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Linnemann C, Şahin F, Li N, Pscherer S, Götz F, Histing T, Nussler AK, Ehnert S. Insulin Can Delay Neutrophil Extracellular Trap Formation In Vitro-Implication for Diabetic Wound Care? BIOLOGY 2023; 12:1082. [PMID: 37626968 PMCID: PMC10452400 DOI: 10.3390/biology12081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Diabetes is a worldwide evolving disease with many associated complications, one of which is delayed or impaired wound healing. Appropriate wound healing strongly relies on the inflammatory reaction directly after injury, which is often altered in diabetic wound healing. After an injury, neutrophils are the first cells to enter the wound site. They have a special defense mechanism, neutrophil extracellular traps (NETs), consisting of released DNA coated with antimicrobial proteins and histones. Despite being a powerful weapon against pathogens, NETs were shown to contribute to impaired wound healing in diabetic mice and are associated with amputations in diabetic foot ulcer patients. The anti-diabetic drugs metformin and liraglutide have already been shown to regulate NET formation. In this study, the effect of insulin was investigated. NET formation after stimulation with PMA (phorbol myristate acetate), LPS (lipopolysaccharide), or calcium ionophore (CI) in the presence/absence of insulin was analyzed. Insulin led to a robust delay of LPS- and PMA-induced NET formation but had no effect on CI-induced NET formation. Mechanistically, insulin induced reactive oxygen species, phosphorylated p38, and ERK, but reduced citrullination of histone H3. Instead, bacterial killing was induced. Insulin might therefore be a new tool for the regulation of NET formation during diabetic wound healing, either in a systemic or topical application.
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Affiliation(s)
- Caren Linnemann
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
| | - Filiz Şahin
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
| | - Ningna Li
- Microbial Genetics, Interfaculty Institute of Microbiology and Infection Medicine, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany
| | - Stefan Pscherer
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
- Department of Internal Medicine III, Sophien- and Hufeland-Hospital, 99425 Weimar, Germany
| | - Friedrich Götz
- Microbial Genetics, Interfaculty Institute of Microbiology and Infection Medicine, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany
| | - Tina Histing
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
| | - Andreas K. Nussler
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
| | - Sabrina Ehnert
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tübingen, Eberhard Karls Universität Tuebingen, 72076 Tuebingen, Germany; (C.L.); (A.K.N.)
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Waldman OV, Dexter BJ, Sulovari A, Oh IC. Clinical presentation of group B Streptococcus-infected diabetic foot ulcers. J Wound Care 2023; 32:S19-S25. [PMID: 37405964 DOI: 10.12968/jowc.2023.32.sup7.s19] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Group B Streptococcus (GBS) is a common pathogen in diabetic foot ulcers (DFUs), where it has been found to result in higher rates of soft tissue infection and amputation despite appropriate treatment. In this study, we aim to investigate clinical characteristics and prognosis of GBS DFU infections, especially those with tenosynovial involvement. We hypothesise that GBS-infected DFUs with tenosynovial involvement leads to an increased number of recurrent infections and unexpected returns to the operating room. METHOD Data were retrospectively collected from GBS-infected DFU patients surgically treated by an orthopaedic foot and ankle surgeon over a four-year period. Demographics, comorbidities, initial laboratory values and culture results from infected bone samples were recorded. Clinical outcome was assessed by recurrent infection and unplanned reoperation(s) within 3 months following the initial surgery. RESULTS In total, 72 patients were treated for GBS-infected DFUs. Intra-operative culture of infected bone identified GBS in 16 patients (22.2%). Significantly more black patients (p=0.017) were afflicted by GBS DFUs. Patients with GBS DFUs had higher initial haemoglobin A1C levels (p=0.019), and those with tenosynovial involvement were likely to require reoperation (p=0.036) and had a greater total number of surgeries (p=0.015) than those without. CONCLUSION GBS-infected DFUs are more common in black patients and those with elevated haemoglobin A1Cs. GBS infections with tenosynovial involvement are particularly destructive and require aggressive treatment by surgeons.
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Affiliation(s)
- Olivia V Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, US
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, US
| | - Brandon J Dexter
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, US
| | - Aron Sulovari
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, US
| | - Irvin C Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, US
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, US
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Hu X, Zhang Y, Chen Y, Zhang YP. Validation and application of the 2019 International Working Group on the Diabetic Foot risk stratification for diabetic foot in Chinese patients. J Diabetes Investig 2023. [PMID: 37060582 DOI: 10.1111/jdi.14014] [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: 10/17/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/17/2023] Open
Abstract
AIMS/INTRODUCTION The purpose of the present study was to evaluate the validation and application of the 2019 International Working Group on the Diabetic Foot (IWGDF) risk stratification system among Chinese patients with diabetes. MATERIALS AND METHODS A retrospective cohort study was carried out with 254 patients with diabetes, but without an active diabetic foot (DF) ulcer. Patients hospitalized from January to May 2017 were enrolled, and the follow-up period was from January to May 2020. Patients were stratified into four risk groups based on the 2019 IWGDF risk stratification system. RESULTS Of the 254 patients, four of 31 patients at risk 1 were diagnosed with DF within 3 years, whereas 12 of 26 patients at risk 2 and 16 of 20 patients at risk 3 developed DF. The area under the curve was 0.919 (P < 0.01, 95% confidence interval 0.893-0.945). Because DF risk 2 and greater (risk 2 + risk 3) was the optimal cut-off point, we simplified the risk stratification system by using two tiers, namely, low risk (risk 0 + 1) and high risk (risk 2 + 3). For the simplified risk stratification system, the sensitivity, specificity, positive likelihood ratio, percent agreement, positive predictive value and negative predictive value were 87.5%, 91.8%, 10.607, 91.3%, 60.8% and 98.1%, respectively. The χ2 -test showed that the odds ratio of the high-risk group (risk 2 + 3) was 29.33-fold that of the low-risk group (risk 0 + 1). CONCLUSIONS The 2019 IWGDF risk stratification system showed high validity and primary screening value in Chinese patients with diabetes. Thus, a simplified, two-tiered IWGDF stratification might be more efficient and cost-effective for predicting DF ulcers.
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Affiliation(s)
- Xiling Hu
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yao Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanming Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yin-Ping Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
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Zengin B, Yuzuguldu B, Simsir IY, Cetinkalp S. An index to prevent major limb amputations in diabetic foot. Endocr Regul 2023; 57:80-91. [PMID: 37183692 DOI: 10.2478/enr-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Objective. Besides the early detection and treatment of diabetic foot ulcers, being aware of the risk factors for major amputation plays a crucial role in preventing the major lower limb amputations. Major lower limb amputations are not just mentally and physically hard for patients, but also have an effect on patient's survival and are a financial burden on both patients and healthcare systems. Subjects and Methods. We defined 37 potential risk factors for major amputation and these risk factors were investigated among 507 patients who had ulcers in their feet and were seen by the diabetic foot ulcer council at Ege University Faculty of Medicine. In our study, 106 (20.9%) patients ended up undergoing major lower limb amputation. Results. The univariate analysis showed that 24 defined risk factors were statistically significant. In the multivariate analysis using the Cox regression model, 6 risk factors remained statistically significant. Multivariate-adjusted hazard ratios were 4.172 for hyperlipidemia, 3.747 for albumin <3.365 g/dL, 3.368 for C-reactive protein (CRP) >2.185 mg/L, 2.067 for presence of gangrenous Wagner stage, 1.931 for smoking tobacco >30 pack/year, and 1.790 for hematocrit (HCT) <31.5%. Most patients with major amputation presented with a neuroischemic foot (58%). Gender and age were not found to be risk factors for major amputation. Having less than 7% of hemoglobin A1c (HbA1c) levels had a direct proportion with major amputation numbers. The mortality rates in one year, two and three years after the major amputation operations were 24.6%, 30%, and 35.9%, respectively. Conclusion. Being familiar with these risk factors for major amputation is crucial for multi-disciplinary teams to take good care of patients with diabetic foot ulcers and to lower the need for major amputations.
