazard ratio, 95% confidence interval) for foot complications were age at diagnosis > 70 years (3.39, 1.33-8.67), male gender (2.55, 1.42-4.55), neuropathy (3.03, 1.74-5.27), peripheral arterial disease (3.04, 1.61-5.74), hypertension > 10 years after diagnosis (2.32, 1.09-4.93) and HbA1c > 9% (2.44, 1.02-5.83). CONCLUSION The identified risk factors for diabetic foot complications suggest that personalized early detection of patients at high risk might be possible by taking the patient's clinical characteristics, medical history and comorbidities into account. Modifiable risk factors, such as hypertension and high levels of blood glucose might be tackled to reduce the risk for diabetic foot complications.
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Affiliation(s)
- Sophia Rossboth
- Research Unit for Diabetes Epidemiology, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.
| | | | - Hans Schoenherr
- Research Unit for Diabetes Epidemiology, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Department of Internal Medicine, St. Vinzenz Hospital Zams, Zams, Austria
| | - Christian Ciardi
- Department of Internal Medicine, St. Vinzenz Hospital Zams, Zams, Austria
| | | | - Willi Oberaigner
- Research Unit for Diabetes Epidemiology, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Kang S, Zhong Y, Liu D, Li W. Traditional Chinese medicine fumigation as auxiliary treatment of diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24200. [PMID: 33530212 PMCID: PMC7850683 DOI: 10.1097/md.0000000000024200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is 1 of the most common clinical complications of diabetes, which seriously affects the quality of life of patients and causes a substantial economic burden on diabetes care. The pathogenesis of DPN is complex. There is no targeted treatment method, and mainstream treatment methods have low efficacy and large side effects. Traditional Chinese medicine has rich clinical experience in the prevention and treatment of diabetic peripheral neuropathy, which has dramatically improved the quality of life of patients. It is clinically proven that traditional Chinese medicine fumigants (TCMF) have apparent effects in treating diabetic peripheral neuropathy. Therefore, we aim to systematically review the effectiveness and safety of TCMF for DPN. METHODS We will search the following databases: PubMed, Embase, Cochrane Library, MEDLINE, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Cqvip Database, and Wanfang Data. Besides, we will also search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The studies published from the inception of the database to November 2020 will be retrieved. The randomized controlled trials on TCMF for DPN will be included. Also, we will search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The main result is clinical efficacy and nerve conduction velocity. Fasting blood glucose, 2 hours postprandial blood glucose, blood lipid, glycosylated hemoglobin, and adverse events are secondary results. We will perform the analyses using RevMan V.5.3 software. RESULTS This study will provide a high-quality comprehensive evaluation of the efficacy and safety of TCMF in the treatment of DPN. CONCLUSIONS This systematic review will evaluate the effectiveness and safety of TCMF in the treatment of DPN, and provide the latest evidence for clinical application. INPLASY REGISTRATION NUMBER INPLASY2020110137.
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Affiliation(s)
- Shixin Kang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine
| | - Yanmei Zhong
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Donghao Liu
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine
| | - Weihong Li
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine
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Rossboth S, Lechleitner M, Oberaigner W. Risk factors for diabetic foot complications in type 2 diabetes-A systematic review. Endocrinol Diabetes Metab 2021; 4:e00175. [PMID: 33532615 PMCID: PMC7831214 DOI: 10.1002/edm2.175] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Aims With increasing numbers of patients with type 2 diabetes mellitus (T2DM) worldwide, the number of associated diabetic foot complications might also increase. This systematic review was performed to summarize published data about risk factors for the diabetic foot (DF) syndrome in order to improve the identification of high-risk patients. Materials and methods Six electronic databases were searched for publications up to August 2019 using predefined stringent inclusion and exclusion criteria. Results Of 9,476 identified articles, 31 articles from 28 different study populations fulfilled the criteria for our evaluation. The overall quality of the studies was good, and the risk of bias was low. There was large heterogeneity among the studies concerning study protocols and patient populations analysed. A total of 79 risk factors were analysed within this review. The majority of studies described a consistently positive association with different outcomes of interest related to DF for gender, peripheral neuropathy, retinopathy, nephropathy, poor glycaemic control, insulin use, duration of diabetes, smoking and height. For age, hypertension, dyslipidaemia and body mass index, the results remain inconsistent. Conclusion A most up-to-date literature review resulted in glycaemic control and smoking as the only amenable risk factors with a consistently positive association for DF. Due to the high personal and financial burden associated with DF and the large heterogeneity among included studies, additional longitudinal studies in large patient populations are necessary to identify more modifiable risk factors that can be used in the prediction and prevention of DF complications.
