1
|
Huang J, Fan Q, Shi L, Shen J, Wang H. A novel chlorin derivative Shengtaibufen (STBF) mediated photodynamic therapy combined with iodophor for the treatment of chronic superficial leg wounds infected with methicillin-resistant Staphylococcus aureus: A retrospective clinical study. Photodiagnosis Photodyn Ther 2024; 48:104300. [PMID: 39097252 DOI: 10.1016/j.pdpdt.2024.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/27/2024] [Accepted: 07/31/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Chronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers. PATIENTS AND METHODS This was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded. RESULTS We found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life). CONCLUSION Our data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.
Collapse
Affiliation(s)
- Jianhua Huang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Qing Fan
- Department of Dermatology, Shanghai Fengxian District Hospital, Shanghai 201499, PR China
| | - Lei Shi
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Jie Shen
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Hongwei Wang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China.
| |
Collapse
|
2
|
Che D, Jiang Z, Xiang X, Zhao L, Liu X, Zhou B, Xie J, Li H, Lv Y, Cao D. Predictors of amputation in patients with diabetic foot ulcers: a multi-centre retrospective cohort study. Endocrine 2024; 85:181-189. [PMID: 38332209 DOI: 10.1007/s12020-024-03704-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Investigating risk factors for amputation in patients with diabetic foot ulcer (DFU) and developing a nomogram prediction model. METHODS We gathered case data of DFU patients from five medical institutions in Anhui Province, China. Following eligibility criteria, a retrospective case-control study was performed on data from 526 patients. RESULTS Among the 526 patients (mean age: 63.32 ± 12.14), 179 were female, and 347 were male; 264 underwent amputation. Univariate analysis identified several predictors for amputation, including Blood type-B, Ambulation, history of amputation (Hx. Of amputation), Bacterial culture-positive, Wagner grade, peripheral arterial disease (PAD), and laboratory parameters (HbA1c, Hb, CRP, ALB, FIB, PLT, Protein). In the multivariate regression, six variables emerged as independent predictors: Blood type-B (OR = 2.332, 95%CI [1.488-3.657], p < 0.001), Hx. Of amputation (2.298 [1.348-3.917], p = 0.002), Bacterial culture-positive (2.490 [1.618-3.830], p <0.001), Wagner 3 (1.787 [1.049-3.046], p = 0.033), Wagner 4-5 (4.272 [2.444-7.468], p <0.001), PAD (1.554 [1.030-2.345], p = 0.036). We developed a nomogram prediction model utilizing the aforementioned independent risk factors. The model demonstrated a favorable predictive ability for amputation risk, as evidenced by its area under the receiver operating characteristics (ROC) curve of 0.756 and the well-fitted corrected nomogram calibration curve. CONCLUSION Our findings underscore Blood type-B, Hx. Of amputation, Bacterial culture-positive, Wagner 3-5, and PAD as independent risk factors for amputation in DFU patients. The resultant nomogram exhibits substantial accuracy in predicting amputation occurrence. Timely identification of these risk factors can reduce DFU-related amputation rates.
Collapse
Affiliation(s)
- Dehui Che
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengwan Jiang
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinjian Xiang
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Xie Liu
- Taihe Hospital of Wannan Medical College, Shiyan, China
| | - Bingru Zhou
- The Affiliated Hospital of North Anhui College of Health Professions, Hefei, China
| | - Juan Xie
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Honghong Li
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Lv
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongsheng Cao
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| |
Collapse
|
3
|
Yazdanpanah L, Shahbazian H, Hesam S, Ahmadi B, Zamani AM. Two-year incidence and risk factors of diabetic foot ulcer: second phase report of Ahvaz diabetic foot cohort (ADFC) study. BMC Endocr Disord 2024; 24:46. [PMID: 38622562 PMCID: PMC11017491 DOI: 10.1186/s12902-024-01572-x] [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: 01/31/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
AIM/INTRODUCTION This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). MATERIALS AND METHODS The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. RESULTS We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. CONCLUSION Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity.
Collapse
Affiliation(s)
- Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Ahmadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Mohammad Zamani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
4
|
Bonnet JB, Szwarc I, Avignon A, Jugant S, Sultan A. Renal function is highly associated with podiatric risk in diabetic patients. Clin Kidney J 2023; 16:2156-2163. [PMID: 37915919 PMCID: PMC10616501 DOI: 10.1093/ckj/sfad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Indexed: 11/03/2023] Open
Abstract
Background Chronic kidney disease (CKD) is correlated with the incidence of diabetic foot ulcer (DFU). Furthermore, the International Working Group on the Diabetic Foot (IWGDF) has proposed a classification of the risk factors for DFU. The purpose of this study was to investigate the relationship between the IWGDF risk classification and the glomerular filtration rate level estimated by the CKD Epidemiology Collaboration formula (eGFR). Methods We conducted a prospective multicentric study. Patients were recruited from either diabetology or nephrology departments. The secondary objectives were to determine this relationship after excluding people on dialysis and to identify the factors associated with podiatric risk. Results Four hundred and eighty-six patients were included, with a mean age of 64.2 years (±15.7) and a mean diabetes duration of 15.7 years (±12.1). Based on the IWGDF classification, 53.5% of the population were in podiatric stage 0, 11.7% in stage 1 and 34.8% in stage 2 or 3. The mean eGFR level was significantly lower in patients with podiatric risk ≥2 (36.8 ± 33.9 mL/min/1.73 m2 vs 71.9 ± 35.3 mL/min/1.73 m2, P < .0001) and a significant association was found between the eGFR and the podiatric risk. This association remained significant after the exclusion of the hemodialysis patients. After receiver operating characteristic analysis, a cutoff of 45 ± 11 mL/min/1.73 m2 (area under the curve 0.76) was found discriminant to define a group of CKD patients at higher risk for podiatric stage ≥2. Conclusion eGFR levels are linked to podiatric stages in diabetes mellitus. Patients with eGFR <45 mL/min/1.73 m2 and dialysis patients should be carefully managed in collaboration with diabetic foot specialized centers.
Collapse
Affiliation(s)
- Jean-Baptiste Bonnet
- Diabetes-Nutrition Department, University Hospital of Montpellier, Montpellier, France
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, University Montpellier, INSERM, CHU, Montpellier, France
| | - Ilan Szwarc
- Department of Nephrology-Transplantation, University Hospital of Montpellier, Montpellier, France
| | - Antoine Avignon
- Diabetes-Nutrition Department, University Hospital of Montpellier, Montpellier, France
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, University Montpellier, INSERM, CHU, Montpellier, France
| | | | - Ariane Sultan
- Diabetes-Nutrition Department, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR, Montpellier, France
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [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] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
Collapse
Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| |
Collapse
|
7
|
Boyko EJ, Zelnick LR, Braffett BH, Pop-Busui R, Cowie CC, Lorenzi GM, Gubitosi-Klug R, Zinman B, de Boer IH. Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2022; 45:357-364. [PMID: 35007329 PMCID: PMC8914413 DOI: 10.2337/dc21-1816] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Intensive glycemic control reduces the risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces the risk of lower-extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study. RESEARCH DESIGN AND METHODS DCCT participants (n = 1,441) completed 6.5 years on average of intensive versus conventional diabetes treatment, after which 1,408 were enrolled in EDIC and followed annually over 23 years for DFU and LEA occurrences by physical examination. Multivariable Cox proportional hazard regression models estimated associations of DCCT treatment assignment and time-updated exposures with DFU or LEA. RESULTS Intensive versus conventional glycemic control was associated with a significant risk reduction for all DFUs (hazard ratio 0.77 [95% CI 0.60, 0.97]) and a similar magnitude but nonsignificant risk reduction for first-recorded DFUs (0.78 [0.59, 1.03]) and first LEAs (0.70 [0.36, 1.36]). In adjusted Cox models, clinical neuropathy, lower sural nerve conduction velocity, and cardiovascular autonomic neuropathy were associated with higher DFU risk; estimated glomerular filtration rate <60 mL/min/1.73 m2, albuminuria, and macular edema with higher LEA risk; and any retinopathy and greater time-weighted mean DCCT/EDIC HbA1c with higher risk of both outcomes (P < 0.05). CONCLUSIONS Early intensive glycemic control decreases long-term DFU risk, the most important antecedent in the causal pathway to LEA.