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Affiliation(s)
- Bugra Zengin
- 1Division of Pediatric Surgery, Department of Surgery, Chlidren's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Burak Yuzuguldu
- 2Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Ilgin Yildirim Simsir
- 3Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sevki Cetinkalp
- 3Division of Endocrinology and Metabolism Disorders, Faculty of Medicine, Ege University, Izmir, Turkey
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Gong H, Ren Y, Li Z, Zha P, Bista R, Li Y, Chen D, Gao Y, Chen L, Ran X, Wang C. Clinical characteristics and risk factors of lower extremity amputation in the diabetic inpatients with foot ulcers. Front Endocrinol (Lausanne) 2023; 14:1144806. [PMID: 37065766 PMCID: PMC10102466 DOI: 10.3389/fendo.2023.1144806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES To analyze clinical characteristics of the diabetic inpatients with foot ulcers and explore the risk factors of lower extremity amputation (LEA) in West China Hospital of Sichuan University. METHODS A retrospective analysis was performed based on the clinical data of the patients with diabetic foot ulcer (DFU) hospitalized in West China Hospital of Sichuan University from January 1, 2012 to December 31, 2020. The DFU patients were divided into three groups: non-amputation, minor amputation, and major amputation groups. The ordinal logistic regression analysis was used to identify the risk factors for LEA. RESULTS 992 diabetic patients (622 males and 370 females) with DFU were hospitalized in the Diabetic Foot Care Center of Sichuan University. Among them, 72 (7.3%) (55 minor amputations and 17 major amputations) cases experienced amputation, and 21(2.1%) refused amputation. Excluding the patients who refused amputation, the mean age and duration of diabetes of and HbA1c the 971 patients with DFU, were 65.1 ± 12.3 years old, 11.1 ± 7.6 years, and 8.6 ± 2.3% respectively. The patients in the major amputation group were older and had longer course of diabetes for a longer period of time than those in the non-amputation and minor amputation groups. Compared with the non-amputation patients (55.1%), more patients with amputation (minor amputation (63.5%) and major amputation (88.2%)) suffered from peripheral arterial disease (P=0.019). The amputated patients had statistically lower hemoglobin, serum albumin and ankle brachial index (ABI), but higher white blood cell, platelet counts, fibrinogen and C-reactive protein levels. The patients with amputation had a higher incidence of osteomyelitis (P = 0.006), foot gangrene (P < 0.001), and a history of prior amputations (P < 0.001) than those without amputation. Furthermore, a history of prior amputation (odds ratio 10.194; 95% CI, 2.646-39.279; P=0.001), foot gangrene (odds ratio 6.466; 95% CI, 1.576-26.539; P=0.010) and ABI (odds ratio 0.791; 95% CI, 0.639-0.980; P = 0.032) were significantly associated with LEAs. CONCLUSIONS The DFU inpatients with amputation were older with long duration of diabetes, poorly glycemic control, malnutrition, PAD, severe foot ulcers with infection. A history of prior amputation, foot gangrene and a low ABI level were the independent predictors of LEA. Multidisciplinary intervention for DFU is essential to avoid amputation of the diabetic patients with foot ulcer.
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Affiliation(s)
- Hongping Gong
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- International Medical Center Ward, Department of General Practice, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenyi Li
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panpan Zha
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Raju Bista
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Chun Wang, ,
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ElHajj Chehadeh S, Sayed NS, Abdelsamad HS, Almahmeed W, Khandoker AH, Jelinek HF, Alsafar HS. Genetic Variants and Their Associations to Type 2 Diabetes Mellitus Complications in the United Arab Emirates. Front Endocrinol (Lausanne) 2022; 12:751885. [PMID: 35069435 PMCID: PMC8772337 DOI: 10.3389/fendo.2021.751885] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Aim Type 2 Diabetes Mellitus (T2DM) is associated with microvascular complications, including diabetic retinopathy (DR), diabetic nephropathy (DNp), and diabetic peripheral neuropathy (DPN). In this study, we investigated genetic variations and Single Nucleotide Polymorphisms (SNPs) associated with DR, DNp, DPN and their combinations among T2DM patients of Arab origin from the United Arab Emirates, to establish the role of genes in the progression of microvascular diabetes complications. Methods A total of 158 Emirati patients with T2DM were recruited in this study. The study population was divided into 8 groups based on the presence of single, dual, or all three complications. SNPs were selected for association analyses through a search of publicly available databases, specifically genome-wide association study (GWAS) catalog, infinome genome interpretation platform, and GWAS Central database. A multivariate logistic regression analysis and association test were performed to evaluate the association between 83 SNPs and DR, DNp, DPN, and their combinations. Results Eighty-three SNPs were identified as being associated with T2DM and 18 SNPs had significant associations to one or more diabetes complications. The most strongly significant association for DR was rs3024997 SNP in the VEGFA gene. The top-ranked SNP for DPN was rs4496877 in the NOS3 gene. A trend towards association was detected at rs833068 and rs3024998 in the VEGFA gene with DR and rs743507 and rs1808593 in the NOS3 gene with DNp. For dual complications, the rs833061, rs833068 and rs3024997 in the VEGFA gene and the rs4149263 SNP in the ABCA1 gene were also with borderline association with DR/DNp and DPN/DNp, respectively. Diabetic with all of the complications was significantly associated with rs2230806 in the ABCA1 gene. In addition, the highly associated SNPs rs3024997 of the VEGFA gene and rs4496877 of the NOS3 gene were linked to DR and DPN after adjusting for the effects of other associated markers, respectively. Conclusions The present study reports associations of different genetic polymorphisms with microvascular complications and their combinations in Emirati T2DM patients, reporting new associations, and corroborating previous findings. Of interest is that some SNPs/genes were only present if multiple comorbidities were present and not associated with any single complication.
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Affiliation(s)
| | - Noura S. Sayed
- Khalifa University Center of Biotechnology, Abu Dhabi, United Arab Emirates
| | - Hanin S. Abdelsamad
- Biomedical Engineering Department, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Institute of Cardiac Science, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ahsan H. Khandoker
- Biomedical Engineering Department, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Herbert F. Jelinek
- Khalifa University Center of Biotechnology, Abu Dhabi, United Arab Emirates
- Biomedical Engineering Department, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Habiba S. Alsafar
- Khalifa University Center of Biotechnology, Abu Dhabi, United Arab Emirates
- Biomedical Engineering Department, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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Knowledge, awareness, and socio-demographic assessment of probiotics, obesity and diabetes. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yunir E, Hidayah CD, Harimurti K, Kshanti IAM. Three Years Survival and Factor Predicting Amputation or Mortality in Patients with High Risk for Diabetic Foot Ulcer in Fatmawati General Hospital, Jakarta. J Prim Care Community Health 2022; 13:21501319211063707. [PMID: 34986684 PMCID: PMC8744153 DOI: 10.1177/21501319211063707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Diabetic foot is one of major complication in diabetes patients with
unfavorable outcome. Survival study in outpatients is limited and factors
related are inconsistent. Survival and its modifiable risk factors should be
identified early since the foot at risk status to reduce
amputation/mortality in type 2 diabetes mellitus (T2DM). Objective: The aims of this study were to investigate survival probability for
amputation or mortality, compare different ulcer risk classification, and
figure out the relation of status of ulcer risk, age, gender, diabetes
duration, body mass index, fasting plasma glucose, HbA1C, and LDL with
amputation or mortality. Methods: This is a retrospective cohort study of 487 T2DM subjects who visited
internal medicine outpatient clinic in Fatmawati General Hospital since
January-December 2016. Status of ulcer risk and risk factors were extracted
from medical record and lower-extremity amputation or mortality was observed
in 3 years from baseline. Result: Three years overall survival is 85.7% (SE 0.17). Patients with high risk for
foot ulcer have survival probability of 80.2% (SE 0.027), which is lower
compared to non-high risk for foot ulcer with survival probability of 91.8%
(SE 0.019). Patients with high risk for foot ulcer (aHR 2.386 [95% CI
1.356-4.20]; P = .003), aged ≥60 years old (aHR 2.051 [95%
CI 1.173-3.585]; P = .012), and HbA1C ≥7% (aHR 2.022 [95%
CI 1.067-3.830]; P = .031) were independently associated
with amputation or mortality. Conclusion: T2DM patients with high risk for foot ulcer have lower survival probability
and higher risk for amputation or mortality in 3 years compared to patients
with non-high risk for foot ulcer. Status of ulcer risk, age ≥60 years, and
HbA1C ≥7% were associated with amputation or mortality in 3 years
observation.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Canggih Dian Hidayah
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Clinical Epidemiological Unit, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.,Division of Geriatrics, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ida Ayu Made Kshanti
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Fatmawati General Hospital, Jakarta, Indonesia
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Chou YY, Hou CC, Wu CW, Huang DW, Tsai SL, Liu TH, Ding LM, Chang CK, Ou KL, Chiu YL, Tzeng YS. Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications. Int Wound J 2021; 19:1329-1338. [PMID: 34879446 PMCID: PMC9493235 DOI: 10.1111/iwj.13727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 12/05/2022] Open
Abstract
Diabetes‐related lower extremity amputations are an enormous burden on global health care and social resources because of the rapid worldwide growth of the diabetic population. This research aimed to determine risk factors that predict major amputation and analyse the time interval from first hospitalisation to amputation by using standard management protocols and Kaplan–Meier survival curves. Data from 246 patients with diabetes mellitus and diabetic foot ulcers from the Division of Plastic and Reconstructive Surgery of the Department of Surgery at XXX Hospital between January 2016 and May 2020 were analysed. Univariate and multivariate analyses of 44 potential risk factors, including invasive ulcer depth and C‐reactive protein levels, showed statistically significant differences for those at increased risk for major amputation. The median time from hospitalisation to lower extremity amputation was approximately 35 days. Most patients with abnormal C‐reactive protein levels and approximately 70% of patients with ulcers invading the bone were at risk for lower extremity amputations within 35 days. Therefore, invasive ulcer depth and C‐reactive protein levels are significant risk factors. Other potential risk factors for major amputation and the time intervals from first hospitalisation to amputation should be analysed to establish further prediction strategies.