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Affiliation(s)
- Sophia Rossboth
- Medical Informatics and TechnologyPublic Health, Health Services Research and Health Technology AssessmentUMIT ‐ University for Health SciencesHall in TrollAustria
| | | | - Willi Oberaigner
- Medical Informatics and TechnologyPublic Health, Health Services Research and Health Technology AssessmentUMIT ‐ University for Health SciencesHall in TrollAustria
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Lim KK, Lee VSY, Tan CS, Kwan YH, Lim ZHX, Wee HL, Østbye T, Low LL. Examining the heterogeneity inexcess risks of coronary heart disease, stroke, dialysis, and lower extremity amputation associated with type 2 diabetes mellitus across demographic subgroups in an Asian population: A population-based matched cohort study. Diabetes Res Clin Pract 2021; 171:108551. [PMID: 33238174 DOI: 10.1016/j.diabres.2020.108551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS To examine whether the excess risks of coronary heart disease (CHD), stroke, dialysis, and lower extremity amputation (LEA) associated with type 2 diabetes mellitus (T2DM) differ across age, sex, and ethnicity in Singapore. METHODS Using a 10-year administrative data, we matched individuals with T2DM using nearest neighbour matching, to those without, in 1:2 ratio. To examine whether the excess risks were heterogeneous across age, sex, and ethnicity, we generated interaction terms of age, sex, and ethnicity with T2DM status in Cox proportional hazard (PH) models. RESULTS The main analyses included ~1 million person years, comprising 66,099 and 120,485 individuals with and without T2DM, respectively. The associations of T2DM with CHD and dialysis, split into two time periods to address violation of PH assumption, were higher with older age in short-term but lower with older age in long-term. The association of T2DM with stroke and LEA were lower with older age. The associations of T2DM with CHD and stroke were also consistently higher in women than men. The associations of T2DM with LEA were higher in ethnic Malays than ethnic Chinese. CONCLUSIONS The excess risks of CHD, stroke, dialysis, and LEA associated with T2DM were heterogeneous across some demographic subgroups.
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Affiliation(s)
- Ka Keat Lim
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore; School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom
| | - Vivian Shu Yi Lee
- SingHealth Regional Health System, Singapore Health Services, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Zoey Hui Xian Lim
- SingHealth Regional Health System, Singapore Health Services, Singapore, Republic of Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Truls Østbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore; Post Acute and Continuing Care, SingHealth Community Hospitals, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore; PULSES Centre Grant, SingHealth Regional Health System, Singapore.
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Tang HY, Jiang AJ, Ma JL, Wang FJ, Shen GM. Understanding the Signaling Pathways Related to the Mechanism and Treatment of Diabetic Peripheral Neuropathy. Endocrinology 2019; 160:2119-2127. [PMID: 31318414 DOI: 10.1210/en.2019-00311] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022]
Abstract
Worldwide, the most prevalent metabolic disorder is diabetes mellitus (DM), an important condition that has been widely studied. Diabetic peripheral neuropathy (DPN), a complication that can occur with DM, is associated with pain and can result in foot ulcers and even amputation. DPN treatments are limited and mainly focus on pain management. There is a clear need to develop treatments for DPN at all stages. To make this progress, it is necessary to understand the molecular signaling pathways related to DPN. For this review, we aimed to concentrate on the main signaling cascades that contribute to DPN. In addition, we provide information with regard to treatments that are being explored.
