1
|
Xu S, Herrera A, Schechter C, Tabassum H, Milosavljevic J, Lopez Fanas R, Daily JP, Myers AK. The Risk of and Associated Demographic and Laboratory Variables for Amputations for Inpatients with Diabetic Foot Ulcers. Endocr Pract 2024; 30:758-764. [PMID: 38729572 DOI: 10.1016/j.eprac.2024.04.019] [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: 02/07/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Diabetic foot ulcers (DFUs) are a leading cause of morbidity and mortality, which disproportionately impacts underserved populations. This study aimed to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system, which cares for an ethnically diverse and underserved population. METHODS This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at 3 hospitals in our health system between June 1, 2016, and May 31, 2021. RESULTS Among 650 patients admitted with DFU, 88% self-identified as non-White race. Male sex (odds ratio [OR], 0.62), low body mass index (OR, 0.98), and history of smoking (OR, 1.45) were significantly associated with amputation during the study period. A higher erythrocyte sedimentation rate (OR, 1.01), C-reactive protein level (OR, 1.05), and white blood cell count (OR, 1.11) and low albumin level (OR, 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%. CONCLUSION Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risk factors associated with DFU amputation included male sex, low body mass index, smoking, and high levels inflammation or low levels of albumin during admission. Many of these patients required multidisciplinary care and intravenous antibiotic therapy, necessitating a longer length of stay and high readmission rate.
Collapse
Affiliation(s)
- Shiming Xu
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, New York
| | - Azucena Herrera
- Department of Medicine, Wakefield Campus, Montefiore Einstein, Bronx, New York
| | - Clyde Schechter
- Department of Family & Social Medicine, Montefiore Einstein, Bronx, New York
| | - Humera Tabassum
- Department of Medicine, Wakefield Campus, Montefiore Einstein, Bronx, New York
| | - Jovan Milosavljevic
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, New York
| | - Raul Lopez Fanas
- Department of Medicine, Wakefield Campus, Montefiore Einstein, Bronx, New York
| | - Johanna P Daily
- Division of Infectious Disease, Department of Medicine, Montefiore Einstein, Bronx, New York
| | - Alyson K Myers
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, New York; Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York.
| |
Collapse
|
2
|
Ge Q, Zhou Y, Liu Z. Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: Based on 46 cases. Int Wound J 2023; 20:2657-2663. [PMID: 36916307 PMCID: PMC10410325 DOI: 10.1111/iwj.14139] [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: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre-hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre-hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.
Collapse
Affiliation(s)
- Qiaoyue Ge
- West China School of Public HealthSichuan University/West China Fourth Hospital, Sichuan UniversityChengduChina
| | - Yue Zhou
- Health and Social Policy DivisionChengdu Preventive Medicine AssociationChengduChina
| | - Zhenmi Liu
- West China School of Public HealthSichuan University/West China Fourth Hospital, Sichuan UniversityChengduChina
| |
Collapse
|
3
|
Yang Q, Ni X, Zhang Y, Zhu B, Zeng Q, Yang C, Shi J, Zhang C, Cai J, Hu J, Li Q, Jiang Y, Cheng Q, Cheng C. Sarcopenia is an independent risk factor for all-cause mortality rate in patients with diabetic foot ulcers. Front Nutr 2023; 10:1097008. [PMID: 37113300 PMCID: PMC10126293 DOI: 10.3389/fnut.2023.1097008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/07/2023] [Indexed: 04/29/2023] Open
Abstract
Objective This study aimed to determine whether sarcopenia affects the all-cause mortality rate of patients with diabetic foot ulcers (DFUs). Research design and methods The clinic-based observational study included 217 patients treated at the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University during a 4-year period. All subjects underwent dual-energy X-ray absorptiometry to determine their body composition during hospitalization. Diagnosis of sarcopenia was based on the Baumgartner diagnostic criteria. Patients were followed up regularly by phone calls until April 1, 2019, and their survival status was recorded.Univariate and multivariate Cox risk ratio regression models were used to analyze factors influencing the all-cause mortality rate of patients with DFUs. Results Of the 217 patients, 158 people survived (82.7%), 33 died (17.3%), and 26 were lost to follow-up. The median follow-up time was 23 (Range 11-34) months. The majority of patients were male (68.6%), with a mean age of 67.29 ± 11.14 years. The 5-year survival rate was 68.3% and 45.9% for all study patients (n = 217) and sarcopenia patients (n = 81), respectively. Multivariate Cox risk regression model showed that age (HR 1.042[95%CI:1.006, 1.078], P = 0.021), sarcopenia (HR 5.051[95%CI:1.968, 12.961], P = 0.001), and serum creatinine (HR 1.007[95%CI: 1.003, 1.010], P < 0.001) were independent risk factors for all-cause mortality rate of patients with DFUs. Kaplan-Meier survival curve indicated that the survival rate of patients with sarcopenia was significantly lower than non-sarcopenia patients (P < 0.001). Conclusions Sarcopenia is an independent risk factor for all-cause mortality of patients with DFUs and hence an important prognostic factor for patients with DFUs. Active prevention and improvement of sarcopenia can potentially improve the survival outcomes of this patient population.