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Affiliation(s)
- Yu-Yu Chou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Chun Hou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Wei Wu
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dun-Wei Huang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Lin Tsai
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Hsuan Liu
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Lu-Ming Ding
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Kai Chang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuang-Ling Ou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Shi L, Wei H, Zhang T, Li Z, Chi X, Liu D, Chang D, Zhang Y, Wang X, Zhao Q. A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers. Diabetol Metab Syndr 2021; 13:92. [PMID: 34465375 PMCID: PMC8407043 DOI: 10.1186/s13098-021-00711-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes. This study aimed to establish weighted risk models for determining DFU occurrence and severity in diabetic patients. METHODS This was a multi-center hospital-based cross-sectional study. A total of 1488 diabetic patients with or without an ulcer from three tertiary hospitals were included in the study. Random forest method was used to develop weighted risk models for assessing DFU risk and severity. Receiver operating characteristic curves were used to validate the models and calculate the optimal cut-off values of the important risk factors. RESULTS We developed potent weighted risk models for evaluating DFU occurrence and severity. The top eight important risk factors for DFU onset were plasma fibrinogen, neutrophil percentage and hemoglobin levels in whole blood, stroke, estimated glomerular filtration rate, age, duration of diabetes, and serum albumin levels. The top 10 important risk factors for DFU severity were serum albumin, neutrophil percentage and hemoglobin levels in whole blood, plasma fibrinogen, hemoglobin A1c, estimated glomerular filtration rate, hypertension, serum uric acid, diabetic retinopathy, and sex. Furthermore, the area under curve values in the models using plasma fibrinogen as a single risk factor for determining DFU risk and severity were 0.86 (sensitivity 0.74, specificity 0.87) and 0.73 (sensitivity 0.76, specificity 0.58), respectively. The optimal cut-off values of plasma fibrinogen for determining DFU risk and severity were 3.88 g/L and 4.74 g/L, respectively. CONCLUSIONS We have established potent weighted risk models for DFU onset and severity, based on which precise prevention strategies can be formulated. Modification of important risk factors may help reduce the incidence and progression of DFUs in diabetic patients.
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Affiliation(s)
- Lu Shi
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Huiyi Wei
- Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Tianxiao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Zhiying Li
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaoxian Chi
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Dandan Liu
- Department of Geratology, Ninth Hospital of Xi'an, Xi'an, 710061, Shaanxi, China
| | - Dandan Chang
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Medical College, Xi'an, 710077, Shaanxi, China
| | - Yueying Zhang
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaodan Wang
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qingbin Zhao
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Altered Secretome of Diabetic Monocytes Could Negatively Influence Fracture Healing-An In Vitro Study. Int J Mol Sci 2021; 22:ijms22179212. [PMID: 34502120 PMCID: PMC8430926 DOI: 10.3390/ijms22179212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a main risk factor for delayed fracture healing and fracture non-unions. Successful fracture healing requires stimuli from different immune cells, known to be affected in diabetics. Especially, application of mononuclear cells has been proposed to promote wound and fracture healing. Thus, aim was to investigate the effect of pre-/diabetic conditions on mononuclear cell functions essential to promote osteoprogenitor cell function. We here show that pre-/diabetic conditions suppress the expression of chemokines, e.g., CCL2 and CCL8 in osteoprogenitor cells. The associated MCP-1 and MCP-2 were significantly reduced in serum of diabetics. Both MCPs chemoattract mononuclear THP-1 cells. Migration of these cells is suppressed under hyperglycemic conditions, proposing that less mononuclear cells invade the site of fracture in diabetics. Further, we show that the composition of cytokines secreted by mononuclear cells strongly differ between diabetics and controls. Similar is seen in THP-1 cells cultured under hyperinsulinemia or hyperglycemia. The altered secretome reduces the positive effect of the THP-1 cell conditioned medium on migration of osteoprogenitor cells. In summary, our data support that factors secreted by mononuclear cells may support fracture healing by promoting migration of osteoprogenitor cells but suggest that this effect might be reduced in diabetics.
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12
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Amputation versus Free Flap: Long-Term Outcomes of Microsurgical Limb Salvage and Risk Factors for Amputation in the Diabetic Population. Plast Reconstr Surg 2021; 147:742-750. [PMID: 33587553 DOI: 10.1097/prs.0000000000007644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstructive microsurgery is an effective limb-saving option for nonhealing lower extremity wounds in diabetic patients. However, the ability to predict the future need for amputation is unclear. This article seeks to identify risk factors for amputation following microsurgical free tissue transfer in the diabetic lower extremity. METHODS Diabetic patients undergoing lower extremity free flap surgery between August of 2011 and January of 2018 performed by a single surgeon were identified retrospectively. Patient comorbidities, reconstructive conditions and flap traits, microsurgical outcomes, and long-term outcomes were examined. Variables conferring risk for future amputation were examined by means of regression analysis. RESULTS Sixty-four patients met the criteria. The overall immediate flap success rate was 94 percent (60 of 64). Long term, 50 patients (78.1 percent) underwent successful salvage, and 14 patients (21.9 percent) required major amputation. Acute flap loss resulted in four amputations, and delayed complications (hematoma, infection, recurrent nonhealing) resulted in 10 amputations. The average time to amputation was 5.6 months. Risk factors for amputation were end-stage renal disease (OR, 30.7; p = 0.0087), hindfoot wounds (OR, 4.6; p = 0.020), elevated hemoglobin A1C level greater than 8.4 percent (OR, 1.4; p = 0.05), and positive wound cultures (OR, 6.1; p = 0.003). CONCLUSIONS Multiple comorbidities and poor glucose control were identified as risk factors for amputation after free flap limb salvage. However, successful limb preservation is possible. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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13
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Schöni M, Waibel FWA, Bauer D, Götschi T, Böni T, Berli MC. Long-term results after internal partial forefoot amputation (resection): a retrospective analysis. Arch Orthop Trauma Surg 2021; 141:543-554. [PMID: 32266517 DOI: 10.1007/s00402-020-03441-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Internal partial forefoot amputation (IPFA) is a treatment option for osteomyelitis and refractory and recurrent chronic ulcers of the forefoot. The aim of our study was to assess the healing rate of chronic ulcers, risk of ulcer recurrence at the same area or re-ulceration at a different area and revision rate in patients treated with IPFA. MATERIALS AND METHODS All patients who underwent IPFA of a phalanx and/or metatarsal head and/or sesamoids at our institution because of chronic ulceration of the forefoot and/or osteomyelitis from 2004 to 2014 were included. Information about patient characteristics, ulcer healing, new ulcer occurrence, and revision surgery were collected. Kaplan-Meier survival curves were plotted for new ulcer occurrence and revision surgery. RESULTS A total of 102 patients were included (108 operated feet). 55.6% of our patients had diabetes. In 44 cases, an IPFA of a phalanx was performed, in 60 cases a metatarsal head resection and in 4 cases an isolated resection of sesamoids. The mean follow-up was 40.9 months. 91.2% of ulcers healed after a mean period of 1.3 months. In 56 feet (51.9%), a new ulcer occurred: 11 feet (10.2%) had an ulcer in the same area as initially (= ulcer recurrence), in 45 feet (41.7%) the ulcer was localized elsewhere (= re-ulceration). Revision surgery was necessary in 39 feet (36.1%). Only one major amputation and five complete transmetatarsal forefoot amputations were necessary during the follow-up period. Thus, the major amputation rate was 0.9%, and the minor amputation rate on the same ray was 13.9%. CONCLUSIONS IPFA is a valuable treatment of chronic ulcers of the forefoot. However, new ulceration is a frequent event following this type of surgery. Our results are consistent with the reported re-ulceration rate after conservative treatment of diabetic foot ulcers. The number of major amputations is low after IPFA. LEVEL OF EVIDENCE Retrospective Case Series Study (Level IV).
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Affiliation(s)
- Madlaina Schöni
- Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Felix W A Waibel
- Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - David Bauer
- Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedic Surgery, Institute for Biomechanics, University of Zurich, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Thomas Böni
- Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin C Berli
- Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Häussling V, Aspera-Werz RH, Rinderknecht H, Springer F, Arnscheidt C, Menger MM, Histing T, Nussler AK, Ehnert S. 3D Environment Is Required In Vitro to Demonstrate Altered Bone Metabolism Characteristic for Type 2 Diabetics. Int J Mol Sci 2021; 22:ijms22062925. [PMID: 33805833 PMCID: PMC8002142 DOI: 10.3390/ijms22062925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
A large British study, with almost 3000 patients, identified diabetes as main risk factor for delayed and nonunion fracture healing, the treatment of which causes large costs for the health system. In the past years, much progress has been made to treat common complications in diabetics. However, there is still a lack of advanced strategies to treat diabetic bone diseases. To develop such therapeutic strategies, mechanisms leading to massive bone alterations in diabetics have to be well understood. We herein describe an in vitro model displaying bone metabolism frequently observed in diabetics. The model is based on osteoblastic SaOS-2 cells, which in direct coculture, stimulate THP-1 cells to form osteoclasts. While in conventional 2D cocultures formation of mineralized matrix is decreased under pre-/diabetic conditions, formation of mineralized matrix is increased in 3D cocultures. Furthermore, we demonstrate a matrix stability of the 3D carrier that is decreased under pre-/diabetic conditions, resembling the in vivo situation in type 2 diabetics. In summary, our results show that a 3D environment is required in this in vitro model to mimic alterations in bone metabolism characteristic for pre-/diabetes. The ability to measure both osteoblast and osteoclast function, and their effect on mineralization and stability of the 3D carrier offers the possibility to use this model also for other purposes, e.g., drug screenings.
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Affiliation(s)
- Victor Häussling
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Romina H. Aspera-Werz
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Helen Rinderknecht
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany;
- Radiology Department, BG Trauma Center Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany
| | - Christian Arnscheidt
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Maximilian M. Menger
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Tina Histing
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
| | - Andreas K. Nussler
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
- Correspondence: ; Tel.: +49-7071-606-1065
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (V.H.); (R.H.A.-W.); (H.R.); (C.A.); (M.M.M.); (T.H.); (S.E.)
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Wu J, Liu M, Huang H. Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity. INT J LOW EXTR WOUND 2021; 21:609-616. [PMID: 33686903 DOI: 10.1177/1534734620982233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.