Collapse
Affiliation(s)
- Edward J Boyko
- Veterans Affairs Puget Sound Health Care System, Seattle, WA.,Department of Medicine, University of Washington, Seattle, WA
| | - Leila R Zelnick
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Rose Gubitosi-Klug
- Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian H de Boer
- Veterans Affairs Puget Sound Health Care System, Seattle, WA.,Department of Medicine, University of Washington, Seattle, WA
| |
Collapse
|
8
|
Doğruel H, Aydemir M, Balci MK. Management of diabetic foot ulcers and the challenging points: An endocrine view. World J Diabetes 2022; 13:27-36. [PMID: 35070057 PMCID: PMC8771264 DOI: 10.4239/wjd.v13.i1.27] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcers (DFU) are one of the most challenging complications of diabetes. Up to one-third of patients with diabetes mellitus (DM) may suffer from DFUs during their life. DFU is one of the leading causes of morbidity in patients with DM. The treatment period is challenging, and the recurrence rate of DFUs is high. Hence, establishing prevention strategies is the most important point to be emphasized. A multidisciplinary approach is necessary in the prevention and treatment of DFUs. Patients at risk should be identified, and prevention measures should be taken based on the risk category. Once a DFU is formed, the appropriate classification and evidence-based treatment interventions should be executed. Glycemic control, diagnosis and treatment of vascular disease, local wound care, diagnosis, and treatment of infection should be addressed along with the proper evaluation and management of general health status.
Collapse
Affiliation(s)
- Hakan Doğruel
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Aydemir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Kemal Balci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Konyaaltı 07059, Antalya, Turkey
| |
Collapse
|
9
|
Connell L, Finn Y, Dunne R, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2022; 4:97. [PMID: 35280849 PMCID: PMC8881692 DOI: 10.12688/hrbopenres.13386.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Health literacy education, for health professionals, has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy, as a relational concept, encompasses individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions often guide the development of health professional education programmes, where the aim is to enhance the patient-practitioner relationship, and ultimately reduce the health literacy burden experienced by patients navigating health services. Currently little is known about qualified health professionals’ education in health literacy and communication skills, and development, implementation or evaluation of such interventions. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy and communication skills through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO. Grey literature will be searched within the references of identified articles; Lenus; ProQuest E-Thesis Portal; RIAN and OpenGrey. A data charting form will be developed with categories including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore a scoping review will be conducted, in order to identify programme characteristics in relation to health literacy competencies and communication skills.
Collapse
Affiliation(s)
- Lauren Connell
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Ireland
| | - Yvonne Finn
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Rosie Dunne
- James Hardiman Library, National University of Ireland, Galway, Galway, Ireland
| | - Jane Sixsmith
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
| |
Collapse
|
10
|
Bundó M, Llussà J, Serra M, la Iglesia PPD, Gimbert RM, Real J, Vlacho B, Mata-Cases M, Cos X, Franch-Nadal J, Mauricio D. Incidence and characteristics of diabetic foot ulcers in subjects with type 2 diabetes in Catalonian primary care centres: An observational multicentre study. Prim Care Diabetes 2021; 15:1033-1039. [PMID: 34419365 DOI: 10.1016/j.pcd.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022]
Abstract
AIMS The main objective was to assess the incidence of diabetic foot ulcers in type 2 diabetes individuals from primary care centres in Catalonia, Spain. METHODS Prospective observational study in 36 Primary Care centres in Catalonia during February 2018 and July 2019 was conducted. We included participants with type 2 diabetes and a new foot ulcer. We estimated the annual foot ulcer incidence and described the characteristics: presence of comorbidities, clinical parameters and the characteristics of the diabetic foot ulcers (DFU) at inclusion in the study. RESULTS The incidence of a new DFU during the 12-month recruitment period was 0.42%. The mean age of the participants was 72.2 years (± 12.7), the majority of them were males (n = 178; 69.5%). Overall, 43.8% of DFUs were located on the dorsal aspect of toes or interdigital spaces. A percentage of 43.4% of the participants had ulcers of less than 1 cm2 surface. Further, 44.1% of the participants had a neuroischemic, 20.3% a neuropathic, 20.3% an ischemic ulcer. A 25.3% of ulcers with a concomitant peripheral artery disease were infected. CONCLUSIONS Although the incidence found was low, our study shows the great complexity of patients with foot ulcers treated in primary care.
Collapse
Affiliation(s)
- Magdalena Bundó
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Primary Health Care Center Ronda Prim, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain
| | - Judit Llussà
- Primary Health Care Centre Sant Roc, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain Catalan Health Institute, Badalona, Spain
| | - Marta Serra
- Primary Health Care Centre Ca n'Oriac, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Sabadell, Spain
| | - Paloma Prats de la Iglesia
- Primary Health Care Centre Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Rosa M Gimbert
- Primary Health Care Centre El Carmel, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Internacional de Catalunya, Epidemiologia i Salut Pública, Sant Cugat, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Pharmacology Department, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Xavier Cos
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Innovation office at Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Primary Health Care Centre Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| |
Collapse
|
11
|
Al Amri AM, Shahrani IM, Almaker YA, Alshehri DM, Argabi MA, Alghamidi FA, Alqahtani YZ. Knowledge, Attitude and Practice Regarding Risk of Diabetic Foot Among Diabetic Patients in Aseer Region, Saudi Arabia. Cureus 2021; 13:e18791. [PMID: 34804657 PMCID: PMC8592378 DOI: 10.7759/cureus.18791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Diabetic foot care is vital as it is preventable complication but dangerous even a small trauma can end with serious consequences. Diabetes may cause nerve damage that affects feet sensation. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, patients may lose notice of early foot abnormalities. Diabetic patients’ awareness regarding how to care for their feet plays a significant role in preventing these complications. Methods A correlation cross-sectional study was conducted targeting all diabetic patients aging 20 years or more. Online questionnaire was used for data collection. Questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends. The questionnaire included patient personal data, patients’ knowledge regarding diabetic foot, attitude and practice regarding the risk of diabetic foot among diabetic patients. Results A total of 1,000 diabetic patients fulfilling the inclusion criteria completed the study questionnaire. Exact of 77.5% of the patients know that Diabetics can get gangrene in the foot, 74.9% know diabetics can develop ulcers in the foot, 66.7% reported that Diabetes can reduce blood flow to the feet of diabetic patients, 66.6% agreed that diabetic patients can suffer from a lack of sensation in the feet. Exact of 84.5% of the study participants agreed that Diabetics should check for any wounds on their feet daily, 78.7% agreed that Diabetics should visit a doctor when there is any infection or wound in the feet, 76.6% think that diabetic patients should wear specialized shoes to avoid diabetic foot according to the doctor's instructions. A total of 822 (82.2%) of the study patients wash their feet daily, and 295 (29.5%) usually wear cotton socks regularly and 39.6% sometimes wear the stock. Only 192 (19.2%) regularly walk barefoot and 41.7% sometimes do. Conclusion In conclusion, the current study results showed that nearly two out of each three diabetic patients were knowledgeable for diabetic foot and its care. High knowledge was associated with young age, high education and having family member with diabetes mellitus (DM). Also, patients had a good attitude towards diabetic foot care and the effect of diabetes on foot health with to some level accepted practice except for some issues.
Collapse
Affiliation(s)
- Ali M Al Amri
- Family Medicine & Diabetes, Asir Central Hospital, Abha, SAU
| | | | | | | | | | | | | |
Collapse
|
12
|
Lee EJ, Jeong IS, Kim IJ, Cho YH, Kim YJ. Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea. Int J Nurs Pract 2021; 28:e13012. [PMID: 34545667 DOI: 10.1111/ijn.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 07/01/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. METHODS A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. RESULTS Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. CONCLUSIONS As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.
Collapse
Affiliation(s)
- Eun Joo Lee
- Department of Nursing, Dong-Eui University, Busan, Republic of Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Republic of Korea
| | - In Ju Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University Yangsan Hospital & Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| |
Collapse
|
13
|
Beulens JWJ, Yauw JS, Elders PJM, Feenstra T, Herings R, Slieker RC, Moons KGM, Nijpels G, van der Heijden AA. Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study. Diabetologia 2021; 64:1550-1562. [PMID: 33904946 PMCID: PMC8075833 DOI: 10.1007/s00125-021-05448-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Approximately 25% of people with type 2 diabetes experience a foot ulcer and their risk of amputation is 10-20 times higher than that of people without type 2 diabetes. Prognostic models can aid in targeted monitoring but an overview of their performance is lacking. This study aimed to systematically review prognostic models for the risk of foot ulcer or amputation and quantify their predictive performance in an independent cohort. METHODS A systematic review identified studies developing prognostic models for foot ulcer or amputation over minimal 1 year follow-up applicable to people with type 2 diabetes. After data extraction and risk of bias assessment (both in duplicate), selected models were externally validated in a prospective cohort with a 5 year follow-up in terms of discrimination (C statistics) and calibration (calibration plots). RESULTS We identified 21 studies with 34 models predicting polyneuropathy, foot ulcer or amputation. Eleven models were validated in 7624 participants, of whom 485 developed an ulcer and 70 underwent amputation. The models for foot ulcer showed C statistics (95% CI) ranging from 0.54 (0.54, 0.54) to 0.81 (0.75, 0.86) and models for amputation showed C statistics (95% CI) ranging from 0.63 (0.55, 0.71) to 0.86 (0.78, 0.94). Most models underestimated the ulcer or amputation risk in the highest risk quintiles. Three models performed well to predict a combined endpoint of amputation and foot ulcer (C statistics >0.75). CONCLUSIONS/INTERPRETATION Thirty-four prognostic models for the risk of foot ulcer or amputation were identified. Although the performance of the models varied considerably, three models performed well to predict foot ulcer or amputation and may be applicable to clinical practice.