Collapse
Affiliation(s)
- Qin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Endocrinology, Tongxin County People's Hospital, Ningxia, China
| | - Xia Ni
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingxiao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Baozhen Zhu
- Department of Intervention, Tongxin County People's Hospital, Ningxia, China
| | - Qinglian Zeng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chan Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiale Shi
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunlin Zhang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiahui Cai
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingsong Jiang
- Department of Nephrology, University of Chinese Academy of Sciences, Chongqing General Hospital, Chongqing, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Diabetic Foot Disease Clinical Treatment Center, Chongqing, China
- *Correspondence: Qingfeng Cheng
| | - Chao Cheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Chao Cheng
| |
Collapse
|
4
|
Aderibigbe BA. Hybrid-Based Wound Dressings: Combination of Synthetic and Biopolymers. Polymers (Basel) 2022; 14:polym14183806. [PMID: 36145951 PMCID: PMC9502880 DOI: 10.3390/polym14183806] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Most commercialized wound dressings are polymer-based. Synthetic and natural polymers have been utilized widely for the development of wound dressings. However, the use of natural polymers is limited by their poor mechanical properties, resulting in their combination with synthetic polymers and other materials to enhance their mechanical properties. Natural polymers are mostly affordable, biocompatible, and biodegradable with promising antimicrobial activity. They have been further tailored into unique hybrid wound dressings when combined with synthetic polymers and selected biomaterials. Some important features required in an ideal wound dressing include the capability to prevent bacteria invasion, reduce odor, absorb exudates, be comfortable, facilitate easy application and removal as well as frequent changing, prevent further skin tear and irritation when applied or removed, and provide a moist environment and soothing effect, be permeable to gases, etc. The efficacy of polymers in the design of wound dressings cannot be overemphasized. This review article reports the efficacy of wound dressings prepared from a combination of synthetic and natural polymers.
Collapse
|
5
|
Meyr AJ, Skolnik J, Mateen S, Sansosti LE. A Comparison of Adverse Short-Term Outcomes Following Forefoot Amputation Performed on an Inpatient Versus Outpatient Basis. J Foot Ankle Surg 2022; 61:67-71. [PMID: 34266720 DOI: 10.1053/j.jfas.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 02/03/2023]
Abstract
The objective of this investigation was to evaluate short-term adverse outcomes following forefoot amputation with a specific comparison between those procedures performed on an inpatient versus outpatient basis. The 2018 American College of Surgeons National Surgical Quality Improvement Program database was interrogated to select those subjects with a 28805 current procedural terminology code (amputation, foot; transmetatarsal) that underwent the procedure with "all layers of incision (deep and superficial) fully closed." This resulted in 326 subjects who underwent the procedure on an inpatient basis and 72 subjects who underwent the procedure on an outpatient basis. Results of the primary outcome measures found no significant differences between groups with respect to the development of a superficial surgical site infection (5.8% vs 5.6%; p = .950), deep incisional infection (3.4% vs 5.6%; p = .380), or wound disruption (3.4% vs 6.9%; p = .163). Additionally, no significant differences were observed between groups with respect to unplanned reoperations (15.6% vs 12.5%; p = .500) or unplanned hospital readmissions (21.8% vs 23.6%; p = .957). The results of this investigation demonstrate no difference in short-term adverse outcomes following the performance of forefoot amputation with primary closure when the procedure is performed on an inpatient or outpatient basis. We hope that this information is utilized in future investigations specifically examining this clinical scenario as it relates to hospital admission criteria related to lower extremity tissue loss, length of hospital stay considerations, the timing of partial foot amputation following revascularization, and the economics of limb preservation.