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Affiliation(s)
- Jialu Wu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Min Liu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Hui Huang
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
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Elkhider ATE, Almobark AO, Badi S, Tahir H, Ramadan A, Khalil AA, Elshaikh E, Ahmed MH. Risk factors associated with lower extremity amputation in Sudanese individuals with diabetes: The need for improvement in primary health care system. J Family Med Prim Care 2021; 10:985-990. [PMID: 34041109 PMCID: PMC8138363 DOI: 10.4103/jfmpc.jfmpc_1881_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Lower extremity amputation (LEA) in individuals with diabetes is a serious health issue with a considerable physical and social burden. The aim of this study was to assess the prevalence and risk factors associated with LEA in diabetic foot ulcer (DFU) patients. Materials and Methods: This was a cross-sectional health facility-based study that recruited 315 diabetes individuals with foot ulcers from the diabetes center in Khartoum, Sudan. Direct interviewing of subjects was used to obtain data, using a standardized validated questionnaire. Chi-square and logistic regression analysis were used in data analysis. Results: 69.5% of the diabetic participants were aged 50 years old or more, and 71.1% were males. Most of the subjects (48.2%) were diabetics for a duration of >10 years, while more than one third (37.5%) of them were diabetic for 5–10 years. The majority (89.5%) had type 2 DM, while only 10.5% were type 1 DM. Two hundred forty-five patients had a left lower foot ulcer; 55.1% of the patients' ulcers were present in the toes, while 21.6% were in the foot sole. The overall prevalence of lower limb amputation was 17.1%. Individuals with diabetes patients with LEA had a higher incidence of hypertension (P = 0.000), retinopathy (P = 0.000), nephropathy (P = 0.002), ulcer size >2.5 cm (P = 0.000), and neuropathy (P = 0.000) through Chi-square analysis. Furthermore, logistic regression analysis showed that amputation was significantly associated with retinopathy (P = 0.000), size of ulcer (P = 0.000), and neuropathy (P = 0.016). Conclusion: The overall prevalence of LEA was 17.1%. The primary risks factors associated with amputation were presence of neuropathy and ulcer size >2.5 cm. Presence of retinopathy predispose diabetic individuals to amputation. Amputation is associated with disability and psychological problems; therefore, there is an urgent need for more improvement in preventative measures and primary health care system in low resource setting country like Sudan in order to decrease diabetes complications, especially patient's education about diabetes management by primary care physicians.
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Affiliation(s)
- Alaa Tag E Elkhider
- Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Ahmed O Almobark
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, P. O. Box 12810, Khartoum, Sudan
| | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Hanan Tahir
- Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Azza Ramadan
- College of Pharmacy, Al-Ain University, Abu Dhabi, United Arab Emirates
| | - Abbas A Khalil
- Department of Medicine, Arrowe Park Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, UK
| | - Elamin Elshaikh
- Department of General Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eagelstone, Milton Keynes, Buckinghamshire, UK
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ALAY H, YILMAZ S, KESMEZ CAN F, PARLAK M. An evaluation of risk factors affecting amputation in patients with diabetic foot Infection. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.809986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Hanley G, Chiou PY, Liu CY, Chen HM, Pfeiffer S. Foot care knowledge, attitudes and practices among patients with diabetic foot and amputation in St. Kitts and Nevis. Int Wound J 2020; 17:1142-1152. [PMID: 32744425 DOI: 10.1111/iwj.13446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 11/27/2022] Open
Abstract
About one-third of admissions to the surgical unit annually are diabetes foot infections in need of amputation In St. Kitts and Nevis. However, the risk factors related to diabetes foot and amputation remain unknown. This study investigated factors associated with diabetic foot and amputation (DFA). Retrospective case control study design, and purposive and quota sampling method was used to recruit the participants. Patients with and without DFA were interviewed at two main hospitals, several primary health centres, and a private doctor's office during July and August 2018. Self-development questionnaires were applied to assess patients' demographic, physical and behaviour, foot care knowledge, attitudes, and practices related to DFA. Chi-square, t-test, and multiple logistic regressions were used to analyse the data. A total of 210 patients were evaluated, 89 had DFA, while 121 did not, with a mean age of 61.10 (SD = 11.85). Participants' responses indicated good knowledge, favourable attitudes, and adequate practices related to foot care. The two items of the questionnaire, ways to maintain blood flow in the lower extremities and wash their feet daily, had significant lower score in DFA group. In multiple logistic regression, knowledge, attitudes, and practices related to foot care were not a significant predictor of DFA. Being male was a predictor of DFA than female (OR = 3.53; 95% CI = 1.65-7.57; P < .01). Participants who were currently unemployed were less likely to have DFA than those who were employed (OR = 0.38; 95% Cl = 0.17-0.86; P < .05). Comparing patients with the longest experience of diabetes mellitus (31 years or more) with those who had diabetes for the shortest period of time (between 1 and 10 years) was less likely to have DFA (OR = 0.38; 95% CI = 0.15-0.97; P = <.05). The combination of these independent variables could explain 29% of the variance in DFA. Based on these findings, strategies to prevent diabetic foot and amputation should focus on male and outdoor heavy worker, and longer duration of diabetes patients which are identified in this study.
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Affiliation(s)
- Gracelyn Hanley
- Department of Nursing, Alexandra Hospital, Charlestown, Saint Kitts and Nevis
| | - Piao-Yi Chiou
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Hui-Mei Chen
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Stefani Pfeiffer
- International and Cross-strait Education Center, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Monge L, Gnavi R, Carnà P, Broglio F, Boffano GM, Giorda CB. Incidence of hospitalization and mortality in patients with diabetic foot regardless of amputation: a population study. Acta Diabetol 2020; 57:221-228. [PMID: 31468200 DOI: 10.1007/s00592-019-01412-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/22/2019] [Indexed: 12/30/2022]
Abstract
AIMS The aim of our study was to estimate the overall rate of first hospitalizations for diabetic foot (DF) regardless of the outcome in amputations, as well as the mortality rate with their determinants in the period 2012-2016 in Piedmont Region in Italy. METHODS The study included all the subjects registered in the Regional Diabetes Registry and alive as at January 1, 2012. DF cases were identified by record linkage with the regional hospital discharge database. Incident cases of diabetic foot were followed up for mortality. RESULTS The 5-year rates were 1762, 324, and 343 × 100,000 patients for first hospitalization without amputations, with major amputations, and with minor amputations, respectively. Patients not undergoing amputations were more than 70% of the cohort. Patients with the more severe stages of diabetes and those with low education were at higher risk of each type of hospitalization. The risk of death during a mean follow-up of 2.5 years was about 16, 18, and 30% among patients without amputations, with major amputations, and with minor amputations, respectively. Males, insulin-treated patients, those affected with severe diabetes complications, particularly on dialysis, and those with lower levels of education were at higher risk. CONCLUSIONS The heavier burden of DF on hospitalizations is due to cases without amputation, a condition that is seldom considered in the diabetes literature. The severity of diabetes, preexisting complications, and low educational levels are associated with both first hospitalization and subsequent survival at any level of severity of DF.
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Affiliation(s)
- Luca Monge
- Diabetic Foot Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | | | - Paolo Carnà
- Epidemiology Unit, ASL TO3, Grugliasco, TO, Italy
| | - Fabio Broglio
- Department of Medical Science, University of Turin, Turin, Italy
| | - Gian Mario Boffano
- Diabetic Foot Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Bekele F, Chelkeba L, Fekadu G, Bekele K. Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: Prospective observational study. Ann Med Surg (Lond) 2020; 51:17-23. [PMID: 32015875 PMCID: PMC6992950 DOI: 10.1016/j.amsu.2020.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Diabetic foot ulcer is one of the complications of diabetes mellitus. The diabetic patients with foot infections especially gangrene require long-term hospitalization and carry the risk of limb amputation. Despite these challenges, there are a scarce studies done on risk factors and no finding on outcomes of diabetic foot ulcers in Ethiopia. Patients and methods A prospective observational study was conducted among diabetes patients with diabetic foot ulcer at Nekemte referral hospital from March 15 to June 15, 2018. Results Of the 115 diabetes foot ulcer patients admitted to Nekemte referral hospital, 64(55.65%) were males and the mean age of participants was 44.4 ± 14.7 years. Fifty-eight (50.43%) of the patients had chronic health problems and 56(48.69%) had diabetic complications. Of patients with complications, 35(30.43%) were undergone amputations. Diabetic foot ulcer grade ≥4 (AOR = 1.7; 95% CI: 1.604, 4.789), inappropriate antibiotics use (AOR = 2.526; 95% CI: 1.767, 8.314), overweight (AOR = 2.767; 95% CI: 1.827, 9.252), obesity (AOR = 3.020; 95% CI: 2.556, 16.397), poor blood glucose control (AOR = 2.592; 95% CI: 1.937, 7.168) and neuropathy (AOR = 1.565; 95% CI: 1.508, 4.822) were predictors of amputation up on multivariable logistic regression analysis. Conclusion Blood glucose level, higher body mass index, inappropriate antibiotics use, neuropathy and advanced grade of diabetic foot ulcer were independent predictors of amputation. Thus, special emphasis for patients having neuropathy and advanced grade of diabetic foot ulcer as well as weight reduction, managing hyperglycaemia, and appropriate antibiotics prescription practice would decrease untoward effects of diabetic foot ulcer. Foot problems are common in people with diabetes throughout the world, affecting up to 15% of diabetic patients. Diabetic foot complications is the major medical, social and economic problem for all types of diabetes. Advanced diabetes foot infections are the most common diabetes-related cause of hospitalization. Empiric antibiotic regimen is selected for diabetic foot infections on the basis of the likely etiologic agent(s). Peripheral arterial disease (PAD) is present in one-half of all patients with foot ulcers.