Collapse
Affiliation(s)
- Joline W J Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Josan S Yauw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Talitha Feenstra
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
- Centre for Nutrition, Prevention and Health Services, Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Ron Herings
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Roderick C Slieker
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giel Nijpels
- Department of General Practice, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Amber A van der Heijden
- Department of General Practice, Amsterdam UMC - Location VUmc, Amsterdam Public Health, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Lee EJ, Jeong IS, Woo SH, Jung HJ, Han EJ, Kang CW, Hyun S. [Development of a Diabetic Foot Ulceration Prediction Model and Nomogram]. J Korean Acad Nurs 2021; 51:280-293. [PMID: 34215707 DOI: 10.4040/jkan.20257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). METHODS This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. RESULTS The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. CONCLUSION The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.
Collapse
Affiliation(s)
- Eun Joo Lee
- College of Nursing, Healthcare Sciences & Human Ecology, Dong-Eui University, Busan, Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Seung Hun Woo
- Department of Orthopedics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyuk Jae Jung
- Endovascular and Vascular and Transplantation Division, Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Eun Jin Han
- Division of Nursing, Severance Hospital, Seoul, Korea
| | - Chang Wan Kang
- IT Convergence College of Components and Materials Engineering, Dong-Eui University, Busan, Korea
| | - Sookyung Hyun
- College of Nursing, Pusan National University, Yangsan, Korea
| |
Collapse
|
15
|
Chappell FM, Crawford F, Horne M, Leese GP, Martin A, Weller D, Boulton AJM, Abbott C, Monteiro-Soares M, Veves A, Riley RD. Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies. BMJ Open Diabetes Res Care 2021; 9:9/1/e002150. [PMID: 34035053 PMCID: PMC8154962 DOI: 10.1136/bmjdrc-2021-002150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/05/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes. RESEARCH DESIGN AND METHODS Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR's performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis. RESULTS CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was -0.374 (95% CI -0.561 to -0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment. CONCLUSION The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.
Collapse
Affiliation(s)
| | - Fay Crawford
- The School of Medicine, University of St Andrews, St Andrews, Fife, UK
- Research, Development and Innovation, NHS Fife, Dunfermline, Fife, UK
| | - Margaret Horne
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew J M Boulton
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester & Manchester Royal Infirmary, Manchester, UK
- University of Miami, Miami, Florida, USA
| | - Caroline Abbott
- Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | | | - Aristidis Veves
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard D Riley
- School of Primary, Community and Social Care, Keele University, Keele, UK
| |
Collapse
|
16
|
Mealy A, Tierney S, Sorensen J. Lower extremity amputations in Ireland: a registry-based study. Ir J Med Sci 2021; 191:839-844. [PMID: 33755918 DOI: 10.1007/s11845-021-02536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the current provision of lower extremity amputations (LEA) in Irish public hospitals by patient characteristics and assess the potential savings for reducing numbers if a national multi-disciplinary foot protection clinic (MDFPC) was established nation-wide. DESIGN AND DATA SOURCES Patient characteristics of LEA conducted during 2016-2019 were analysed based on discharge data from the national hospital inpatient enquiry system. Reported consequences from existing literature were used to extrapolate national consequences. RESULTS Public hospitals registered 3104 hospital admissions with LEA during 2016-2019. 68% (n = 2099) of these were minor amputations. About 76% (n = 1592) of minor amputations and 52% (n = 525) of major amputations were performed on patients with a diagnosis of diabetes. If the implementation of a national MDFPC programmed could reduce the number of diabetic amputations by 20%, 80 minor and 26 major amputations could be avoided annually. This would avoid nearly 3000 hospital bed days and correspond to a potential annual saving of €3 M. CONCLUSION LEA has severe impact on patients' lives and hospital resources. Potential savings from effective prevention strategies may offer both health improvements and cost-savings.
Collapse
Affiliation(s)
| | - Sean Tierney
- Tallaght University Hospital, Dublin, Republic of Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre, RCSI, Dublin, Republic of Ireland
| |
Collapse
|
17
|
Hamri WH, Diaf M. Lipoprotein Ratios: A Potential Biomarker for Clinical Diagnosis of Atherosclerosis in Type 1 Diabetic Patients With Foot Ulceration. Cureus 2021; 13:e14064. [PMID: 33898147 PMCID: PMC8059674 DOI: 10.7759/cureus.14064] [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] [Indexed: 11/05/2022] Open
Abstract
Background Lipoprotein ratios are indicators of atherosclerosis and related diseases such as cardiovascular diseases (CVDs). Early and accurate diagnosis of atherosclerotic disease in patients with diabetic foot ulceration (DFU) is required urgently and remains fundamental to assess the risk of CVDs. This study aimed to determine whether lipoprotein ratios can predict atherosclerosis in type 1 diabetic patients with DFU. Methodology This was a cross-sectional study including 255 patients with confirmed type 1 diabetes with a male-to-female ratio of 1.19. Patients admitted to the hospital due to diabetes-related complications were divided into the following groups: patients without DFU (n = 153) and patients with DFU (n = 102). Clinical, biological, and pathophysiological features of patients were compared. Results Our study reported a distinct predominance of males (54.50%), with a mean age of 28.64 ± 10.92 years and duration of diabetes of 10.40 ± 9.25 years. The prevalence of DFU was 40.0%. The receiver operator characteristic curve was applied to define the best cut-off lipid ratios to detect atherosclerosis. Total cholesterol (TC)/high-density lipoprotein (HDL) ratio was a valid marker for atherosclerosis with a sensitivity of 86.3%, specificity of 71.4%, and diagnostic accuracy of 0.836%. The findings showed that the fourth quartiles (odds ratio [OR] = 83.02 [22.18-310.75]; p = <10-3) of TC/HDL ratio was significantly higher in patients with DFU. Similarly, the last quartiles (fourth) of low-density lipoprotein (LDL)/HDL and triglyceride (TG)/HDL ratio were higher in DFU group (OR = 33.71 [12.04-94.38], p = <10-3; OR = 9.60 [4.27-21.58], p = <10-3; respectively). In the DFU group, conventional lipid profiles and lipid ratios were markedly higher in males compared to females patients (TG = 1.31 ± 0.69 g/L vs. 1.04 ± 0.84 g/L, p = 0.04; respectively; TC/HDL = 4.79 ± 1.04 vs. 4.22 ± 0.98, p = 0.03; respectively; LDL/HDL = 2.91 ± 1.13 vs. 2.17 ± 1.28, p = 0.01; respectively; TG/HDL = 3.65 ± 2.53 vs. 2.67 ± 1.94, p = 0.008; respectively). Conclusions Elevated atherogenic indices were significantly associated with the atherosclerotic load in patients with DFU, supporting the use of lipid ratios as a biomarker for the diagnosis of atherosclerosis disease in clinical practice in the future.
Collapse
Affiliation(s)
| | - Mustapha Diaf
- Department of Biology, Djillali Liabes University, Sidi Bel Abbes, DZA
| |
Collapse
|
18
|
Wang D, Ouyang J, Zhou P, Yan J, Shu L, Xu X. A Novel Low-Cost Wireless Footwear System for Monitoring Diabetic Foot Patients. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:43-54. [PMID: 33296308 DOI: 10.1109/tbcas.2020.3043538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diabetic foot is one of the main complications of diabetes with the characteristics of high incidence and difficulty in treatment. Diabetic patients with peripheral neuropathy may develop foot ulcers, and in severe cases amputations are required and some may even die. Plantar pressure can be used to assess the risk of developing diabetic foot, but the existing plantar pressure monitoring methods are not suitable for long-term monitoring in daily life. This study presents a novel low-cost shoe system for daily monitoring of plantar pressure in diabetics. It includes an insole with pressure sensor array, which can dynamically monitor the plantar pressure and display the changes of plantar pressure in real time in the mobile phone to provide early warning for patients with high risk of diabetic foot. As for the sensor, copper and carbon black were adopted as the electrode and conductive filler respectively, enabling a mass production with low price. It was soft and bendable, meeting the performance needs of daily plantar pressure monitoring. All devices were encapsulated in shoes, and the data was transmitted wirelessly through Bluetooth, which did not affect the user's walking. After using random forest for feature selection, five classifiers were used to classify the plantar pressure of healthy people, diabetic patients without peripheral neuropathy, and diabetic patients with peripheral neuropathy collected by this system. The experimental results showed that the accuracy of the random forest classifier was the highest, reaching 94.7%, which indicated that the system could be useful for daily plantar pressure monitoring of diabetic patients.