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Affiliation(s)
- He-Yong Tang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Ai-Juan Jiang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jun-Long Ma
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Fan-Jing Wang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Guo-Ming Shen
- Anhui University of Chinese Medicine, Hefei, Anhui, China
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Guo Z, Yue C, Qian Q, He H, Mo Z. Factors associated with lower-extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital. Int Wound J 2019; 16:1304-1313. [PMID: 31448507 DOI: 10.1111/iwj.13190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/28/2019] [Indexed: 12/30/2022] Open
Abstract
Providing a better understanding of the risk factors for amputation in this particular region, Hunan province, in China might help patients with diabetic foot ulcers receive timely and appropriate medical care and help prevent amputation. Diabetic foot ulcer patients referred to the Third Xiangya Hospital during the period between December 2014 and September 2018 were enrolled. Participants who underwent amputations and received conservative treatments were compared using univariate and multivariate analyses to identify the independent predictors of amputation. Those who required amputation presented significantly higher levels of white blood cell counts, platelet counts, erythrocyte sedimentation rate, C-reactive protein, and glycated haemoglobin (HbA1c) levels. However, levels of haemoglobin, postprandial plasma C-peptide, triglyceride, high-density lipoprotein cholesterol, albumin, and uric acid were decreased in patients with amputations. Patients with more advanced Wagner grades had much higher rates of amputation. Multivariable-adjusted odds ratios in stepwise logistic regression model was 1.317 for HbA1c (95% CI: 1.015-1.709), 0.255 for triglyceride (95% CI: 0.067-0.975), and 20.947 for Wagner grades (95% CI: 4.216-104.080). Independent risk factors for amputation in these Chinese diabetic foot ulcer patients included an elevated HbA1c level, lower triglyceride level, and higher Wagner grades.
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Affiliation(s)
- Zi Guo
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chun Yue
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Qian
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Honghui He
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
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Yusof NM, Rahman JA, Zulkifly AH, Che-Ahmad A, Khalid KA, Sulong AF, Vijayasingham N. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems. Singapore Med J 2017; 56:626-31. [PMID: 26668408 DOI: 10.11622/smedj.2015172] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients' profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems.
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Affiliation(s)
- Nazri Mohd Yusof
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Ahmad Hafiz Zulkifly
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Aminudin Che-Ahmad
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Kamarul Ariffin Khalid
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Ahmad Fadzli Sulong
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
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Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, Yang Y, Wang P. Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Diabetes Res 2017; 2017:8787261. [PMID: 29119118 PMCID: PMC5651135 DOI: 10.1155/2017/8787261] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To systematically evaluate the diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. METHODS We searched EMBASE (OvidSP), MEDLINE (OvidSP), the Cochrane Library, and Web of Science to identify diagnostic accuracy trials of monofilament tests for detecting diabetic peripheral neuropathy. We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. RESULTS A total of 19 comparative trials met the inclusion criteria and were part of the qualitative synthesis. Eight trials using nerve conduction studies as the reference standard were selected for the meta-analysis. The pooled sensitivity and specificity of monofilament tests for detecting diabetic peripheral neuropathy were 0.53 (95% confidence interval (CI) 0.32 to 0.74) and 0.88 (95% CI 0.78 to 0.94), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.56 (95% CI 2.93 to 7.10) and 0.53 (95% CI 0.35 to 0.81), respectively. CONCLUSIONS Our review indicated that monofilament tests had limited sensitivity for screening diabetic peripheral neuropathy. The clinical use of the monofilament test in the evaluation of diabetic peripheral neuropathy cannot be encouraged based on currently available evidence.
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Affiliation(s)
- Fengyi Wang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jiadan Yu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shaxin Liu
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Rengang Zhang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xichao Ma
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yonghong Yang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Pu Wang
- Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Venkataraman K, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh GCH. Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes. Arch Phys Med Rehabil 2016; 97:1473-1480. [PMID: 27178094 DOI: 10.1016/j.apmr.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. DESIGN Retrospective medical records review. SETTING All community hospitals. PARTICIPANTS Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. RESULTS Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. CONCLUSIONS Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.