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Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacy, Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Kumera Bekele
- Department of Nursing, College of Health Science, Selale University, Fiche, Ethiopia
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Simhachalam Kutikuppala L, Nulukurthi T, Kumar S. A clinical study of risk factors associated with amputation in diabetic foot disease patients attending a tertiary care hospital in a rural setting. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2020. [DOI: 10.4103/jcrsm.jcrsm_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moon KC, Kim SB, Han SK, Jeong SH, Dhong ES. Risk factors for major amputation in hospitalized diabetic patients with forefoot ulcers. Diabetes Res Clin Pract 2019; 158:107905. [PMID: 31676331 DOI: 10.1016/j.diabres.2019.107905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 01/13/2023]
Abstract
AIMS The purpose of this study was to investigate the risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers. METHODS Between January 2003 and December 2018, a total of 1792 diabetic patients were admitted to the diabetic wound center for the management of diabetic foot ulcers. Among the patients, 1032 diabetic patients with forefoot ulcers were included in this study. Nine hundred and eighty-three patients (95%) healed without major amputations while 49 patients (5%) healed after major amputations. Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from the patients in these two groups for comparison. RESULTS Among the 88 potential risk factors, 34 showed statistically significant differences between the two groups. In the univariate analysis of 88 risk factors, 33 showed statistically significant differences. In stepwise multiple logistic regression analysis, four of the 33 risk factors remained statistically significant. The multivariate-adjusted odds ratios for gender, magnesium levels, platelet levels, and glycated hemoglobin (HbA1c) levels were 8.216, 2.480, 1.009, and 0.570, respectively. CONCLUSION Risk factors for major amputation in patients hospitalized with diabetic forefoot ulcers include male gender, increased magnesium, increased platelet levels, and low levels of HbA1c.
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Soo-Byn Kim
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea.
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
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Bellazreg F, Guigua A, Ferjani A, Hattab Z, Boukadida J, Ach K, Letaief R, Hachfi W, Letaief A. Correlation between superficial and intra-operative specimens in diabetic foot infections: results of a cross-sectional Tunisian study. Afr Health Sci 2019; 19:2505-2514. [PMID: 32127823 PMCID: PMC7040269 DOI: 10.4314/ahs.v19i3.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the correlation between superficial, and intra-operative specimens in diabetic foot infections (DFIs). Methods We conducted a cross-sectional study in patients with DFIs hospitalized in a Tunisian teaching hospital. Superficial specimens were collected for all patients, and intra-operative specimens were collected in operated patients. The specimens were processed using standard microbiology techniques. Antimicrobial susceptibility testing was carried out according to the protocol established by the European Committee on Anti-microbial Susceptibility Testing. Intra-operative and superficial specimens were considered correlated if they isolated the same microorganism(s), or if they were both negative. Results One hundred twelve patients, 81 males and 31 females, mean age 56 years, were included. Superficial samples were positive in 77% of cases, and isolated 126 microorganisms. Among the positive samples, 71% were monomicrobial. The most frequently isolated microorganisms were Enterobacteriaceae (53%), followed by streptococci (21%) and Staphylococcus aureus (17%). Nine microorganisms (7%) were multi-drug resistant. Intra-operative samples were positive in 93% of cases. Superficial specimens were correlated to intra-operative specimens in 67% of cases. Initial antibiotic therapy was appropriate in 70% of cases. The lower-extremity amputation and the mortality rates were 41% and 1%, respectively. Conclusion In our study, DFIs were most frequently caused by Enterobacteriaceae and superficial specimens were correlated to intra-operative specimens in only two thirds of cases. Clinicians should emphasize on the systematic practice of intraoperative specimens in all patients with DFIs treated surgically, while well-performed superficial specimens could be useful for prescribing appropriate antibiotic therapy in other patients.
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Affiliation(s)
- Foued Bellazreg
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Ahmed Guigua
- Department of Internal Medicine, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Asma Ferjani
- Department of Microbiology, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Zouhour Hattab
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Jalel Boukadida
- Department of Microbiology, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Koussay Ach
- Department of Endocrinolgy, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Rached Letaief
- Department of General Surgery, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Wissem Hachfi
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
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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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Fazio S, Edwards J, Miyamoto S, Henderson S, Dharmar M, Young HM. More than A1C: Types of success among adults with type-2 diabetes participating in a technology-enabled nurse coaching intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:106-112. [PMID: 30172572 PMCID: PMC6289853 DOI: 10.1016/j.pec.2018.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Success in diabetes research and self-management is often defined as a significant decrease in glycated hemoglobin (A1C). The aim of this article is to explore different types of successes experienced by adults with type-2 diabetes participating in a health technology and nurse coaching clinical trial. METHODS A qualitative analysis was conducted using surveys and documentation from motivational interview-based coaching sessions between study nurses and intervention participants. RESULTS Of the 132 cases reviewed, types of success predominantly fell into five categories: 1) change in health behaviors; 2) change in mindset or awareness; 3) change in engagement with healthcare resources; 4) change in physical or emotional health; and 5) change in health indicators. CONCLUSION Experiences of success in diabetes are more varied than traditional A1C-based outcome models. Our findings suggest coaching and technology can assist patients to achieve a range of successes in diabetes management through goal setting, health tracking, resolving barriers, and aligning goals with factors that impact change. PRACTICE IMPLICATIONS While A1C reduction is a critical factor in decreasing risk of diabetes-related complications, when healthcare professionals focus on A1C as the main indicator of diabetes management success, important changes in individuals' health and well-being may be overlooked or undervalued.
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Affiliation(s)
- Sarina Fazio
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA; UC Davis Medical Center, UC Davis Health.
| | - Jennifer Edwards
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA.
| | - Sheridan Miyamoto
- College of Nursing, The Pennsylvania State University, University Park, USA.
| | - Stuart Henderson
- Schools of Health Evaluation, Clinical and Translational Science Center, University of California Davis, Sacramento, USA.
| | - Madan Dharmar
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA; Department of Pediatrics, School of Medicine, Betty Irene Moore School of Nursing University of California, Davis, Sacramento, USA.
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA.
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Ferreira L, Carvalho A, Carvalho R. Short-term predictors of amputation in patients with diabetic foot ulcers. Diabetes Metab Syndr 2018; 12:875-879. [PMID: 29802073 DOI: 10.1016/j.dsx.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Diabetic foot ulcers are the leading cause of non-traumatic lower extremity amputation. The aim of this study was to establish short-term predictors of lower extremity amputation (LEA) in patients with diabetic foot ulcers (DFU). METHODS A retrospective observational study was performed. Patients observed for the first time in a multidisciplinary outpatient diabetic foot clinic during 1-year were reviewed. We examined demographic and clinical data and the occurrence of LEA within 180 days. Bivariate descriptive analysis was performed and three logistic regression models were created to predict short-term LEA. RESULTS During 1-year 613 patients were observed for the first time in our diabetic foot clinic. Relevant data and eligibility was available from 479 patients with DFU; 38.41%, 40,71% and 20,88% had neuropathic, neuroischemic and ischemic ulcers, respectively. Considering a follow-up of 180 days, amputation occurred in 10.02% (n = 48) of patients: 3.13% (n = 15) major amputation and 6.89% (n = 33) minor amputation. Independent predictors of short-term LEA included moderate to severe infection [OR 5.23 (IC 95% 2.51-10.80; p < 0.001)], previous history of LEA [OR 3.93 (IC 95% 1.81-8.53; p = 0.001)], peripheral arterial disease [OR 3.51 (IC 95% 1.29-9.58; p = 0.014)] and presence of any walking disability [OR 3.35 (IC 95% 1.58-7.13; p = 0.002)]. CONCLUSION In DFU patients the risk of LEA at 180 days is associated to moderate to severe infection at the initial presentation, previous history of LEA, peripheral arterial disease and presence of any walking disability. To prevent future amputations these patients should be identified early and managed by a multidisciplinary team. LEVEL OF CLINICAL EVIDENCE Level 2.
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Affiliation(s)
- Lia Ferreira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Portugal.
| | - André Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Portugal
| | - Rui Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Portugal
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Shatnawi NJ, Al-Zoubi NA, Hawamdeh H, Khader YS, Omari AEK, Khammash MR. Redefined clinical spectra of diabetic foot syndrome. Vasc Health Risk Manag 2018; 14:291-298. [PMID: 30425505 PMCID: PMC6201996 DOI: 10.2147/vhrm.s169502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. Patients and methods This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/International Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS. Results In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revascularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS. Conclusion Redefining DFS into ulcerative, septic and gangrenous by integration of the predominant clinical presentation and the clinical criteria for DFI diagnosis and classification of IDSA/IWGDF showed significant differences in amputation rate. Therefore, it can be used clinically to categorize patients with DFS to predict amputations and to help in planning their management. Further prospective studies are suggested to validate these results.