Collapse
|
19
|
Lu Q, Wang J, Wei X, Wang G, Xu Y. Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients. Diabetes Metab Syndr Obes 2021; 14:2019-2027. [PMID: 33976562 PMCID: PMC8106455 DOI: 10.2147/dmso.s307815] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU). METHODS We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups. RESULTS Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17-4.53], p = 0.02), smoking (2.58 [1.31-5.07], p = 0.01), coronary artery disease (CAD) (2.67 [1.35-5.29], p = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51-33.13], p < 0.01), Wagner 5 (5.50 [1.89-16.01], p < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03-1.48], p = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03-1.48], p = 0.03), hemoglobin (Hb) (0.98 [0.96-1.00], p = 0.01), plasma albumin (ALB) (0.88 [0.81-0.95], p < 0.01) and white blood cell (WBC) (1.10 [1.04-1.16], p < 0.01). CONCLUSION Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.
Collapse
Affiliation(s)
- Qingwei Lu
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
| | - Jun Wang
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
- Correspondence: Jun Wang; Gang Wang Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300000, People’s Republic of China Email ;
| | - Xiaolu Wei
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical University, Yantai, 264003, People’s Republic of China
| | - Gang Wang
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
| | - Yang Xu
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
| |
Collapse
|
20
|
Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, Heggie R, Smith M, Horne M, Amanna A, Martin A, Gupta S, Gray K, Weller D, Brittenden J, Leese G. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technol Assess 2020; 24:1-198. [PMID: 33236718 PMCID: PMC7768791 DOI: 10.3310/hta24620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. OBJECTIVES Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. DESIGN We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. INTERVENTIONS The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. MAIN OUTCOME MEASURE The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy. DATA SOURCES Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. REVIEW METHODS We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. RESULTS The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. LIMITATIONS The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. CONCLUSIONS There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. FUTURE WORK RECOMMENDATIONS Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. STUDY REGISTRATION This study is registered as PROSPERO CRD42016052324. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Fay Crawford
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
- The Sir James Mackenzie Institute for Early Diagnosis, The School of Medicine, University of St Andrews, St Andrews, UK
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Lewsey
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Neil Hawkins
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald Nicolson
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Smith
- Library & Knowledge Service, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | | | - Aparna Amanna
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Angela Martin
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Saket Gupta
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Karen Gray
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julie Brittenden
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Graham Leese
- Diabetes and Endocrinology, Ninewells Hospital, NHS Tayside, Dundee, UK
| |
Collapse
|
21
|
Aldana PC, Cartron AM, Khachemoune A. Reappraising Diabetic Foot Ulcers: A Focus on Mechanisms of Ulceration and Clinical Evaluation. INT J LOW EXTR WOUND 2020; 21:294-302. [PMID: 32734837 DOI: 10.1177/1534734620944514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetic foot ulcers (DFU) are one of the most devastating complications of diabetes as they have significant effects on patient morbidity and mortality. Since their first description in the 19th century, our understanding of DFU has evolved as we uncover the mechanisms that mediate ulceration. In this review, we aim to summarize the various pathways that lead to the development of DFU in order to reappraise physicians' understanding of these complex wounds. Relevant pathways include the following: (1) neuropathy (motor neuropathy, loss of protective sensation, and autonomic sympathetic dysfunction), (2) vascular disease (arterial ischemia, venous insufficiency, and microvascular changes), and (3) metabolism (signaling and immunological effects of hyperglycemia). We also discuss the clinical presentation of DFU and an evidence-based evaluation to assist clinicians in early identification and classification of these wounds to inform management of DFU. Finally, we summarize complications of DFU caused by the various pathways mediating ulceration and briefly overview DFU management in order to educate physicians about the potential risks if left untreated. A better understanding of the synergistic pathways leading to DFU is essential for clinicians to improve DFU diagnosis, tailor intervention, and mitigate significant patient morbidity and mortality.
Collapse
Affiliation(s)
| | | | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,SUNY Downstate, Brooklyn, NY, USA
| |
Collapse
|
22
|
Naemi R, Chockalingam N, Lutale JK, Abbas ZG. Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania. BMJ Open Diabetes Res Care 2020; 8:8/1/e001122. [PMID: 32371531 PMCID: PMC7228475 DOI: 10.1136/bmjdrc-2019-001122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/28/2020] [Accepted: 03/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes. RESEARCH DESIGN AND METHODS 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence. RESULTS A number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428). CONCLUSION Nail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.
Collapse
Affiliation(s)
- Roozbeh Naemi
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | | | - Janet K Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Abbas Medical Centre, Dar es Salaam, Tanzania
| |
Collapse
|
23
|
Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2020; 20:41. [PMID: 31924173 PMCID: PMC6954527 DOI: 10.1186/s12889-019-8133-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background Diabetes and its complications including foot ulcer constitute a global public health challenge attributing to a significant cause of morbidity and mortality. Foot ulcer is one of the long-term complication of diabetes mellitus which lead to infection and amputation of lower extremities. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the magnitude of foot ulcer in diabetics and factors contributing to it. Methods We identified articles through electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science and Google Scholar. Accordingly, we identified 95 published and one unpublished article. Finally, eleven studies which fullfilled eligibility criteria were included in final systematic review and meta-analysis. Data were extracted using a standardized data extraction checklist and the analyses were conducted using STATA version 14. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. Results The overall magnitude of foot ulcer was 12.98% (95%CI: 7.81–18.15) in diabetic patients in Ethiopia. Sub-group analyses revealed highest prevalence in Addis Ababa (19.31% (95%CI: 2.7. 41.37)). Foot ulcer was significantly associated with rural residence (OR = 2.72, 95%, CI: 1.84–4.01)), presence of callus on the feet ((OR = 12.67, 95%, CI: 6.47–24.79)), a body mass index of ≥24.5 ((OR = 2.68, 95%, CI: 1.58–4.56)), poor self- care practice ((OR = 1.47, 95%CI: 1.25–1.73)), type I diabetes mellitus ((OR = 0.42, 95%, CI: 0.22–0.79)), staying with DM for < 10 years ((OR = 0.23, 95%, CI: 0.11–0.50)), and age < 45 years ((OR = 0.44, 95%, CI: 0.21–0.92)). Conclusion The prevalence of diabetic foot ulcers in Ethiopia is relatively low, although its trend is increasing from time to time. Socio-demographic factors, body weight, and healthcare practice contribute to the development of diabetic foot ulcers. Appropriate interventions towards patient self-care practice, lifestyle modification and follow-up are wanted to prevent diabetic foot ulcers.
Collapse
|
24
|
Wang L, Jones D, Chapman GJ, Siddle HJ, Russell DA, Alazmani A, Culmer P. A Review of Wearable Sensor Systems to Monitor Plantar Loading in the Assessment of Diabetic Foot Ulcers. IEEE Trans Biomed Eng 2019; 67:1989-2004. [PMID: 31899409 DOI: 10.1109/tbme.2019.2953630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diabetes is highly prevalent throughout the world and imposes a high economic cost on countries at all income levels. Foot ulceration is one devastating consequence of diabetes, which can lead to amputation and mortality. Clinical assessment of diabetic foot ulcer (DFU) is currently subjective and limited, impeding effective diagnosis, treatment and prevention. Studies have shown that pressure and shear stress at the plantar surface of the foot plays an important role in the development of DFUs. Quantification of these could provide an improved means of assessment of the risk of developing DFUs. However, commercially-available sensing technology can only measure plantar pressures, neglecting shear stresses and thus limiting their clinical utility. Research into new sensor systems which can measure both plantar pressure and shear stresses are thus critical. Our aim in this paper is to provide the reader with an overview of recent advances in plantar pressure and stress sensing and offer insights into future needs in this critical area of healthcare. Firstly, we use current clinical understanding as the basis to define requirements for wearable sensor systems capable of assessing DFU. Secondly, we review the fundamental sensing technologies employed in this field and investigate the capabilities of the resultant wearable systems, including both commercial and research-grade equipment. Finally, we discuss research trends, ongoing challenges and future opportunities for improved sensing technologies to monitor plantar loading in the diabetic foot.