Collapse
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Jennifer Skolnik
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Laura E Sansosti
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| |
Collapse
|
6
|
Smerdely P. Mortality is not increased with Diabetes in hospitalised very old adults: a multi-site review. BMC Geriatr 2020; 20:522. [PMID: 33272212 PMCID: PMC7712574 DOI: 10.1186/s12877-020-01913-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient. Methods A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over 6 years (2012–2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital’s electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome. Results A total of 139,130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p < 0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p < 0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p < 0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p = 0.523). Conclusion Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.
Collapse
Affiliation(s)
- Peter Smerdely
- Department of Aged Care, St George Hospital, 3 Chapel Street, Kogarah, Sydney, NSW, 2217, Australia. .,School of Population Health, University of NSW, Sydney, Australia.
| |
Collapse
|
7
|
Shi R, Lian W, Jin Y, Cao C, Han S, Yang X, Zhao S, Li M, Zhao H. Role and effect of vein-transplanted human umbilical cord mesenchymal stem cells in the repair of diabetic foot ulcers in rats. Acta Biochim Biophys Sin (Shanghai) 2020; 52:620-630. [PMID: 32484226 PMCID: PMC7333920 DOI: 10.1093/abbs/gmaa039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot ulcer (DFU) is one of diabetic complications, which is frequently present and tormented in diabetes mellitus. Most multipotent mesenchymal stromal cells (MSCs) are capable of immune evasion, providing an allogeneic, ready-to-use, cell product option for therapeutic applications. The beneficial effect of MSCs for the treatment of a variety of traumatic injuries, such as open wounds, has been extensively explored. In this study, a rat DFU model was used to simulate the pathophysiology of clinical patients and to investigate the localization of human umbilical cord mesenchymal stem cells (hUC-MSCs) after intravenous transplantation and its role in DFU healing, so as to evaluate the potential of hUC-MSCs in the treatment of DFU. The diabetic rat model was established by streptozotocin injection, which was used to create full-thickness foot dorsal skin wounds to mimic DFU by a 6-mm skin biopsy punch and a Westcott scissor. The hUC-MSCs were transplanted through femoral vein, and the ulcer cicatrization situation and the fate of hUC-MSCs were evaluated. Our data suggest that intravenously transplantated hUC-MSCs have the ability to migrate and locate to the wound tissue and are helpful to wound healing in DFU rats, partly by regulating inflammation, trans-differentiation and providing growth factors that promote angiogenesis, cell proliferation and collagen deposition. Herein, we demonstrate that hUC-MSC transplantation is able to accelerate DFU healing in rats and transplantation of exogenous stem cells may be a potential strategy for clinical application in DFUs.
Collapse
Affiliation(s)
- Rongfeng Shi
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Weishuai Lian
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Yinpeng Jin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Chuanwu Cao
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Shilong Han
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Xiaohu Yang
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Suming Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Maoquan Li
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Hui Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| |
Collapse
|
8
|
Saluja S, Anderson SG, Hambleton I, Shoo H, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabet Med 2020; 37:211-218. [PMID: 31613404 DOI: 10.1111/dme.14151] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetic foot ulcers portend an almost twofold increase in all-cause mortality compared with diabetes on its own. AIM To investigate the association between diabetic foot ulcers and risk of death. METHODS We performed a meta-analysis of all observational studies investigating the association between diabetic foot ulcers and all-cause mortality. Risk ratios and risk differences were pooled in a random-effects model. The I2 statistic was used to quantify heterogeneity between studies. RESULTS Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person-years of follow-up. The crude event rate for all-cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person-years) than in those who developed foot ulcers (230.8 per 1000 person-years). Diabetic foot ulceration was associated with an increased risk of all-cause mortality (pooled relative risk 2.45, 95% CI 1.85-2.85). We did not observe any tangible differences in risk of all-cause mortality from diagnosis in studies reporting a mean duration of follow-up of ≤3 years (relative risk 2.43, 95% CI 2.27-2.61) or >3 years (relative risk 2.26, 95% CI 2.13-2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta-analysis. CONCLUSIONS Our study shows an excess rate of all-cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