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Affiliation(s)
- Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kin Ming Chan
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore
| | | | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore
| | - Chye Hua Ee
- Elder Care and Health Consultancy, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Yun JS, Cha SA, Lim TS, Lee EY, Song KH, Ahn YB, Yoo KD, Kim JS, Park YM, Ko SH. Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy. Medicine (Baltimore) 2016; 95:e3128. [PMID: 27015188 PMCID: PMC4998383 DOI: 10.1097/md.0000000000003128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/13/2016] [Accepted: 02/25/2016] [Indexed: 01/16/2023] Open
Abstract
We investigated the factors that might influence the development of diabetic foot ulcers (DFUs) in type 2 diabetes patients without diabetic polyneuropathy (DPN).From January 2000 to December 2005, a total of 595 patients who had type 2 diabetes without DPN between the ages of 25 and 75 years, and had no prior history of DFUs were consecutively enrolled in the study. A cardiovascular autonomic function test was performed to diagnose cardiovascular autonomic neuropathy (CAN) using heart rate variability parameters.The median follow-up time was 13.3 years. Among the 449 (75.4%) patients who completed the follow-up evaluation, 22 (4.9%) patients developed new ulcers, and 6 (1.3%) patients underwent the procedure for lower extremity amputations. The patients in the DFUs group had a longer duration of diabetes, higher baseline HbA1c levels, higher rates of nephropathy, and CAN. A Cox hazard regression analysis results revealed that the development of DFUs was significantly associated with the presence of CAN (normal vs definite CAN; HR, 4.45; 95% confidence interval, 1.29-15.33) after adjusting for possible confounding factors.The development of DFUs was independently associated with CAN in patients with type 2 diabetes without DPN. We suggested the importance of CAN as a predictor of DFUs even in the patients without DPN, and the need to pay attention to patients with definite CAN and type 2 diabetes.
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Affiliation(s)
- Jae-Seung Yun
- From the Division of Endocrinology and Metabolism (J-SY, S-AC, T-SL, Y-BA, S-HK) Division of Cardiology (K-DY), Department of Internal Medicine, and Department of Rehabilitation Medicine (J-SK), St Vincent's Hospital; Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital (E-YL); Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St Mary's Hospital (K-HS), College of Medicine, The Catholic University of Korea, Seoul, Korea; and Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health (Y-MP), Research Triangle Park, NC
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Ai L, Hu Y, Zhang X, Zeng H, Zhao J, Zhao J, Chai Y, Lu J, Tang J, Bao Y, Liu F, Jia W. High cystatin C levels predict undesirable outcome for diabetic foot ulcerations. Wound Repair Regen 2016; 24:560-7. [PMID: 26864251 DOI: 10.1111/wrr.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
We investigated the relationship between serum cystatin C levels and the prognosis of diabetic foot ulcerations (DFU). A population-based cohort study involving 1018 patients with type 2 diabetes was conducted. These patients recruited and divided into two groups: nondiabetic foot ulcer group (NDF, n = 865, 85.5%) and diabetic foot ulcer group (DFU, n = 147, 14.5%).After a 1-year-follow-up, DFUs were grouped into healing (n = 110, 74.8%) and nonhealing (n = 37, 25.2%) group based on the clinical prognosis. Compared with the healing group, the nonhealing group were older, had long diabetic duration and had significantly increased serum cystatin C concentrations in DFU (p < 0.01). After adjustments for age, diabetes duration, renal function and infection control, multiple logistical regression analysis revealed that cystatin C remained associated increased risk of undesirable DFU outcome (OR = 7.279, 95% CI: 1.299-40.784, p < 0.05). When divided into quartiles according to cystatin C levels, the healing rate of Quartile 4 was significantly lower (57.9%) compared with other groups (p < 0.01). The odd is ratio (OR) analysis showed that the risk of undesirable DFU outcome in Quartile 4 was significantly higher (OR = 4.554, 95% CI: 3.14-5.12, p < 0.05) compared with that in Quartile 1. We concluded that there was a strong and independent association between serum cystatin C and diabetic foot ulceration prognosis, cystatin C > 1.35 mg/L predicts more than sixfold increased risk of incurable foot ulceration.