Collapse
|
25
|
Danny Darlington CJ, Suresh Kumar S, Jagdish S, Sridhar MG. Evaluation of Serum Vitamin D Levels in Diabetic Foot Infections: A Cross-Sectional Study in a Tertiary Care Center in South India. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:474-482. [PMID: 31875082 PMCID: PMC6885722 DOI: 10.30476/ijms.2018.44951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The impact of diabetic foot infections is enormous in India. Studies on vitamin D levels in diabetes mellitus foot infections are scarce. The primary objective of the present study was to compare the serum vitamin D level between diabetics with foot infections and those without foot infections and the secondary objective was to assess the association between the vitamin D level and the severity of foot infections and outcomes. Methods The study included 176 type 2 diabetics who attended Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, between September 2012 and June 2014. The serum vitamin D level was measured for 88 diabetics with foot infections (Group 1) and 88 without foot infections (Group 2) using the ELISA 25OH vitamin D DIAsource kit (DIAsource ImmunoAssays S.A., Belgium) and compared. Both groups were followed up for 6 months for outcomes. The qualitative variables were analyzed using the χ2 test and the quantitative variables using the Student t test. The statistical analyses were performed using SPSS, version 17.0. A P value of less than 0.05 was considered significant. Results The mean serum vitamin D level was not significantly different between the two groups (P=0.306). Among the patients in Group 1 who either required amputations or died, 97.44% had subnormal vitamin D levels in contrast to 59.18% in those who were grafted or achieved wound healing (P=0.001). Among those who achieved wound healing within 6 months, 78.9% had normal vitamin D levels (P=0.0006). Conclusion The study found no significant difference in the serum level of vitamin D between diabetics with and without foot infections. However, vitamin D deficiency was associated with a poor outcome in diabetics with foot infections.
Collapse
Affiliation(s)
| | - Sathasivam Suresh Kumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sadasivan Jagdish
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Magadi Gopalakrishna Sridhar
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| |
Collapse
|
26
|
Abstract
Patients with irritable bowel syndrome (IBS) suffer from abdominal pain, bloating, and abnormal defecation. Reducing the dietary intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been shown to be beneficial in reducing IBS symptoms. However, diet modification plays an important role in the composition of colonic microbiota. Currently, the effects of a FODMAP diet on the composition of the gut microbiome are not known. We conducted a systematic review to determine (1) the effectiveness of low-FODMAPs diet to reduce symptoms of patients with IBS and (2) the association between a low-FOMAPs diet and the composition of gut microbiome. Four electronic databases were searched using key words "IBS" or "irritable bowel syndrome," and "FODMAP" or "FODMAPs" or "fermentable oligosaccharides, disaccharides, monosaccharides, and polyols," and "microbiome." Two reviewers (H.S. and Y.T.L.) selected and reviewed articles according to our inclusion criteria. A total of 87 articles were reviewed and 7 met inclusion criteria. Based on the systematic review, low FODMAPs appear to reduce gastrointestinal symptoms for a least a subset of patients with IBS. However, due to the heterogeneity of reviewed studies, the influence on patients' gut microbiome composition and/or microbiota metabolites requires additional studies.
Collapse
|
27
|
Five-year outcomes of patients attending a diabetic foot clinic in a tertiary referral centre. Ir J Med Sci 2019; 189:511-515. [DOI: 10.1007/s11845-019-02108-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
|
28
|
Megallaa MH, Ismail AA, Zeitoun MH, Khalifa MS. Association of diabetic foot ulcers with chronic vascular diabetic complications in patients with type 2 diabetes. Diabetes Metab Syndr 2019; 13:1287-1292. [PMID: 31336479 DOI: 10.1016/j.dsx.2019.01.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Diabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group. SUBJECTS AND METHODS This cross-sectional study included 180 type 2 diabetic patients (aged 30-70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects. RESULTS The prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD). CONCLUSION Chronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD).
Collapse
Affiliation(s)
- Magdy H Megallaa
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azza A Ismail
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammed H Zeitoun
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mai S Khalifa
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| |
Collapse
|
29
|
Crawford F, Cezard G, Chappell FM. The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta-analyses. Diabet Med 2018; 35:1480-1493. [PMID: 30102422 DOI: 10.1111/dme.13797] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 12/14/2022]
Abstract
AIMS Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. METHODS We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (ORs) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration. RESULTS The 10 studies contained data from 16 385 participants. A history of foot ulceration produced the largest OR [6.59 (95% CI 2.49 to 17.45)], insensitivity to a 10 g monofilament [3.18 (95% CI 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% CI 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% CI 69.9% to 97.2%) and 95.3% (95% CI 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% CI 8.2% to 17.3%) and 63.9% (95% CI 61.1% to 66.6%). CONCLUSIONS This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10 g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines.
Collapse
Affiliation(s)
- F Crawford
- Research and Development, NHS Fife, Queen Margaret Hospital, Dunfermline, Scotland
| | - G Cezard
- Population and Health Research Group (PHRG), School of Geography and Sustainable Development (SGSD), Irvine Building, University of St Andrews, St Andrews, UK
- The Centre for Population Health Sciences, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - F M Chappell
- The Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
| |
Collapse
|
30
|
Sarfo-Kantanka O, Kyei I, Mbanya JC, Owusu-Ansah M. Diabetes-related foot disorders among adult Ghanaians. Diabet Foot Ankle 2018; 9:1511678. [PMID: 30202507 PMCID: PMC6127807 DOI: 10.1080/2000625x.2018.1511678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/30/2018] [Accepted: 08/05/2018] [Indexed: 01/13/2023]
Abstract
Background: Diabetic foot remains a challenge in most low-middle-income countries (LMICs). A severe deficit in data exists on them in sub-Saharan Africa (SSA). Up-to-date data on the longitudinal trajectories and determinants can provide a benchmark for reducing diabetic foot complications in SSA. Objective: The primary objective of this study was to estimate trends in the incidence of diabetic foot and determine predictors in an adult Ghanaian diabetes cohort. Design: The study is a retrospective longitudinal study over a 12 year period. Methods: We applied Poisson regression analysis and Cox proportional hazard models to demographic and clinical information obtained from patients who enrolled in a diabetes specialist clinic in Ghana from 2005 to 2016 to identify longitudinal trends in incidence and predictors of diabetic foot. Results: The study comprised 7383 patients (63.8% female, mean follow-up duration: 8.6 years). The mean incidence of foot disorders was 8.39% (5.27% males and 3.12% females). An increase in the incidence of diabetic foot ranging from 3.25% in 2005 to 12.57% in 2016, p < 0.001, was determined. Diabetic foot, with adjusted hazard ratio (HR; 95% confidence interval (CI)), was predicted by disease duration, that is, for every 5-year increase in diabetes duration: 2.56 (1.41-3.06); male gender: 3.51 (1.41-3.06); increased body mass index (BMI), that is, for every 5 kg/m2: 3.20 (2.51-7.52); poor glycaemic control, that is, for every percentage increase in HbA1c: 1.11 (1.05-2.25), hypertension: 1.14 (1.12-3.21); nephropathy: 1.15 (1.12-3.21); and previous foot disorders: 3.24 (2.12-7.21). Conclusions: We have found a trend towards an increased incidence of diabetic foot in an outpatient tertiary diabetes setting in Ghana. Systemic and individual-level factors aimed at preventive foot screening as well as vascular risk factor control should be intensified in diabetic patients in Ghana and other LMICs. Abbreviations: BMI: Body Mass Index, BP: Blood Pressure, CI: Confidence Interval, HR: Hazard Ratio, HbA1c: Glycated Hemoglobin, PAD: Peripheral Arterial Disease, NCDs: Non Communicable Disease, SSA: Sub Saharan Africa.
Collapse
Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ishmael Kyei
- General Surgery Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Micheal Owusu-Ansah
- Department of Family Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| |
Collapse
|
31
|
Inagaki N, Harashima SI, Iijima H. Canagliflozin for the treatment of type 2 diabetes: a comparison between Japanese and non-Japanese patients. Expert Opin Pharmacother 2018; 19:895-908. [PMID: 29799286 DOI: 10.1080/14656566.2018.1473378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Canagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, improves various cardiometabolic parameters. Although canagliflozin was originally discovered in Japan, no comprehensive summary of its effects in Japanese patients has been reported. As differences exist in the pathologic features of diabetes between Japanese and non-Japanese populations, it is important to consolidate Japanese data for canagliflozin. Areas covered: The authors summarize Japanese clinical trial and post-marketing surveillance data for canagliflozin, and make comparisons with non-Japanese data. They also consider the therapeutic potential of canagliflozin in Japanese patients by presenting results from the CANagliflozin cardioVascular Assessment Study (CANVAS) Program. Expert opinion: In Japanese patients, canagliflozin 100 mg, administered as monotherapy or combination therapy, improved blood glucose, body weight, and blood pressure, and was well tolerated; the efficacy and safety profiles were comparable to previous clinical studies in other countries. In the CANVAS Program, canagliflozin reduced major cardiovascular events, and although Japan was not included in this program, canagliflozin may have cardiovascular benefits in Japanese patients, in whom control of multiple risk factors is important for preventing diabetic complications. Patients with high cardiovascular risk often have multiple comorbidities, so it is important to consider the risk-benefit balance of using SGLT2 inhibitors in individual patients.