Collapse
Affiliation(s)
- S Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - S G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
| | - I Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
| | - H Shoo
- Diabetes and Endocrine Department, Countess of Chester NHS Foundation Trust, Chester, UK
| | - M Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - E B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | - M Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - G Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - A H Heald
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Salford, UK
| |
Collapse
|
9
|
Factors associated with In-Hospital Mortality among Patients with Diabetes Admitted for Lower Extremity Infections. J ASEAN Fed Endocr Soc 2019; 34:36-43. [PMID: 33442135 PMCID: PMC7784136 DOI: 10.15605/jafes.034.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022] Open
Abstract
Objective To determine the factors associated with in-hospital mortality among diabetic patients admitted for lower extremity infection. Methodology This is a retrospective analysis of diabetic patients with lower extremity infection admitted at the UPPhilippine General Hospital. Data was analyzed through multiple logistic regression after multiple imputation was performed for missing data. Results 441 patients with diabetes were included in the analysis, of which 98.1% have Type 2 diabetes mellitus; 58.1% were males and the mean age of the cohort was 56.7±11.1 years. The mortality rate was 11.1% over the 3-year period from 2015 to 2017, of which 46% died from myocardial infarction (MI). Multivariate logistic regression showed the following were associated with increased likelihood of in-hospital mortality: non-performance of surgery (OR=4.22, 95%CI 1.10-16.27, p=0.036), elevated BUN (OR=1.06, 95%CI 1.01-1.11, p=0.016), MI (OR=27.19, 95%CI 6.38-115.94, p=0.000), respiratory failure requiring mechanical ventilation (OR=26.14, 95%CI 6.28-108.80, p=0.000), gastrointestinal bleeding (OR=10.08, 95%CI 1.87-54.38, p=0.007), hospital-acquired pneumonia (OR=9.46, 95%CI 2.52-35.51, p=0.001) and shock (OR=7.09, 95%CI 2.17-23.22, p=0.001). Conclusion In the in-patient setting, morbidity and mortality is high among diabetic patients with lower extremity infection. Non-performance of surgery, elevated BUN, MI, respiratory failure requiring mechanical ventilation, gastrointestinal bleeding, hospital acquired pneumonia and shock are associated with in-hospital death.
Collapse
|
10
|
Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
Collapse
Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
| | | |
Collapse
|
11
|
López-Valverde ME, Aragón-Sánchez J, López-de-Andrés A, Guerrero-Cedeño V, Tejedor-Méndez R, Víquez-Molina G, Jiménez-García R. Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation. Diabetes Res Clin Pract 2018; 141:175-180. [PMID: 29777746 DOI: 10.1016/j.diabres.2018.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Long-term mortality of patients with diabetes who undergo lower extremity amputation (LEA) has not been reported in Spain. METHODS The retrospective cohort included all subjects who underwent LEAs from January 1, 2005 to December 31, 2015 in San Jorge Hospital, Huesca, Spain. Live status of every patient up to September 2017 and the date of death were retrieved using the national death index. RESULTS The series included 203 patients: 116 patients (57.1%) underwent a minor amputation and 87 patients (42.9%) underwent a major amputation. Twenty-five patients (12.3%) died in the perioperative period. Significant risk factors of perioperative mortality were undergoing an above-the-knee amputation, postoperative cardiac complications, age >74 years and acute renal failure. Survival rates at 1, 3, and 5 years were 90.6, 72.8, and 55.5% in patients who underwent a minor amputation compared with 70.8, 41.3, and 34.4% in patients who underwent a major amputation, respectively. Log-rank test between the two groups was χ2 = 12.7 (p < 0.01). CONCLUSIONS Long-term survival was worse in patients who underwent a major amputation with a 5-year mortality of 65.6%. This mortality is worse than what has been reported for some types of common malignancies.