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Affiliation(s)
- Ligen Ai
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Yanyun Hu
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Xiaoyan Zhang
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Hui Zeng
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Jun Zhao
- The Multi-disciplinary Collaborative Diabetic Foot Group of Shanghai Clinical Center of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Department of Vascular Surgery, The Multi-disciplinary Collaborative Diabetic Foot Group of Shanghai Clinical Center of Diabetes, Shanghai Clinical Center of Trauma and Orthopedics, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Jungong Zhao
- The Multi-disciplinary Collaborative Diabetic Foot Group of Shanghai Clinical Center of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Department of Interventional Radiology, The Multi-disciplinary Collaborative Diabetic Foot Group of Shanghai Clinical Center of Diabetes, Shanghai Clinical Center of Trauma and Orthopedics, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Yimin Chai
- Department of Orthopedics, The Multi-disciplinary Collaborative Diabetic Foot Group of Shanghai Clinical Center of Diabetes, Shanghai Clinical Center of Trauma and Orthopedics, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Junxi Lu
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Junling Tang
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Yuqian Bao
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Fang Liu
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
| | - Weiping Jia
- Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Disease, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital
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Zhao J, Deng W, Zhang Y, Zheng Y, Zhou L, Boey J, Armstrong DG, Yang G, Liang Z, Chen B. Association between Serum Cystatin C and Diabetic Foot Ulceration in Patients with Type 2 Diabetes: A Cross-Sectional Study. J Diabetes Res 2016; 2016:8029340. [PMID: 27668262 PMCID: PMC5030429 DOI: 10.1155/2016/8029340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 02/06/2023] Open
Abstract
Serum cystatin C (CysC) has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU) in patients with type 2 diabetes (T2D). 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC) curve. The prevalence of coronary artery disease, diabetic nephropathy (DN), and DFU dramatically increased with CysC (P < 0.01) in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO2, and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects.
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Affiliation(s)
- Jie Zhao
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wuquan Deng
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yuping Zhang
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yanling Zheng
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Lina Zhou
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Johnson Boey
- Department of Podiatry, Singapore General Hospital, Singapore 169608
| | - David G. Armstrong
- Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tucson, AZ 85724, USA
| | - Gangyi Yang
- Department of Endocrinology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Ziwen Liang
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
- *Ziwen Liang: and
| | - Bing Chen
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
- *Bing Chen:
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Zhou ZY, Liu YK, Chen HL, Yang HL, Liu F. HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes. INT J LOW EXTR WOUND 2015; 14:168-77. [PMID: 26130760 DOI: 10.1177/1534734615593190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this meta-analysis, we aimed to assess glycosylated hemoglobin (HbA1c) level and lower extremity amputation (LEA) risk in patients with diabetes. Systematic computerized searches of the PubMed and Web of Knowledge were performed. We compared HbA1c level between groups with LEA and without LEA by meta-analysis; we also examined the dose–response relationship between HbA1c level and LEA risk. Sixteen studies were included in the meta-analysis. Eleven studies with 43 566 patients compared HbA1c between groups with and without LEA. The mean HbA1c (%) ranged from 8.3 to 12.5 in the group with LEA and from 7.4 to 11.3 in the group without LEA. The pooled weighted mean difference was 1.110 (95% confidence interval = 0.510-1.709; Z = 3.63, P = .008). The funnel plot was symmetrical, and Begg’s test ( z = 0.00, P = 1.000) and Egger’s test ( t = −0.02, P = .984) suggested no significant publication bias. Six studies with 109 933 patients included in the dose–response meta-analysis. The LEA incidence ranged from 0.3% to 14.6% between different HbA1c levels. Dose–response meta-analysis showed statistically significant association between HbA1c and LEA risk (χ2 = 65.51, P = .000). In linear model, the odds ratio for LEA incidence was 1.229 (95% confidence interval = 1.169-1.292) for every 1% HbA1c increase. In the spline model, the odds ratio of LEA risk increased with HbA1c levels, especially when HbA1c ranged from 5% to 9%. Our meta-analysis indicates that high level of HbA1c is an important risk factor for LEA in patients with diabetes. This evidence supports the strategy for lowering glucose levels to reduce amputation in patients with diabetes.