Collapse
Affiliation(s)
- Nobuya Inagaki
- a Department of Diabetes, Endocrinology and Nutrition , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Shin-Ichi Harashima
- a Department of Diabetes, Endocrinology and Nutrition , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Hiroaki Iijima
- b Ikuyaku. Integrated Value Development Division, Medical Affairs Department , Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
| |
Collapse
|
32
|
Iwase M, Fujii H, Nakamura U, Ohkuma T, Ide H, Jodai-Kitamura T, Sumi A, Komorita Y, Yoshinari M, Kitazono T. Incidence of diabetic foot ulcer in Japanese patients with type 2 diabetes mellitus: The Fukuoka diabetes registry. Diabetes Res Clin Pract 2018; 137:183-189. [PMID: 29382584 DOI: 10.1016/j.diabres.2018.01.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/30/2017] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
AIMS Although diabetic foot ulcer (DFU) is a serious diabetic complication, there have been no large-scale epidemiological studies of DFU in Japan. We prospectively investigated the incidences of DFU and limb amputation, the risk for developing DFU, and mortality in Japanese patients with type 2 diabetes. METHODS We followed 4870 participants (mean age, 65 years) with type 2 diabetes attending an outpatient diabetes clinic for a median of 5.3 years (follow-up rate, 97.7%). The primary outcome was the development of DFU. RESULTS During the follow-up period, DFU occurred in 74 participants (incidence rate, 2.9/1000 person-years) and limb amputation in 12 (incidence rate, 0.47/1000 person-years). DFU recurrence was observed in 21.4% of participants with history of DFU. History of DFU, chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2), depressive symptoms, and poor glycemic control were significant risk factors for developing DFU. Survival was significantly lower in participants with DFU and/or history of DFU compared with those without (5-year survival rates: with DFU, 87.7%, without DFU, 95.3%; P < .0001). The hazard ratio for death was 1.80 (95% confidence interval, 1.13-2.73, P = .014) in those with DFU and/or history of DFU in a multi-adjusted model. The most common cause of death was cardiovascular disease among participants with DFU, whereas it was malignant neoplasm among those without. CONCLUSIONS Incidences of DFU and limb amputation were 0.3% and 0.05% per year in this Japanese cohort, respectively. Mortality significantly increased approximately 2-fold in those with DFU and/or history of DFU compared with those without.
Collapse
Affiliation(s)
- Masanori Iwase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan.
| | - Hiroki Fujii
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Udai Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hitoshi Ide
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan
| | - Tamaki Jodai-Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Sumi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuji Komorita
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahito Yoshinari
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
33
|
Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, Cheraghian B, Hesam S. Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study. Int J Endocrinol 2018; 2018:7631659. [PMID: 29736169 PMCID: PMC5875034 DOI: 10.1155/2018/7631659] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/30/2018] [Indexed: 01/30/2023] Open
Abstract
AIM/INTRODUCTION This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). MATERIALS AND METHODS In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. RESULTS Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. CONCLUSION Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.
Collapse
Affiliation(s)
- Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Iraj Nazari
- Department of Vascular Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Reza Arti
- Department of Orthopedic, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Ahmadi
- Infectious Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
34
|
Stoekenbroek RM, Lokin JLC, Nielen MM, Stroes ESG, Koelemay MJW. How common are foot problems among individuals with diabetes? Diabetic foot ulcers in the Dutch population. Diabetologia 2017; 60:1271-1275. [PMID: 28409210 PMCID: PMC5487691 DOI: 10.1007/s00125-017-4274-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Contemporary data on diabetic foot ulcer prevalence are scarce. Most studies were conducted in the 1990s, reporting incidence rates of 1.9-2.6%. Since then the prevalence of diabetes has doubled and the organisation of diabetes care has undergone major changes. Up-to-date data that quantify the occurrence of diabetic foot ulcers are required and could serve as baseline measures for future studies. METHODS Individuals with diabetes (n = 81,793) were identified from the NIVEL (Netherlands institute for health services research) Primary Care Database, which contains data for standardised routine care and is representative of the Dutch population. The annual incidence rates of ulcers and other foot abnormalities were calculated using data collected between 2010 and 2013. To account for inaccuracies, incidence rates were calculated using: (1) only individuals with a documented foot examination; (2) all individuals; and (3) individuals with explicit documentation of present/absent foot ulceration. RESULTS There were 412 individuals with documented ulceration during the registration period (0.50%). The annual incidence rate of foot ulcers was 0.34% (range 0.22-1.08%). Of those individuals with a documented foot examination, 14.6% had absent pedal pulsations, 17.3% had neuropathy and 10.1% had callus/pressure marks. CONCLUSIONS/INTERPRETATION The annual incidence rate of foot ulcers in the current study was lower than previously reported. This observation could reflect the efficacy of screening practices and an increased awareness among professionals and patients. Nevertheless, approximately one in every five diabetic individuals had at least one identifiable risk factor on foot examination. This signifies the importance of preventive screening.
Collapse
Affiliation(s)
- Robert M Stoekenbroek
- Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands.
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Joost L C Lokin
- Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Mark M Nielen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark J W Koelemay
- Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| |
Collapse
|
35
|
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. Ann Med 2017; 49:106-116. [PMID: 27585063 DOI: 10.1080/07853890.2016.1231932] [Citation(s) in RCA: 844] [Impact Index Per Article: 120.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot is a severe public health issue, yet rare studies investigated its global epidemiology. Here we performed a systematic review and meta-analysis through searching PubMed, EMBASE, ISI Web of science, and Cochrane database. We found that that global diabetic foot ulcer prevalence was 6.3% (95%CI: 5.4-7.3%), which was higher in males (4.5%, 95%CI: 3.7-5.2%) than in females (3.5%, 95%CI: 2.8-4.2%), and higher in type 2 diabetic patients (6.4%, 95%CI: 4.6-8.1%) than in type 1 diabetics (5.5%, 95%CI: 3.2-7.7%). North America had the highest prevalence (13.0%, 95%CI: 10.0-15.9%), Oceania had the lowest (3.0%, 95% CI: 0.9-5.0%), and the prevalence in Asia, Europe, and Africa were 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), and 7.2% (95%CI: 5.1-9.3%), respectively. Australia has the lowest (1.5%, 95%CI: 0.7-2.4%) and Belgium has the highest prevalence (16.6%, 95%CI: 10.7-22.4%), followed by Canada (14.8%, 95%CI: 9.4-20.1%) and USA (13.0%, 95%CI: 8.3-17.7%). The patients with diabetic foot ulcer were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot ulceration. Our results provide suggestions for policy makers in deciding preventing strategy of diabetic foot ulceration in the future. Key messages Global prevalence of diabetic foot is 6.3% (95%CI: 5.4-7.3%), and the prevalence in North America, Asia, Europe, Africa and Oceania was 13.0% (95%CI: 10.0-15.9%), 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), 7.2% (95%CI: 5.1-9.3%), and 3.0% (95% CI: 0.9-5.0%). Diabetic foot was more prevalent in males than in females, and more prevalent in type 2 diabetic foot patients than in type 1 diabetic foot patients. The patients with diabetic foot were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot.
Collapse
Affiliation(s)
- Pengzi Zhang
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Jing Lu
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Yali Jing
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Sunyinyan Tang
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Dalong Zhu
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Yan Bi
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| |
Collapse
|
36
|
Mahon AM, MacGilchrist C, McIntosh C, O'Brien T. Characterization of patients with diabetic foot disease presenting to an Irish Podiatry Centre: profiling suitability for entry to a clinical trial of advanced wound therapeutics. Ir J Med Sci 2016; 186:659-669. [PMID: 27730333 DOI: 10.1007/s11845-016-1511-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diabetes mellitus, coined the 'Black Death of the Twenty-First Century', is associated with complications, including foot ulceration with potential loss of limb. There is a need for development of new wound therapies through completion of robust clinical trials. AIMS To profile demographics and wound characteristics of an Irish cohort with diabetes, forecast eligibility for entry to a clinical trial of advanced wound therapeutics, and adjust criteria to optimize eligibility for enrolment. METHODS A cross-sectional study of out-patients attending a Podiatry centre over 12 weeks was conducted. Information was collected through clinical assessment, including Neuropathy Disability Score and Ankle-Brachial Pressure Index. Ulcers were characterised as 'healing' or 'non-healing'; a 'healing' wound decreased by 30 % over the previous month, accomplished by retrospective analysis of files. Statistics, including binomial logistic regression and column analysis for eligibility assessment, were conducted. RESULTS Seventy-four participants were identified with a mean age of 67 (± 8.79) years. Non-healing DFU status correlated significantly with larger wound area (P = 0.013), infection (P = 0.009), and greater degrees of ischaemia (P = 0.015). The eligibility criteria were modelled after those proposed by the EU consortium project REDDSTAR. In this Irish population, these criteria limit eligibility to 1.4 %. CONCLUSIONS This research found an eligibility criterion of wound area 2-10 cm2 for enrolment in a clinical trial of mesenchymal stromal cell therapy too restrictive. Extension of wound area to 1-10 cm2 and the inclusion of neuro-ischaemic ulcers increased eligibility for enrolment from 1.4 to 20 %.