Collapse
Affiliation(s)
| | - Javier Aragón-Sánchez
- Department of Surgery, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | | | | | | | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| |
Collapse
|
12
|
Kim YK, Lee HS, Ryu JJ, In Lee H, Seo SG. Sarcopenia increases the risk for mortality in patients who undergo amputation for diabetic foot. J Foot Ankle Res 2018; 11:32. [PMID: 29946364 PMCID: PMC6006937 DOI: 10.1186/s13047-018-0274-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/05/2018] [Indexed: 12/25/2022] Open
Abstract
Background Although there have been reports that diabetes affects the prevalence of sarcopenia, no studies have examined the relationship between sarcopenia and mortality in patients undergoing leg amputation. The purpose of this study is to determine whether sarcopenia affects the mortality rate of patients undergoing diabetic foot amputation. Methods From among patients who underwent limb amputation for diabetes complications, this study included 167 patients who underwent abdominal CT within 1 year of amputation. We defined sarcopenia using sex-specific cut-off points for the L3 skeletal muscle index. The 5-year survival rate was analyzed. All patients were divided into two groups and compared according to the presence of sarcopenia. The mortality rate according to sarcopenia was assessed via the Kaplan-Meier method and log-rank test. Uni- and multivariate Cox regression analyses evaluated factors associated with survival rate. Results Among the total of 167 patients, the overall 5-year mortality rate was 52.7%. Of the 112 patients with sarcopenia, the 5-year mortality rate was 60.7%. Of the 55 patients without sarcopenia, the 5-year mortality rate was 36.4%. Kaplan-Meier analysis showed a high mortality of the sarcopenia group in the univariate (p = 0.016) and multivariate (p = 0.047) analysis. Conclusions Our study is the first to analyze the relationship between diabetic amputation and sarcopenia. Sarcopenia increases the risk of mortality in patients who undergo amputation for diabetic foot. Therefore, patients with diabetes should be careful to prevent sarcopenia with enough regular exercise as well as prevent diabetic foot disease.
Collapse
Affiliation(s)
- You Keun Kim
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Seoul, 05505 Republic of Korea
| | - Ho Seong Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Seoul, 05505 Republic of Korea
| | - Jae Jung Ryu
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Seoul, 05505 Republic of Korea
| | - Hye In Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Seoul, 05505 Republic of Korea
| | - Sang Gyo Seo
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Seoul, 05505 Republic of Korea.,2Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
Adderley NJ, Mallett S, Marshall T, Ghosh S, Rayman G, Bellary S, Coleman J, Akiboye F, Toulis KA, Nirantharakumar K. Temporal and external validation of a prediction model for adverse outcomes among inpatients with diabetes. Diabet Med 2018; 35:798-806. [PMID: 29485723 DOI: 10.1111/dme.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 02/06/2023]
Abstract
AIM To temporally and externally validate our previously developed prediction model, which used data from University Hospitals Birmingham to identify inpatients with diabetes at high risk of adverse outcome (mortality or excessive length of stay), in order to demonstrate its applicability to other hospital populations within the UK. METHODS Temporal validation was performed using data from University Hospitals Birmingham and external validation was performed using data from both the Heart of England NHS Foundation Trust and Ipswich Hospital. All adult inpatients with diabetes were included. Variables included in the model were age, gender, ethnicity, admission type, intensive therapy unit admission, insulin therapy, albumin, sodium, potassium, haemoglobin, C-reactive protein, estimated GFR and neutrophil count. Adverse outcome was defined as excessive length of stay or death. RESULTS Model discrimination in the temporal and external validation datasets was good. In temporal validation using data from University Hospitals Birmingham, the area under the curve was 0.797 (95% CI 0.785-0.810), sensitivity was 70% (95% CI 67-72) and specificity was 75% (95% CI 74-76). In external validation using data from Heart of England NHS Foundation Trust, the area under the curve was 0.758 (95% CI 0.747-0.768), sensitivity was 73% (95% CI 71-74) and specificity was 66% (95% CI 65-67). In external validation using data from Ipswich, the area under the curve was 0.736 (95% CI 0.711-0.761), sensitivity was 63% (95% CI 59-68) and specificity was 69% (95% CI 67-72). These results were similar to those for the internally validated model derived from University Hospitals Birmingham. CONCLUSIONS The prediction model to identify patients with diabetes at high risk of developing an adverse event while in hospital performed well in temporal and external validation. The externally validated prediction model is a novel tool that can be used to improve care pathways for inpatients with diabetes. Further research to assess clinical utility is needed.