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Affiliation(s)
- Nawaf J Shatnawi
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan,
| | - Nabil A Al-Zoubi
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan,
| | - Hasan Hawamdeh
- Department of Basic Medical Science, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abd El-Karim Omari
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan,
| | - Muhammad R Khammash
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan,
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Fesseha BK, Abularrage CJ, Hines KF, Sherman R, Frost P, Langan S, Canner J, Likes KC, Hosseini SM, Jack G, Hicks CW, Yalamanchi S, Mathioudakis N. Association of Hemoglobin A 1c and Wound Healing in Diabetic Foot Ulcers. Diabetes Care 2018; 41:1478-1485. [PMID: 29661917 PMCID: PMC6014539 DOI: 10.2337/dc17-1683] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 03/26/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study evaluated the association between hemoglobin A1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS We conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (≥90 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders. RESULTS Baseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of -0.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C <7.5% (hazard ratio [HR] 2.07; 95% CI 1.08-4.00), but no association with wound healing was seen with the mean A1C change from baseline in this group. Neither nadir A1C change nor mean A1C change were associated with long-term wound healing in participants with baseline A1C ≥7.5%. CONCLUSIONS There does not appear to be a clinically meaningful association between baseline or prospective A1C and wound healing in patients with DFUs. The paradoxical finding of accelerated wound healing and increase in A1C in participants with better baseline glycemic control requires confirmation in further studies.
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Affiliation(s)
- Betiel K Fesseha
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Kathryn F Hines
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Ronald Sherman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Priscilla Frost
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Susan Langan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph Canner
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Kendall C Likes
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Sayed M Hosseini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Gwendolyne Jack
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Swaytha Yalamanchi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, Khader YS, Garaibeh K, Heis HA. Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Diabetes Metab Syndr Obes 2018; 11:313-319. [PMID: 29950877 PMCID: PMC6018853 DOI: 10.2147/dmso.s165967] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This study was conducted to determine the risk factors of major lower extremity amputations in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. PATIENTS AND METHODS This retrospective study involved 225 type 2 diabetic patients referred for management of diabetic foot syndrome at King Abdullah University Hospital in the period between January 2014 and December 2015. A structured customized diabetic foot data collection form with diabetic foot characteristics chart was used for documentation of relevant information, which checks for age, sex, body mass index, smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases, stroke, chronic renal impairment, renal replacement therapy (hem-dialysis), and history of diabetes-related complication in both feet prior to the study period. The predictors for major lower limb amputations were compared between groups using chi-square test, and binary logistic regression was used to determine the factors associated with major amputation. RESULTS Twenty-seven limbs underwent major amputations with an overall rate of major amputation of 11.6%. The following predictors were found to be associated with the higher incidence of major lower limb amputations: duration of diabetes ≥15 years, HbA1c ≥8%, patients on insulin, with hypertension, cardiac diseases, chronic renal impairment, stroke, having gangrene, higher number of components, higher Wagner classification, and ischemia. However, the rate did not differ significantly between men and women. CONCLUSION Presentation with gangrenous tissue and poor glycemic control are the important risks and significant predictive factors for type 2 diabetes-related major lower limb amputations.
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Affiliation(s)
- Nawaf J Shatnawi
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Nabil A Al-Zoubi
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Hassan M Hawamdeh
- Department of Basic Medical Science, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled Garaibeh
- Department of Orthopedic Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Hussein A Heis
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan
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[Operative treatment of diabetics with vascular complications : Secondary data analysis of diagnosis-related groups statistics from 2005 to 2014 in Germany]. Chirurg 2018; 89:545-551. [PMID: 29589075 DOI: 10.1007/s00104-018-0628-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In Germany approximately 40,000 amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. OBJECTIVE The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. MATERIAL AND METHODS The microdata of the diagnosis-related groups (DRG) statistics of the Federal Statistical Office were analyzed over the period from 2005 to 2014. All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications (diabetic angiopathy and peripheral arterial disease) was encrypted. RESULTS The median age of the 1,811,422 cases was 73 years and 62% were male. While the total number of amputations remained stable over time, there was a 41% reduction in knee-preserving and a 31% reduction in non-knee preserving major amputations with an 18% increase in minor amputations. Revascularization increased by 33% from 36 procedures in 2005 to 48 procedures per 100,000 inhabitants. The increase in revascularization was evident in the area of endovascular therapy alone where there was an increase of 78%. CONCLUSION Due to the significant increase in endovascular revascularization measures, there was a significant increase in the proportion of diabetes patients with vascular pathologies in whom revascularization was carried out. As a result, improved limb preservation was achieved despite equally high amputation rates due to increasing minor amputation rates.
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Prevalence and correlations between suicide attempt, depression, substance use, and functionality among patients with limb amputations. Int J Rehabil Res 2018; 41:52-56. [DOI: 10.1097/mrr.0000000000000259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evidence based review of literature on detriments to healing of diabetic foot ulcers. Foot Ankle Surg 2017; 23:215-224. [PMID: 29202978 DOI: 10.1016/j.fas.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. METHOD A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. RESULTS Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. CONCLUSION Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.
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Beyaz S, Güler ÜÖ, Bağır GŞ. Factors affecting lifespan following below-knee amputation in diabetic patients. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:393-397. [PMID: 28865844 PMCID: PMC6197166 DOI: 10.1016/j.aott.2017.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/20/2017] [Accepted: 07/09/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Untreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems. MATERIALS AND METHODS A total of 470 patients (299 males, 171 females) with a mean age of 64.32 years who underwent below-knee amputation for diabetic foot problems between 2004 and 2014 were enrolled in the study. The length of time from the operation to time of death was recorded in days. Patient details were obtained, including age during surgery, BMI, oral antidiabetic and insulin usage, dialysis therapy history, lower extremity endovascular intervention, previous amputation at the same extremity, the need for stump revision surgery during follow-up, and above-knee amputation at the same site. Biochemical test results of pre-operative HbA1c, ESR, and levels of CRP, BUN, and creatinine were also obtained. RESULTS A total of 333 patients (70.9%) died and 137 (29.1%) survived post-surgery. Survival rates were 90% in the first 7 days, 84% in the first 30 days, and 64% after the first year. Patient median life expectancy post-surgery was 930 ± 106 days. Hemodialysis treatment (p = 0.001), endovascular intervention (p = 0.04), sex (p = 0.004), age (p = 0.001), BUN level (p = 0.001), and duration of insulin use (p = 0.003) were shown to be effective predictors of mortality. CONCLUSIONS Life expectancy is low (<3 years) in DM patients requiring below-knee amputations for untreatable foot problems. Survival could be predicted by duration of insulin use, age, sex, and renal insufficiency. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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İçer M, Durgun HM. Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.298615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wu JT, Wong M, Lo ZJ, Wong WE, Narayanan S, Tan GWL, Chandrasekar S. A Series of 210 Peripheral Arterial Disease Below-Knee Amputations and Predictors for Subsequent Above-Knee Amputations. Ann Vasc Dis 2017; 10. [PMID: 29147164 PMCID: PMC5684163 DOI: 10.3400/avd.oa.17-00046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To review patient characteristics and outcomes after peripheral arterial disease (PAD)-related below-knee amputation (BKA), and identify risk factors predicting subsequent above-knee amputation (AKA). Materials and Methods: A retrospective study of 210 BKAs between May 2008 and December 2015. Results: The mean age of the study population was 66 years. Most of the patients had cardiovascular comorbidities, and 33% had end-stage renal failure (ESRF); 89% were American Society of Anesthesiologists 3 or 4. Previous ipsilateral lower-limb minor amputation was present in 49% and previous contralateral lower-limb major amputation was present in 20% patients. Limb salvage revascularization via angioplasty prior to BKA was performed in 73%, while 27% had extensive tissue loss that was not suitable for limb salvage. Postoperatively, 20% had BKA wound infection, with 3% requiring further surgical debridement, and 9% (19 patients) required subsequent AKA within 1 month. Overall survival analysis at 1–5 years was 75%, 66%, 64%, 59%, and 58%, respectively. Multivariate analysis showed ESRF (Odds Ratio [OR]=3.85; p=0.01) and preoperative non-ambulatory status (OR=5.58; p=0.01) to be independent risk factors in predicting for subsequent AKA. Conclusion: Patients with underlying ESRF or preoperative non-ambulatory status may benefit from direct AKA if major amputation is required.
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Affiliation(s)
- Jing Ting Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maggie Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Wei-En Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sriram Narayanan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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von Lengerke T, Kröning B, Lange K. Patients' intention to speak up for health care providers' hand hygiene in inpatient diabetic foot wound treatment: a cross-sectional survey in diabetes outpatient centres in Lower Saxony, Germany. PSYCHOL HEALTH MED 2016; 22:1137-1148. [PMID: 27998179 DOI: 10.1080/13548506.2016.1268696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs' hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434) = 41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292) = 4.4, p = .013) and knowledge on HCPs' hand hygiene (F(2, 294) = 3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs' hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge.
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Affiliation(s)
| | - Barbara Kröning
- a Hannover Medical School , Medical Psychology Unit , Hannover , Germany
| | - Karin Lange
- a Hannover Medical School , Medical Psychology Unit , Hannover , Germany
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Navarro-Peternella FM, Lopes APAT, de Arruda GO, Teston EF, Marcon SS. Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons: A cross-sectional trial. J Clin Transl Endocrinol 2016; 6:30-36. [PMID: 29067239 PMCID: PMC5644468 DOI: 10.1016/j.jcte.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/18/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
AIMS This trial aims to identify differences between genders in relation to factors associated with the risk of diabetic foot in elderly persons. METHODS We evaluated 187 older adults diagnosed with diabetes type 2. The variables investigated were sociodemographic data, clinical history of diabetes mellitus and complaints about the feet. The plantar sensitivity was evaluated on both feet, with the use of Semmes-Weinstein monofilaments. For data analysis we used chi-square test and binary logistic regression (p < 0.05; 95% CI). RESULTS We included 174 elderly people who had no history of stroke and peripheral vascular disease. Most (58.6%) were female and among them the risk factors for diabetic foot were older age (p < 0.021; OR 6.0), presence of calluses (p < 0.046; OR 2.83) and claw toes (p < 0.041; OR 3.18). And among men, the risk factors for diabetic foot were insulin use (p < 0.008; OR 5.22), presence of sensory comorbidities (p < 0.007; OR 5.0), ulcers (p < 0.001), numbness (p < 0.002; OR 6.6) and stiffness in the feet (p < 0.009; OR 5.44). CONCLUSION The factors associated with the development of diabetic foot were presented differently in women and men, so a targeted and more specific preventive approach is required.