Collapse
Affiliation(s)
- A M Mahon
- Discipline of Podiatric Medicine, College of Medicine, Nursing and Health Sciences, Aras Moyola, National University of Ireland, Galway, Republic of Ireland. .,Regenerative Medicine Institute, Biosciences Research Building, National University of Ireland, Galway, Republic of Ireland.
| | - C MacGilchrist
- Discipline of Podiatric Medicine, College of Medicine, Nursing and Health Sciences, Aras Moyola, National University of Ireland, Galway, Republic of Ireland
| | - C McIntosh
- Discipline of Podiatric Medicine, College of Medicine, Nursing and Health Sciences, Aras Moyola, National University of Ireland, Galway, Republic of Ireland
| | - T O'Brien
- Regenerative Medicine Institute, Biosciences Research Building, National University of Ireland, Galway, Republic of Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Republic of Ireland
| |
Collapse
|
37
|
Teoh JC, Lee DY, Lee T. The influence of sex, body mass and body mass index on plantar soft-tissue stiffness in healthy people in their 60s. J Biomech 2016; 49:3022-3025. [PMID: 27527728 DOI: 10.1016/j.jbiomech.2016.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/11/2022]
Abstract
Foot abnormality has become a public health concern. Early detection of pathological soft tissue is therefore an important preventive measure, especially in older people who generally have a higher risk of foot pathology. However, the interpretation of plantar tissue stiffness data - whether to normalize the data or to separate the data on the basis of sex- remains questionable. The objective of this study was to assess the influence of sex and physical attributes such as body mass (BM) and body mass index (BMI) on plantar soft-tissue stiffness, and to evaluate whether it is necessary to isolate the differences in sex, BM and BMI in the data analysis. One hundred healthy subjects in their 60s were recruited for the experiment. Localized force response was obtained underneath the second metatarsal head (MTH) pad at three different dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0°. No significant relationship was found between the independent variables and plantar stiffness. From the experimental results, it can be deduced that BM and BMI are weakly associated with plantar tissue stiffness, and that there is no significant difference in stiffness between male and female participants. No difference was found between left and right foot measurements. This suggests that normalizing of plantar tissue stiffness by BM and BMI is not necessary in healthy people in their 60s. The data can be pooled and treated equally regardless of sex.
Collapse
Affiliation(s)
- Jee Chin Teoh
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Taeyong Lee
- College of Science & Industry Convergence, Ewha Womans University, Seoul, South Korea.
| |
Collapse
|
38
|
Jiang Y, Wang X, Xia L, Fu X, Xu Z, Ran X, Yan L, Li Q, Mo Z, Yan Z, Ji Q, Li Q. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen 2016; 23:222-30. [PMID: 25682850 DOI: 10.1111/wrr.12263] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/08/2015] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
To determine the annual incidence and clinically relevant risk factors for foot ulceration in a large cohort study of diabetic foot ulcer (DFU) patients and diabetes mellitus (DM) patients in China. To investigate a cohort of 1,333 patients comprising 452 DFU patients and 881 DM patients, who underwent foot screening, physical examination, and laboratory tests in eight hospitals. The patients were assessed at baseline in terms of their demographic information, medical and social history, peripheral neuropathy disease (PND) screening, periphery artery disease (PAD) screening, assessment of nutritional status, and diabetic control. One year later, the patients were followed up to determine the incidence of new foot ulcers, amputation, and mortality. By univariate analysis, statistically significant differences were found in age, location, gender, living alone (yes/no), occupation, smoking, hypertension, PND, PAD, nephropathy, retinopathy, cataracts, duration of diabetes, Glycosylated hemoglobin A (HbA1c), fasting plasma glucose level, postprandial blood glucose level, insulin level, blood urea nitrogen, creatinine, cholesterol, triglyeride, high density lipoprotein (HDL), serum albumin, white blood cell, and body mass index. A binary logistic regression model was used to examine which of these risk factors were independent risk factors for foot ulceration. A total of 687 (51.5%) of the 1,333 patients were followed up for an average of 12 months; there were 458 DM patients and 229 DFU patients. A total of 46 patients died during the follow-up period; 13 were DM patients, and 33 were DFU patients. Of the 641 patients, 445 (69.4%) patients were DM patients, and 196 (30.6%) were DFU patients. At follow-up, 36/445 DM patients (8.1%), and 62/196 DFU patients (31.6%), developed new ulcers; 10/196 DFU patients underwent an amputation. The annual incidence of ulceration for DM patients and amputation for DFU patients were 8.1 and 5.1%, respectively. The annual mortality of the DM patients and DMF patients were 2.8 and 14.4%, respectively. A binary logistic regression model was used to examine which risk factors were independent risk factors for foot ulceration during the follow-up period, and the final results showed that nephropathy (odds ratio 2.32), insulin level (odds ratio 3.136, 2.629), and decreased HDL (odds ratio 0.427) were associated with increased risks for foot ulceration. Complications of diabetes affecting the feet represent a serious problem in China. The incidence of foot ulcers and amputation are much higher than that of Western countries. More intensive surveillance and aggressive care following a diagnosis of DFU and earlier referral to specialty care might improve the patient outcome.
Collapse
Affiliation(s)
- Yufeng Jiang
- Wound Healing Center, Trauma Center of Postgraduate Medical School, Chinese PLA General Hospital, Beijing, China.,The Key Laboratory of Wound Repair and Regeneration of PLA, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.,The Diabetic Center, 306th Hospital of Chinese P.L.A, Beijing, China
| | - Xuemei Wang
- The School of Public Health of Inner Mongolia Medical College, Hohhot, China
| | - Lei Xia
- Wound Healing Center, Trauma Center of Postgraduate Medical School, Chinese PLA General Hospital, Beijing, China
| | - Xiaobing Fu
- Wound Healing Center, Trauma Center of Postgraduate Medical School, Chinese PLA General Hospital, Beijing, China.,The Key Laboratory of Wound Repair and Regeneration of PLA, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China
| | - Zhangrong Xu
- The Diabetic Center, 306th Hospital of Chinese P.L.A, Beijing, China
| | - Xingwu Ran
- Huaxi Hospital of Sichuan University, Chengdu, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiu Li
- People's Hospital of ShanDong Province, JiNan, China
| | - Zhaohui Mo
- Third Xiangya Hospital, Central South Univety, Changsha, China
| | - Zhaoli Yan
- The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
| | - Qiuhe Ji
- Xijing Hospital of Fourth Military Medical University, Xi'an, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
39
|
Tracey ML, Gilmartin M, O'Neill K, Fitzgerald AP, McHugh SM, Buckley CM, Canavan RJ, Kearney PM. Epidemiology of diabetes and complications among adults in the Republic of Ireland 1998-2015: a systematic review and meta-analysis. BMC Public Health 2016; 16:132. [PMID: 26861703 PMCID: PMC4748605 DOI: 10.1186/s12889-016-2818-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 02/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background Accurate estimates of the burden of diabetes are essential for future planning and evaluation of services. In Ireland, there is no diabetes register and prevalence estimates vary. The aim of this review was to systematically identify and review studies reporting the prevalence of diabetes and complications among adults in Ireland between 1998 and 2015 and to examine trends in prevalence over time. Methods A systematic literature search was carried out using PubMed and Embase. Diabetes prevalence estimates were pooled by random-effects meta-analysis. Poisson regression was carried out using data from four nationally representative studies to calculate prevalence rates of doctor diagnosed diabetes between 1998 and 2015 and was also used to assess whether the rate of doctor diagnosed diabetes changed over time. Results Fifteen studies (eight diabetes prevalence and seven complication prevalence) were eligible for inclusion. In adults aged 18 years and over, the national prevalence of doctor diagnosed diabetes significantly increased from 2.2 % in 1998 to 5.2 % in 2015 (ptrend ≤ 0.001). The prevalence of diabetes complications ranged widely depending on study population and methodology used (6.5–25.2 % retinopathy; 3.2–32.0 % neuropathy; 2.5-5.2 % nephropathy). Conclusions Between 1998 and 2015, there was a significant increase in the prevalence of doctor diagnosed diabetes among adults in Ireland. Trends in microvascular and macrovascular complications prevalence could not be examined due to heterogeneity between studies and the limited availability of data. Reliable baseline data are needed to monitor improvements in care over time at a national level. A comprehensive national diabetes register is urgently needed in Ireland. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2818-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marsha L Tracey
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland.
| | - Michael Gilmartin
- Department of Medicine, Royal College of Surgeons, Dublin, Republic of Ireland
| | - Kate O'Neill
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Sheena M McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Claire M Buckley
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland.,Department of Public Health, Heath Service Executive (HSE) South, Cork, Republic of Ireland
| | - Ronan J Canavan
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| |
Collapse
|
40
|
Egan AM, Dinneen SF. In-hospital metabolic regulation in patients with a diabetic foot ulcer: is it worthwhile? Diabetes Metab Res Rev 2016; 32 Suppl 1:297-302. [PMID: 26453180 DOI: 10.1002/dmrr.2741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/15/2015] [Accepted: 09/20/2015] [Indexed: 01/08/2023]
Abstract
It is well established that hyperglycaemia is associated with many negative cardiovascular and immunological effects. Because of the high prevalence of underlying vascular disease along with associated infection, patients with diabetic foot ulcers are especially vulnerable to these adverse consequences. While studies consistently demonstrate worse outcomes in the setting of hyperglycaemia during hospitalization, multiple trials examining the effects of intensive glycaemic control reveal mixed results. In particular, effects on mortality are varied, and although there may be some benefit in the setting of infection, hypoglycaemia is a concern when glucose levels are treated down to the normoglycaemic range. Therefore, although metabolic regulation is worthwhile theoretically, the optimal intensity of control is unclear. There is a need for future research to clarify the benefits and risks associated with strict metabolic control in patients with diabetic foot ulceration. In the interim recommendations from international guidelines should be followed; these advise pre-meal glucose targets of <7.8 mmol/L and random targets of <10.0 mmol/L in general medical and surgical settings.