Collapse
Affiliation(s)
- N J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - S Mallett
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - S Ghosh
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - G Rayman
- Ipswich Hospital NHS Trust, Ipswich
| | - S Bellary
- Heart of England Foundation Trust, Birmingham, UK
| | - J Coleman
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | | | - K A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham
- 424 General Military Hospital, Thessaloniki, Greece
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| |
Collapse
|
14
|
Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61:959-967. [PMID: 29264632 PMCID: PMC6448990 DOI: 10.1007/s00125-017-4522-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. METHODS This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. RESULTS The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age- and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR 1.72 [95% CI 1.56, 1.90], p < 0.001) increased risk of mortality in those with type 2 diabetes. Risk of death increased by 14% per quintile of deprivation in a univariable analysis (HR 1.14 [95% CI 1.10, 1.17]). In multivariable Cox regression analyses, there was a 48% increased risk of mortality in individuals with a foot ulcer (HR 1.48 [95% CI 1.33, 1.66]) independent of the Townsend index score (HR 1.13 [95% CI 1.10, 1.17], per quintile), baseline age, sex, diabetes type, smoking status, hypertension, statin use, β-blocker use, metformin use, HbA1c levels and insulin use. CONCLUSIONS/INTERPRETATION This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.
Collapse
Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Haika Shoo
- Diabetes and Endocrine Department, East Cheshire NHS Trust, Macclesfield, UK
| | - Sushant Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Endocrinology and Diabetes, Leighton Hospital, Crewe, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - George Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - Adrian H Heald
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Stott Lane, Salford, UK.
- School of Medical Sciences, Faculty of Biology, Medicine, and Health, and Manchester Academic Health Science Centre (MAHSC), The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
| |
Collapse
|
15
|
Costa RHR, Cardoso NA, Procópio RJ, Navarro TP, Dardik A, de Loiola Cisneros L. Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia. Diabetes Metab Syndr 2017; 11 Suppl 2:S583-S587. [PMID: 28465149 DOI: 10.1016/j.dsx.2017.04.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Foot ulcer is also a clinical marker for limb amputation and for death in diabetic patients. The purpose of this study was to determine amputation and mortality rates and its associated factors in patients with diabetic foot ulcerations in a tertiary hospital in Brazil. METHODS Retrospective medical records from 654 diabetic foot patients were reviewed. The risk factors were determined using the conditional logistic regression model analysis. RESULTS The mean patient age was 63.1 years (SD 12.20). Peripheral arterial disease was present in 160 patients (24.5%). Major amputations were performed in 135 (21%). The in-hospital mortality rate was 12% and the mortality rate of the amputees was 22.2%. The lowest hemoglobin level, the median value was 9.50g/dL, (4.0-17.0). Anemia was detected in 89.6% of patients submitted to amputation and in 82,1% of those who died. Hemoglobin <11g/dL was the most significant risk factor for major amputation (odds ratio 5.57, p<0.0001). The presence of peripheral arterial disease and old age were also a risk for major amputation (odds ratio 1.84, p=0.007 and 1.02, p=0.028, respectively). Factors associated with increased risk for death were hemoglobin <11g/dL (odds ratio 4.04, p<0.001), major amputation (1.79, p=0.03) and old age (1.05, p<0,001). CONCLUSIONS Diabetic foot ulcer is associated with high amputation and mortality rates. Old age, peripheral arterial disease and low hemoglobin level are risk factor for major amputation. Old age, major amputation and low hemoglobin level are risk factors for death.