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Affiliation(s)
| | - Ana Patrícia A. Torquato Lopes
- Department of Nursing, Universidade Federal de Mato Grosso do Sul, Paraná, Brazil
- Department of Nursing, State University of Maringá, Paraná, Brazil
| | - Guilherme Oliveira de Arruda
- Department of Nursing, State University of Maringá, Paraná, Brazil
- Psychosocial Care Center – Alcohol and Other Drugs (CAPS-AD), Maringá, Brazil
| | | | - Sonia Silva Marcon
- Department of Health Sciences and Nursing, State University of Maringá, Paraná, Brazil
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Rossaneis MA, Haddad MDCFL, Mathias TADF, Marcon SS. Differences in foot self-care and lifestyle between men and women with diabetes mellitus. Rev Lat Am Enfermagem 2016; 24:e2761. [PMID: 27533270 PMCID: PMC4996089 DOI: 10.1590/1518-8345.1203.2761] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to investigate differences with regard to foot self-care and lifestyle between men and women with diabetes mellitus. METHOD cross-sectional study conducted in a sample of 1,515 individuals with diabetes mellitus aged 40 years old or older. Poisson regression models were used to identity differences in foot self-care deficit and lifestyle between sexes, adjusting for socioeconomic and clinical characteristics, smoking and alcohol consumption. RESULTS foot self-care deficit, characterized by not regularly drying between toes; not regularly checking feet; walking barefoot; poor hygiene and inappropriately trimmed nails, was significantly higher among men, though men presented a lower prevalence of feet scaling and use of inappropriate shoes when compared to women. With regard to lifestyle, men presented less healthy habits, such as not adhering to a proper diet and taking laboratory exams to check for lipid profile at the frequency recommended. CONCLUSION the nursing team should take into account gender differences concerning foot self-care and lifestyle when implementing educational activities and interventions intended to decrease risk factors for foot ulceration. OBJETIVO investigar as diferenças no autocuidado com os pés e no estilo de vida entre mulheres e homens diabéticos. MÉTODO estudo transversal realizado com uma amostra de 1.515 diabéticos com 40 anos ou mais. Foram utilizados modelos de regressão de Poisson para identificar diferenças entre os sexos na prevalência de déficit de autocuidado com os pés e no estilo de vida, ajustando-se por características socioeconômicas, clínicas, tabagismo e alcoolismo. RESULTADOS a prevalência de déficit de autocuidado com os pés, caracterizada por baixa frequência de secagem dos espaços interdigitais; da não avaliação periódica dos pés; do hábito de andar descalço; de higiene insatisfatória e corte inadequado de unhas foi significativamente maior entre os homens. Contudo, eles apresentaram menor prevalência na prática de escaldar os pés e no uso de calçados inadequados em comparação às mulheres. Em relação ao estilo de vida, os homens também apresentaram comportamentos menos saudáveis pois tem significativamente menor controle alimentar e não realizam os exames laboratoriais referentes ao perfil lipídico na frequência recomendada. CONCLUSÃO considerar as diferenças de gênero no autocuidado com os pés e no estilo de vida permite à equipe de enfermagem direcionar atividades educacionais e intervenções nos fatores de risco à ulceração dos pés. OBJETIVO investigar las diferencias en el autocuidado de los pies y estilo de vida entre mujeres y hombres diabéticos. MÉTODO estudio transversal realizado con una muestra de 1.515 diabéticos con 40 años o más. Fueron utilizados los modelos de regresión de Poisson para identificar diferencias entre los sexos en la prevalencia de déficit de autocuidado de los pies y estilo de vida, ajustándolas por características socioeconómicas, clínicas, tabaquismo y alcoholismo. RESULTADOS la prevalencia de déficit de autocuidado de los pies, caracterizada por: baja frecuencia de secado de los espacios interdigitales; falta de evaluación periódica de los pies; hábito de andar descalzo; higiene insatisfactoria; y, corte inadecuado de uñas, fue significativamente mayor entre los hombre. Sin embargo, estos presentaron menor prevalencia en la práctica de escaldar los pies y en el uso de calzados inadecuados en comparación a las mujeres. En relación al estilo de vida, los hombres también presentaron comportamientos menos saludables ya que tienen significativamente menor control alimentario y no realizan los exámenes de laboratorio referentes al perfil lipídico, con la frecuencia recomendada. CONCLUSIÓN considerar las diferencias de género en el autocuidado de los pies y en el estilo de vida, le permite al equipo de enfermería realizar actividades educacionales e intervenciones en los factores de riesgo para la ulceración de los pies.
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Affiliation(s)
- Mariana Angela Rossaneis
- PhD, Assistant Professor, Departamento de Enfermagem, Universidade
Estadual de Londrina, Londrina, PR, Brazil
| | | | | | - Sonia Silva Marcon
- PhD, Full Professor, Departamento de Enfermagem, Universidade Estadual
de Maringá, Maringá, PR, Brazil
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Malyar NM, Freisinger E, Meyborg M, Lüders F, Gebauer K, Reinecke H, Lawall H. Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complications 2016; 30:1117-22. [PMID: 27118161 DOI: 10.1016/j.jdiacomp.2016.03.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/18/2022]
Abstract
AIMS The prevalence of diabetes mellitus (DM) and its associated complications such as peripheral artery disease (PAD) and diabetic foot syndrome (DFS) are increasing worldwide. We aimed to determine the contemporary acute and long-term outcome of patients with PAD and DFS in Germany. METHODS Nationwide, anonymized data of 40,335 patients hospitalized for PAD and/or DFS from the years 2009-2011 were analyzed and followed up until 2013. Patients were classified into 3 groups: DFS, PAD+DM and PAD without DM. In-hospital and long-term outcome (1156days, 95% CI 1.151-1.161) regarding major and minor amputation and mortality was assessed. Cumulative amputation-free survival and overall survival rates were calculated using Kaplan-Meier analysis. RESULTS The proportion of DFS, PAD+DM and PAD only was 17.3%, 21.5% and 61.2%, respectively. At index-hospitalization, DFS patients had the highest amputation (31.9% vs. 11.1% vs. 6.0%), yet the lowest revascularization rate (18.2% vs. 67.8% vs. 71.6%) compared to patients with PAD only and PAD+DM (P<0.001). Cumulative 4-year survival (57.4%, 60.8% and 70.0%) and amputation-free-survival (45.4%, 74.4% and 86.5%) were lowest for DFS followed by PAD+DM and PAD only (P<0.001). CONCLUSIONS Patients with diabetes, particularly those with DFS, have persistent high rates of limb amputation and of mortality in a real-world setting. Our data emphasize the need for further dedicated research to identify and target the underlying causes of the extraordinary poor outcome in this high risk population.
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Affiliation(s)
- Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Meyborg
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Florian Lüders
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Katrin Gebauer
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen und Akademie für Gefäßkrankheiten, Ettlingen, Germany
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Ochman S, Raschke MJ, Stukenborg-Colsman C, Daniilidis K. [Hallux amputation]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:352-64. [PMID: 27379857 DOI: 10.1007/s00064-016-0458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/15/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover. INDICATIONS In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy. CONTRAINDICATIONS In the case of insufficient blood supply an expansion of the resection margins should be taken into account. If there are possible alternatives to amputation. Surgery for patients with renal failure requiring dialysis associated with increased complication rate. SURGICAL TECHNIQUE A dorsal cuneiform resection is performed to facilitate implantation of a plantar skin transplant and wound healing. Important is the resection of bone in a slide oblique technique. Amputation scars should be outside pressure zones. Partial amputations in the area of the first ray as exarticulation or via the individual amputated segments possible (as opposed to toes 2-5). POSTOPERATIVE MANAGEMENT Direct postoperative weight-bearing with rigid insole and dispensing aid for 6-8 weeks. Following complete wound healing, foot support with orthopedic arch and transverse strain relief should be advocated, together with a joint roll in ready-made individual shoes. RESULTS Both trauma and nontrauma cases were included in our present cohort. A total of 7 cases were surgically revised in 2014 due to superficial skin necrosis that was likely the result of skin tension from the wound stitches.