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Affiliation(s)
- Zhen-Yu Zhou
- First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Ya-Ke Liu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | | | - Hui-Lin Yang
- First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Fan Liu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
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Lai YJ, Hu HY, Lin CH, Lee ST, Kuo SC, Chou P. Incidence and risk factors of lower extremity amputations in people with type 2 diabetes in Taiwan, 2001-2010. J Diabetes 2015; 7:260-7. [PMID: 24823436 DOI: 10.1111/1753-0407.12168] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/30/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetic patients have an increased risk of lower extremity amputations (LEAs). In the present study we analyzed the incidence of LEA in patients with type 2 diabetes mellitus (T2DM) in Taiwan from 2001 to 2010, and determined risk factors for LEA. METHODS Data from the Taiwan National Health Insurance Research Database collected between 1 January 2001 and 31 December 2010 were analyzed. First, the incidence of LEA in the diabetic population was calculated. Subsequently, patients with new-onset T2DM during the study period were selected, and Cox's proportional hazards model was used to identify factors associated with LEA. The characteristics of patients who underwent major and multiple amputations were also analyzed. RESULTS From 2001 to 2010, 1588 non-traumatic LEAs were performed among the study subjects; 776 (48.9%) were minor and 812 (51.1%) were major LEAs. Over the period in question, the incidence of LEAs decreased from 3.08 to 1.65 per 1000 person-years. Factors associated with LEA included peripheral arterial occlusive disease (hazard ratio [HR] 4.134; 95% confidence interval [CI] 2.72-6.29), diabetic neuropathy (HR 2.34; 95% CI 1.62-3.38), diabetic retinopathy (HR 2.07; 95% CI 1.12-3.82), heart failure (HR 2.13; 95% CI 1.45-3.15), male gender (HR 1.64; 95% CI 1.24-2.18), and adult onset diabetes (HR 1.02; 95% CI 1.01-1.04). Patients with a history of stroke were more likely to undergo major and multiple amputations (P < 0.001 and P < 0.01, respectively). CONCLUSIONS The incidence of LEA in the Taiwan diabetic population decreased over the study period. The results indicate that efforts to improve diabetic care should be supported and sustainable, especially for those at high risk.
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Affiliation(s)
- Yun-Ju Lai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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Choi MSS, Jeon SB, Lee JH. Predictive factors for successful limb salvage surgery in diabetic foot patients. BMC Surg 2014; 14:113. [PMID: 25551288 PMCID: PMC4320552 DOI: 10.1186/1471-2482-14-113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background The goal of salvage surgery in the diabetic foot is maximal preservation of the limb, but it is also important to resect unviable tissue sufficiently to avoid reamputation. This study aims to provide information on determining the optimal amputation level that allows preservation of as much limb length as possible without the risk of further reamputation by analyzing several predictive factors. Methods Between April 2004 and July 2013, 154 patients underwent limb salvage surgery for distal diabetic foot gangrene. According to the final level of amputation, the patients were divided into two groups: Patients with primary success of the limb salvage, and patients that failed to heal after the primary limb salvage surgery. The factors predictive of success, including comorbidity, laboratory findings, and radiologic findings were evaluated by a retrospective chart review. Results The mean age of the study population was 63.9 years, with a male-to-female ratio of approximately 2:1. The mean follow-up duration was 30 months. Statistical analysis showed that underlying renal disease, limited activity before surgery, a low hemoglobin level, a high white blood cell count, a high C-reactive protein level, and damage to two or more vessels on preoperative computed tomography (CT) angiogram were significantly associated with the success or failure of limb salvage. The five-year survival rate was 81.6% for the limb salvage success group and 36.4% for the limb salvage failure group. Conclusion This study evaluated the factors predictive of the success of limb salvage surgery and identified indicators for preserving as much as possible of the leg of a patient with diabetic foot. This should help surgeons to establish the appropriate amputation level for a case of diabetic foot and help prevent consecutive operations.
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Affiliation(s)
| | | | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University, 153 Gyeongchun-ro, Guri 471-701, South Korea.