Collapse
Affiliation(s)
| | - Natália Anício Cardoso
- Post-Graduate Program for Surgery and Ophthalmology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ricardo Jayme Procópio
- Endovascular Unit of University Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Túlio Pinho Navarro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | |
Collapse
|
16
|
Essackjee Z, Gooday C, Nunney I, Dhatariya K. Indicators of prognosis for admissions from a specialist diabetic foot clinic: a retrospective service improvement exercise. J Wound Care 2017; 26:40-45. [PMID: 28103162 DOI: 10.12968/jowc.2017.26.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To look at haematological and biochemical variables as predictors of outcomes in people admitted to hospital with a diabetic foot ulcer (DFU) without the use of technology or devices. In particular, to see if there was a relationship between admission blood cell and protein levels, and the likelihood of angioplasty, amputation, and death at one year after admission. METHOD A five-year retrospective analysis of patients admitted to a tertiary multidisciplinary specialist diabetic foot clinic looking at admission C-reactive protein (CRP), white cell count (WCC), neutrophil count and HbA1c and their relationship to likelihood of angioplasty, minor or major amputation, and death at one year after admission. RESULTS We identified 206 patients, in whom there was 1 year mortality rate of 6.3%. Raised WCC and CRP levels were significantly associated with major amputation (p=0.0035 and p<0.01, respectively). Raised WCC and neutrophil levels and were significantly associated with mortality (p=0.01 and p=0.002, respectively). The need for angioplasty was associated with raised CRP (p<0.05) but not with WCC or neutrophil count. There was no association of risk of minor amputations with admission HbA1c, CRP, WCC and neutrophils. Mean length of hospital stay was 17.5 (standard deviation ±14.0) days. CONCLUSION Commonly measured haematological and biochemical markers were useful predictors of outcomes for patients admitted to hospital for acute foot wounds. In addition, we found a much lower 1 year mortality and shorter length of hospital stay than previously recorded, possibly due to the introduction of a multidisciplinary weekly ward round.
Collapse
Affiliation(s)
- Z Essackjee
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C Gooday
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - I Nunney
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Dhatariya
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| |
Collapse
|
17
|
Nawata K, Kimura M. An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes? Health (London) 2017. [DOI: 10.4236/health.2017.98081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
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.
Collapse
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:
| |
Collapse
|
19
|
Guo MW, Ahn HJ, Juarez DT, Miyamura J, Sentell TL. Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai'i, December 2006-December 2010. Prev Chronic Dis 2015; 12:E124. [PMID: 26247424 PMCID: PMC4552136 DOI: 10.5888/pcd12.150092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of this study was to compare in-hospital deaths and length of stays for diabetes-related preventable hospitalizations (D-RPHs) in Hawai'i for Asian American, Pacific Islander, and white Medicare recipients aged 65 years or older. METHODS We considered all hospitalizations of older (>65 years) Japanese, Chinese, Native Hawaiians, Filipinos, and whites living in Hawai'i with Medicare as the primary insurer from December 2006 through December 2010 (n = 127,079). We used International Classification of Diseases - 9th Revision (ICD-9) codes to identify D-RPHs as defined by the Agency for Healthcare Research and Quality. Length of stays and deaths during hospitalization were compared for Asian American and Pacific Islander versus whites in multivariable regression models, adjusting for age, sex, location of residence (Oahu, y/n), and comorbidity. RESULTS Among the group studied, 1,700 hospitalizations of 1,424 patients were D-RPHs. Native Hawaiians were significantly more likely to die during a D-RPH (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.42-10.87) than whites. Filipinos had a significantly shorter length of stay (relative risk [RR], 0.77; 95% CI, 0.62-0.95) for D-RPH than whites. Among Native Hawaiians with a D-RPH, 59% were in the youngest age group (65-75 y) whereas only 6.3% were in the oldest (≥85 y). By contrast, 23.2% of Japanese were in the youngest age group, and 32.2% were in the oldest. CONCLUSION This statewide study found significant differences in the clinical characteristics and outcomes of D-RPHs for Asian American and Pacific Islanders in Hawai'i. Native Hawaiians were more likely to die during a D-RPH and were hospitalized at a younger age for a D-RPH than other studied racial/ethnic groups. Focused interventions targeting Native Hawaiians are needed to avoid these outcomes.
Collapse
Affiliation(s)
- Mary W Guo
- Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed T102, Honolulu, HI 96822.
| | - Hyeong Jun Ahn
- Biostatistics Core, John A. Burns School of Medicine, Honolulu, Hawai'i
| | - Deborah T Juarez
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, Hawai'i
| | - Jill Miyamura
- Hawaii Health Information Corporation, Honolulu, Hawai'i
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, Hawai'i
| |
Collapse
|
20
|
Nawata K, Kawabuchi K. Evaluation of Length of Hospital Stay Joining Educational Programs for Type 2 Diabetes Mellitus Patients: Can We Control Medical Costs in Japan? Health (London) 2015. [DOI: 10.4236/health.2015.72030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
21
|
Bruun C, Guassora AD, Nielsen ABS, Siersma V, Holstein PE, de Fine Olivarius N. Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus. Diabet Med 2014; 31:1468-76. [PMID: 25047765 DOI: 10.1111/dme.12551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/11/2014] [Accepted: 07/17/2014] [Indexed: 11/26/2022]
Abstract
AIM To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. METHODS This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively. RESULTS Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22-30.61). The same trend was seen for 'poor' vs 'good' influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65-18.84). Of 1058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. 'Poor' vs 'good' influence of the patients' own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40-14.92). When general practitioners assessed the influence of patients' life circumstances as 'poor' vs 'good', the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22-7.24). 'Poor' vs 'very good' patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models. CONCLUSIONS General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications.