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Affiliation(s)
- S Ochman
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - M J Raschke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - C Stukenborg-Colsman
- Department für Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakoniekrankenhaus Annastift, Hannover, Deutschland
| | - K Daniilidis
- Department für Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakoniekrankenhaus Annastift, Hannover, Deutschland
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Dresing K. [Diabetic foot syndrome]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:321-2. [PMID: 27339218 DOI: 10.1007/s00064-016-0456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Bohn B, Schöfl C, Zimmer V, Hummel M, Heise N, Siegel E, Karges W, Riedl M, Holl RW. Achievement of treatment goals for secondary prevention of myocardial infarction or stroke in 29,325 patients with type 2 diabetes: a German/Austrian DPV-multicenter analysis. Cardiovasc Diabetol 2016; 15:72. [PMID: 27141979 PMCID: PMC4855873 DOI: 10.1186/s12933-016-0391-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/22/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To analyze whether medical care is in accordance with guidelines for secondary prevention of myocardial infarction (MI), or stroke in patients with type 2 diabetes from Germany and Austria. METHODS 29,325 patients (≥ 20 years of age) with type 2 diabetes and MI, or stroke, documented between 2006 and 2015 were selected from the Diabetes-Patienten-Verlaufsdokumentation database. We analyzed medication, clinical characteristics, and lifestyle factors according to national secondary prevention guidelines in patients with MI, or stroke, separately. RESULTS HbA1C <7.5 % was achieved in 64.9 % (MI), and in 61.1 % (stroke) of patients. LDL <100 mg/dl was documented in 56.2 % (MI), and in 42.2 % (stroke). Non-smoking was reported in 92.0 % (MI), and in 93.1 % (stroke), physical activity in 9.6 % (MI), and 5.5 % (stroke). Target values of blood pressure (<130/80 mmHg in MI, 120/70-140/90 in stroke) were reached in 67.0 % (MI), and in 89.9 % (stroke). Prescription prevalence of inhibitors of platelet aggregation (IPA) was 50.7 % (MI), and 31.7 % (stroke). 57.0 % (MI), and 40.1 % (stroke) used statins, 65.1 % (MI), and 65.8 % (stroke) used any type of antihypertensives, and ACE inhibitors were prescribed in 49.7 % (MI), and 41.3 % (stroke). A body mass index (BMI) <27 kg/m(2) and the use of beta blockers were only recommended in subjects with MI. Of the patients with MI, 32.0 % had a BMI <27 kg/m(2), and 59.5 % used beta blockers. CONCLUSIONS Achievement of treatment goals in secondary prevention of MI, or stroke in subjects with type 2 diabetes needs improvement. Target goals were met more frequently in patients with MI compared to subjects with stroke. Especially the use of IPA was very low in patients with stroke. There remains great potential to reduce the risk of repeated macrovascular events and premature death, as well as to increase patients' quality of life.
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Affiliation(s)
- Barbara Bohn
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Christof Schöfl
- />Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
| | - Vincent Zimmer
- />Department for Internal Medicine, Protestant Hospital Zweibrücken, Zweibrücken, Germany
- />Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Michael Hummel
- />Specialized Diabetes Practice Rosenheim & Institute of Diabetes Research, Helmholtz Center Munich, Munich, Germany
| | - Nikolai Heise
- />Alb Fils Kliniken, Helfenstein Clinic, Geislingen, Germany
| | - Erhard Siegel
- />Department of Internal Medicine, St. Josefs Hospital, Heidelberg, Germany
| | - Wolfram Karges
- />Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Michaela Riedl
- />Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Reinhard W. Holl
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - On behalf of the DPV-initiative
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
- />Department for Internal Medicine, Protestant Hospital Zweibrücken, Zweibrücken, Germany
- />Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- />Specialized Diabetes Practice Rosenheim & Institute of Diabetes Research, Helmholtz Center Munich, Munich, Germany
- />Alb Fils Kliniken, Helfenstein Clinic, Geislingen, Germany
- />Department of Internal Medicine, St. Josefs Hospital, Heidelberg, Germany
- />Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
- />Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Papanas N, Maltezos E. Glycated Hemoglobin as a Risk Factor for Lower Extremity Amputations in Diabetes: "Success Is Counted Sweetest". INT J LOW EXTR WOUND 2016; 14:106-7. [PMID: 26187323 DOI: 10.1177/1534734615592313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Papanas
- Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - E Maltezos
- Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Rasmussen BSB, Yderstraede KB, Carstensen B, Skov O, Beck-Nielsen H. Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years. Diabetologia 2016; 59:121-129. [PMID: 26590707 DOI: 10.1007/s00125-015-3781-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to describe the trends in rates of amputation among individuals with and without diabetes. METHODS We studied amputation rates in the County of Funen (approximately 0.5 million residents) during the period 1996-2011. Amputations were identified from the hospital administrative system, diabetes status by linkage with the Danish National Diabetes Register, and mortality and population data by extraction from Statistics Denmark. Amputation rates were analysed using proportional hazard models. We analysed the incidence of the first amputation at each level as well as the incidence of further amputations, subdivided by level of amputation. RESULTS During the period 1996-2011, a total of 2,832 amputations were performed, of which 1,285 were among patients with diabetes and 1,547 among individuals without diabetes. Relative to persons without diabetes, patients with diabetes had an HR for below-ankle amputations (BAAs) of 14.7 for men and 7.5 for women, and for from-ankle-to-knee amputations (BKAs) of 7.6 and 8.4 for men and women, respectively. For above-knee amputations (AKAs) the numbers were 4.0 for men and 3.7 for women. We found an annual reduction in BAA rates among patients with diabetes of 9.8%, and the annual reduction in BKA for patients with diabetes was 15.1%. CONCLUSIONS/INTERPRETATION The amputation rate in patients with diabetes is still several-fold higher than in persons without diabetes, but the improvements in diabetes care in recent years have resulted in a steady decline in amputation rates among patients with diabetes from this Danish cohort.
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Affiliation(s)
- Benjamin S B Rasmussen
- Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Knud B Yderstraede
- Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | | | - Ole Skov
- Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
| | - Henning Beck-Nielsen
- Department of Medical Endocrinology, Odense University Hospital Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark
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Rodrigues BT, Vangaveti VN, Malabu UH. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study. J Diabetes Res 2016; 2016:5941957. [PMID: 27446962 PMCID: PMC4942664 DOI: 10.1155/2016/5941957] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/03/2016] [Indexed: 01/26/2023] Open
Abstract
Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98-65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.
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Affiliation(s)
- Beverly T. Rodrigues
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Venkat N. Vangaveti
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Usman H. Malabu
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
- *Usman H. Malabu:
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Verrone Quilici MT, Del Fiol FDS, Franzin Vieira AE, Toledo MI. Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection. J Diabetes Res 2016; 2016:8931508. [PMID: 26998493 PMCID: PMC4779829 DOI: 10.1155/2016/8931508] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/04/2016] [Accepted: 01/27/2016] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.
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Affiliation(s)
| | - Fernando de Sá Del Fiol
- University of Sorocaba, Rodovia Raposo Tavares, Km 92,5, 18023-000 Sorocaba, SP, Brazil
- *Fernando de Sá Del Fiol:
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Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2015; 13 Suppl 1:13-9. [PMID: 26478562 DOI: 10.1111/iwj.12526] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.
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Affiliation(s)
- Sik Namgoong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Suyoung Jung
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Woo-Kyung Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
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Kogani M, Mansournia MA, Doosti-Irani A, Holakouie-Naieni K. Risk factors for amputation in patients with diabetic foot ulcer in southwest Iran: a matched case-control study. Epidemiol Health 2015; 37:e2015044. [PMID: 26493777 PMCID: PMC4652061 DOI: 10.4178/epih/e2015044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/05/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: Amputation is a multifactorial complication in diabetic patients. The aim of this study was to determine the risk factors associated with amputation in patients with diabetic foot ulcers. METHODS: This matched case-control study was conducted based on new cases of amputation from March 2012 to November 2014. We selected new cases who had undergone amputation, and the control group was chosen from the cities or areas where the cases resided. Each case was matched with two controls based on the duration of diabetes and location. Conditional logistic regression was used to evaluate the associations between potential risk factors and amputation. RESULTS: A total of 131 cases were compared with 262 controls. The results of the adjusted model showed that sex (odds ratio [OR], 8.66; 95% confidence interval [CI], 2.68 to 27.91), fewer than two hemoglobin A1c (HbA1c) tests per year (OR, 13.97; 95% CI, 4.97 to 39.26), unsuitable shoes (OR, 5.50; 95% CI, 2.20 to 13.77), smoking (OR, 3.44; 95% CI, 1.45 to 8.13), and body mass index (OR, 1.20; 95% CI, 1.03 to 1.41) were associated with amputation in diabetic patients. CONCLUSIONS: The most important factors associated with amputation were females, irregular monitoring of HbA1c levels, improper footwear, and smoking. Developing educational programs and working to ensure a higher quality of care for diabetic patients are necessary steps to address these issues.
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Affiliation(s)
- Mohammad Kogani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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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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Witzel II, Jelinek HF, Khalaf K, Lee S, Khandoker AH, Alsafar H. Identifying Common Genetic Risk Factors of Diabetic Neuropathies. Front Endocrinol (Lausanne) 2015; 6:88. [PMID: 26074879 PMCID: PMC4447004 DOI: 10.3389/fendo.2015.00088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a global public health problem of epidemic proportions, with 60-70% of affected individuals suffering from associated neurovascular complications that act on multiple organ systems. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy. These conditions seriously impact an individual's quality of life and significantly increase the risk of morbidity and mortality. Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities. We thereby aim to contribute to the creation of a genetic-metabolic model that will help to elucidate the cause of diabetic neuropathies, evaluate a patient's risk profile, and ultimately facilitate preventative and targeted treatment for the individual.
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Affiliation(s)
- Ini-Isabée Witzel
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Herbert F. Jelinek
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
- Centre for Research in Complex Systems, School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Sungmun Lee
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Ahsan H. Khandoker
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
- Electrical and Electronic Engineering Department, The University of Melbourne, Parkville, VIC, Australia
| | - Habiba Alsafar
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
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