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Tang ZQ, Chen HL, Zhao FF. Gender differences of lower extremity amputation risk in patients with diabetic foot: a meta-analysis. INT J LOW EXTR WOUND 2014; 13:197-204. [PMID: 25106444 DOI: 10.1177/1534734614545872] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this meta-analysis, we aim to evaluate gender differences of lower extremity amputation risk in patients with diabetic foot. Systematic computerized searches of PubMed and Web of Knowledge were performed. The pooled odds ratio (OR) and 95% confidence interval (CI) for amputation risk were calculated. Twenty studies with 15 385 case (present amputation) and 438 760 control (absent amputation) patients were included in the meta-analysis. The pooled crude OR was 1.676 (95% CI 1.307-2.149; Z = 4.07, P = .000). In the retrospective study subgroup, the pooled OR was 1.708 (95% CI = 1.235-2.363; Z = 3.24, P = .001); in the prospective study subgroup, the pooled OR was 1.478 (95% CI = 1.189-1.838; Z = 3.51, P = .000). The pooled adjusted OR was 1.439 (95% CI = 1.238-1.671; Z = 4.76, P = .000). In retrospective study subgroup, the pooled OR was 1.440 (95% CI = 1.208-1.717; Z = 4.07, P = .000); in prospective study subgroup, the pooled OR was 1.478 (95% CI = 1.080-2.024; Z = 2.44, P = .015). No significant publication bias was found. Sensitivity analyses by omitting a heterogeneity study showed the results were robust. In conclusion, our meta-analysis indicates that men with diabetic foot have about one half increased amputation risk than women with diabetic foot. Men with diabetes should receive more complete follow-up and more adequate health education.
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Affiliation(s)
- Zhu-Qi Tang
- Department of Endocrinology, Affiliated Hospital of Nantong University, Nantong City, People's Republic of China
| | - Hong-Lin Chen
- School of nursing, Nantong University, Nantong City, People's Republic of China
| | - Fang-Fang Zhao
- School of nursing, Nantong University, Nantong City, People's Republic of China
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Chang NT, Chan CL, Lu YT, Hsu JC, Hsu YN, Chu D, Yang NP. Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000-2011 nationwide hospitalized data analysis. BMC Public Health 2013; 13:1107. [PMID: 24289250 PMCID: PMC4219520 DOI: 10.1186/1471-2458-13-1107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lower extremity (LE) peripheral artery disease (PAD), which is associated with a reduced quality of life and increased mortality from atherosclerotic cardio-/cerebro-vascular occlusion, is a significant public health problem, especial for an aging society such as that of Taiwan. METHODS Specific datasets of the 2000-2011 nationwide inpatient databases were analyzed. Two inclusion criteria, including one of the major diagnosis codes of PAD and one of three categorical invasive treatments of LE PAD, were used consecutively to select cases diagnosed as LE PAD and receiving invasive treatment. The epidemiology of invasively-treated PAD in Taiwan was estimated, and the influences of potential confounders on these invasively-treated methods were evaluated. RESULTS In general, the invasively-treated incidence of PAD in Taiwan doubled, from 3.73/10,000 (in 2000) to 7.48/10,000 (in 2011). On average, the total direct medical cost of one hospitalized and invasively-treated PAD case ranged from $US 4,600 to $US 5,900. The annual cases of bypass surgery for the PAD cases averaged 1,000 and the cases for limb amputation ranged from 4,100 to 5,100 annually. However, the number of percutaneous transluminal angioplasty (PTA) procedures remarkably increased by 15 times, from 600/year to 9,100/year, from 2000 to 2011. 51.3% of all the enrolled cases were treated with limb amputations, and female, young and middle-aged people (30-65 years of age), DM patients and those on a low income had a tendency to undergo amputation due to PAD. 37.6% of all the enrolled cases were treated with PTAs related to hypertension, cardiovascular disease, hyperlipidemia and catastrophic Illness. 2-year PTA failure rates of 22.13%, 11.91% and 10.61% were noted among the first (2000-2001), second (2004-2005) and the third (2008-2009) cohort groups, respectively. CONCLUSIONS In Taiwan, a gender difference and age and period effects on the invasively-treated incidence of LE PAD were observed. Female, young and middle-aged people (30-50 and 50-65 years of age), DM patients and those on a low income had a tendency to undergo amputation. The number of PTA procedures remarkably increased, but the 2-year failure rate of PTAs reduced from 2000 to 2011.