Collapse
Affiliation(s)
- C Bruun
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
22
|
Li R, Yuan L, Guo XH, Lou QQ, Zhao F, Shen L, Zhang MX, Sun ZL. The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.05.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
23
|
Aragón-Sánchez J, Lázaro-Martínez JL, García-Álvarez Y, Morales EG, Hernández-Herrero MJ. Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease. Diabetes Res Clin Pract 2014; 104:e23-5. [PMID: 24530117 DOI: 10.1016/j.diabres.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 07/22/2013] [Accepted: 01/02/2014] [Indexed: 01/15/2023]
Abstract
Albuminuria has been previously reported as a risk factor for mortality in people with diabetes. In a retrospective series of 455 patients with diabetes and foot ulcers, albuminuria was a predictive factor of in-hospital mortality. Other predictive factors were: white blood cell count>12.9×10(9)/L, haemoglobin<108g/L and age >75 years old.
Collapse
|
24
|
Siracuse JJ, Gill HL, Jones DW, Schneider DB, Connolly PH, Parrack I, Huang ZS, Meltzer AJ. Risk factors for protracted postoperative length of stay after lower extremity bypass for critical limb ischemia. Ann Vasc Surg 2014; 28:1432-8. [PMID: 24517986 DOI: 10.1016/j.avsg.2013.12.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/27/2013] [Accepted: 12/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared with other common chronic conditions, admissions for management of peripheral arterial disease (PAD) are associated with prolonged hospitalizations. Length of stay (LOS) is one of many metrics receiving increased attention in the current focus on efficient healthcare delivery. Our objective was to characterize LOS among patients with severe PAD, those undergoing surgical bypass for critical limb ischemia (CLI), and identify risk factors for protracted postoperative LOS. METHODS Patient data from the 2007 to 2009 American College of Surgeons National Surgical Quality Improvement Program were used to develop a database consisting of patients undergoing bypass surgery for CLI (n = 4,894). Protracted postoperative LOS was defined as the top quartile of days hospitalized from surgery to discharge. Preoperative risk factors with significant association (Pearson chi-squared test; P < 0.05) were used to develop a logistic regression model for protracted postoperative LOS. RESULTS Average postoperative LOS was 7.5 days (median 6 days). The top quartile of postoperative LOS, >8 days, was used to define protracted LOS. Independent preoperative risk factors for protracted postoperative LOS included demographic characteristics (advanced age and non-Caucasian race), comorbidities, and medical history (e.g., obesity, dialysis dependence, severe cardiac and pulmonary disease, and bleeding disorders). Indicators of PAD severity (e.g., distal target sites, open wounds or gangrene, and prior arterial surgery) were also independent predictors of protracted LOS after surgery. The greatest predictors of extended postoperative LOS were prolonged preoperative hospitalization (OR 2.2 [95% CI: 1.8-2.6], P < 0.001) and preoperative dependent functional status (OR 2.0 [95% CI: 1.7-2.3], P < 0.001 for partial dependence; OR 2.8 [95% CI: 1.8-4.3], P < 0.001 for totally dependent status), where OR and CI stand for odds ratio and confidence interval. CONCLUSIONS Here, we identify preoperative risk factors for protracted postoperative LOS after infrainguinal bypass for CLI. These findings provide an important evidence basis for ongoing efforts to reduce healthcare spending and facilitate provision of efficient health care. Future efforts will include prospective identification of patients at high risk for protracted postoperative LOS and targeted multidisciplinary efforts to reduce associated costs without sacrificing healthcare quality.
Collapse
Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
| | - Heather L Gill
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Darren B Schneider
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Peter H Connolly
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Inkyong Parrack
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Zhen S Huang
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| |
Collapse
|