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Affiliation(s)
| | | | | | | | | | | | - Nan-Ping Yang
- Department of Medical Research, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan.
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Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MCR. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 2013; 44:119-24. [PMID: 23124278 DOI: 10.1007/s12020-012-9829-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/23/2012] [Indexed: 12/20/2022]
Abstract
Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81-6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01-20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
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Affiliation(s)
- Arnaldo Moura Neto
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Elgzyri T, Larsson J, Thörne J, Eriksson KF, Apelqvist J. Outcome of Ischemic Foot Ulcer in Diabetic Patients Who Had no Invasive Vascular Intervention. Eur J Vasc Endovasc Surg 2013; 46:110-7. [DOI: 10.1016/j.ejvs.2013.04.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/05/2013] [Indexed: 11/25/2022]
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Risk factors of treatment failure in diabetic foot ulcer patients. Arch Plast Surg 2013; 40:123-8. [PMID: 23532959 PMCID: PMC3605556 DOI: 10.5999/aps.2013.40.2.123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/25/2012] [Accepted: 01/02/2013] [Indexed: 11/09/2022] Open
Abstract
Background Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. Methods A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. Results The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. Conclusions The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.
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Li Q, Wang X, Hu X, Han C. A survey of diabetic foot patients with hospitalized amputations performed in a medical center over 5 years in China: limitations and lessons learnt. INT J LOW EXTR WOUND 2012; 11:194-200. [PMID: 22885610 DOI: 10.1177/1534734612457030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To perform a retrospective survey of the clinical features and clinical courses of diabetic foot patients with amputations hospitalized in the Second Affiliated Hospital of Zhejiang University from 2007 to 2011. According to the database from the medical records department in our hospital 36 cases of diabetic patients were selected out of 805 cases of amputees. The clinical information was recorded in detail. With the contact information provided in the medical record, telephone interviews were conducted for each patient and their family to complete the record for the current disease progression and the patient's treatment process. Among all of the patients with hospitalized amputations, 36/805(4.47%) were diabetic foot patients with amputations, accounting for 36/273(13.19%) of non-traumatic amputations. The average age of the diabetic patients with first-time amputations was 62 years, the average BMI was greater than 24.5 kg/m(2), and the waist-to-hip ratio was greater than 0.92. Among the 22 patients who completed the follow-up interviews, 17 had only small amputations. Diabetic amputation has become a common clinical problem. The patients were mainly elderly, overweight or obese. Amputations at the toe level still accounted for a large proportion of the patients. Overall, the follow-up interviews indicated that the patients lacked good understanding of and concern for their own disease, with unclear control of blood sugar and no standardized control method. Helping the patients to understand the disease and paying attention to health education may play a role in the prevention and treatment of diabetes and diabetic foot disease.
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Affiliation(s)
- Qiyin Li
- Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Kosachunhanun N, Tongprasert S, Rerkasem K. Diabetic foot problems in tertiary care diabetic clinic in Thailand. INT J LOW EXTR WOUND 2012; 11:124-7. [PMID: 22553278 DOI: 10.1177/1534734612446967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Foot problems in patients with diabetes cause substantial morbidity and may lead to lower extremity amputations. These risks may be reduced by appropriate screening and intervention measures. Effective screening assigns the patient to a risk category and dictates both the type and frequency of appropriate foot interventions. Less than half of diabetic patients in tertiary care hospital in Thailand received annual foot examination and there are limited data available on the nature of foot problems in such setting. This study reported a cross-sectional data of 438 diabetic patients attend tertiary diabetic clinic in the university hospital in Northern Thailand. Neuropathy manifestations as skin dryness, limitation of joint mobility and insensate to monofilament was the most common manifestation of diabetic foot problems in this setting. Most patients were not protected by proper footwear. More effort is needed to educate diabetic patients about foot care and improve their choice and selection of footwear.
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