Collapse
Affiliation(s)
- Aoife M Egan
- Galway University Hospitals and National University of Ireland Galway, Galway, Ireland
| | - Sean F Dinneen
- Galway University Hospitals and National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
41
|
Kirsner R, Vivas A. Lower‐extremity ulcers: diagnosis and management. Br J Dermatol 2015; 173:379-90. [DOI: 10.1111/bjd.13953] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 01/30/2023]
Affiliation(s)
- R.S. Kirsner
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
| | - A.C. Vivas
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
| |
Collapse
|
42
|
Jiang Y, Ran X, Jia L, Yang C, Wang P, Ma J, Chen B, Yu Y, Feng B, Chen L, Yin H, Cheng Z, Yan Z, Yang Y, Liu F, Xu Z. Epidemiology of Type 2 Diabetic Foot Problems and Predictive Factors for Amputation in China. INT J LOW EXTR WOUND 2015; 14:19-27. [PMID: 25573978 DOI: 10.1177/1534734614564867] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
To determine incidence and clinically relevant risk factors for diabetic amputation in a large cohort study of diabetic foot ulceration patients in China, we investigated a total of 669 diabetic foot ulceration patients, who were assessed at baseline for demographic information, medical and social history, peripheral neuropathy screening, periphery artery disease screening, assessment of nutritional status and diabetic control, physical examination including foot deformity in 15 Grade III-A hospitals. Of the 669 patients, 435 were male and 201 were female, with the mean age being 64.0 years. Of all patients, 110 had neuropathic ulcers, 122 had ischemic ulcers, 276 had neuroischemic ulcers, and 12 cases were unclassified. Wagner classification showed 61 cases were grade I, 216 cases grade II, 159 cases grade III, 137 cases grade IV, and 7 cases grade V. The overall amputation rate among diabetic foot patients was 19.03%, and major and minor amputation rates were 2.14% and 16.88%, respectively. By univariate analysis, statistically significant differences were found in smoking, rest pain, ulcer history, revascularization history, amputation history, gangrene, infection, Wagner grades, duration of diabetes, and postprandial blood glucose, aldehyde, total protein, globulin, albumin, white blood cell (WBC), hemoglobin, HbA1c, ulcer property, body mass index, as well as creatinine. Binary logistic regression model showed that increased WBC (odds ratio 1.25) and ulcer history (odds ratio 6.8) were associated with increased risks from diabetic foot ulcer to major amputation; increased duration of diabetes (odds ratio 1.004), WBC (odds ratio 1.102), infection (odds ratio 2.323), foot deformity (odds ratio 1.973), revascularization history (odds ratio 2.662), and decreased postprandial blood sugar (odds ratio 0.94) were associated with increased risks from diabetic foot ulcer to minor amputation. It is of great importance to give better management to diabetic patients at early stages. Following a diagnosis of DFU more intensive surveillance and aggressive care may improve outcome.
Collapse
Affiliation(s)
- Yufeng Jiang
- The Diabetic Center of PLA, The 306th Hospital of Chinese PLA, Beijing, China
| | - Xingwu Ran
- Huaxi Hospital of Sichuan University, Chengdu, China
| | - Lijing Jia
- The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chuan Yang
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Penghua Wang
- Metabolic Diseases Hospital, Tianjin Medical University, Tianjin, China
| | - Jianhua Ma
- Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | - Bing Chen
- Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yanmei Yu
- Mudanjiang Diabetes Hospital, Mudanjiang, China
| | - Bo Feng
- East Hospital Affiliated to School of Medicine, Tongji University, Shanghai, China
| | - Lili Chen
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Han Yin
- Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhifeng Cheng
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhaoli Yan
- The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
| | - Yuzhi Yang
- Heilongjiang Provincial Hospital, Harbin, China
| | - Fang Liu
- Shanghai Sixth People Hospital, Shanghai, China
| | - Zhangrong Xu
- The Diabetic Center of PLA, The 306th Hospital of Chinese PLA, Beijing, China
| |
Collapse
|
43
|
Nehring P, Mrozikiewicz-Rakowska B, Krzyżewska M, Sobczyk-Kopcioł A, Płoski R, Broda G, Karnafel W. Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study. J Diabetes Metab Disord 2014; 13:79. [PMID: 25114882 PMCID: PMC4128535 DOI: 10.1186/2251-6581-13-79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022]
Abstract
Background Diabetic foot is a serious condition in patients with a long lasting diabetes mellitus. Diabetic foot treated improperly may lead not only to delayed ulceration healing, generalized inflammation, unnecessary surgical intervention, but also to the lower limb amputation. The aim of this study was to compare diabetic foot risk factors in population with type 2 diabetes and risk factors for diabetes in healthy subjects. Methods The study included 900 subjects: 145 with diabetic foot, 293 with type 2 diabetes without diabetic foot and 462 healthy controls matched in terms of mean age, gender structure and cardiovascular diseases absence. Study was conducted in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. In statistical analysis a logistic regression model, U Mann-Whitney’s and t-Student test were used. Results The binomial logit models analysis showed that the risk of diabetic foot in patients with type 2 diabetes was decreased by patient’s age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.92-0.96; p = 0.00001) and hyperlipidaemia (OR = 0.54; 95% CI: 0.36-0.81; p = 0.01). In contrast, male gender (OR = 2.83; 95% CI: 1.86-4.28; p = 0.00001) diabetes duration (OR = 1.04; 95% CI: 1.03-1.06; p = 0.0003), weight (OR = 1.04; 95% CI: 1.03-1.06; p = 0.00001), height (OR = 1.08; 95% CI: 1.05-1.11; p = 0.00001) and waist circumference (OR = 1.028; 95% CI: 1.007-1.050; p = 0.006) increase the risk of diabetic foot. The onset of type 2 diabetes in healthy subjects was increased by weight (OR = 1.035; 95% CI: 1.024-1.046; p = 0.00001), WC (OR = 1.075; 95% CI: 1.055-1.096; p = 00001), hip circumference (OR = 1.03; 95% CI: 1.01-1.05; p = 0.005), overweight defined with body mass index (BMI) above 24,9 kg/m2 (OR = 2.49; 95% CI: 1.77-3.51; p = 0.00001) and hyperlipidaemia (OR = 3.53; 95% CI: 2.57-4.84; p = 0.00001). Conclusions Risk factors for Type 2 diabetes and diabetic foot are only partially common. Study proved that patients who are prone to developing diabetic foot experience different risk factors than patients who are at risk of diabetes. Identification of relationship between diabetic foot and diabetes risk factors in appropriate groups may help clinicians to focus on certain factors in diabetic foot prevention.
Collapse
Affiliation(s)
- Piotr Nehring
- Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, ul. Banacha 1a, Warsaw 02-097, Poland
| | - Beata Mrozikiewicz-Rakowska
- Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, ul. Banacha 1a, Warsaw 02-097, Poland
| | - Monika Krzyżewska
- Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, ul. Banacha 1a, Warsaw 02-097, Poland
| | | | - Rafał Płoski
- Department of Medical Genetic, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Broda
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Waldemar Karnafel
- Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, ul. Banacha 1a, Warsaw 02-097, Poland
| |
Collapse
|
44
|
Yotsu RR, Pham NM, Oe M, Nagase T, Sanada H, Hara H, Fukuda S, Fujitani J, Yamamoto-Honda R, Kajio H, Noda M, Tamaki T. Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type. J Diabetes Complications 2014; 28:528-35. [PMID: 24846054 DOI: 10.1016/j.jdiacomp.2014.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/07/2014] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
AIMS To identify differences in the characteristics of patients with diabetic foot ulcers (DFUs) according to their etiological classification and to compare their healing time. METHODS Over a 4.5-year period, 73 patients with DFUs were recruited. DFUs were etiologically classified as being of neuropathic, ischemic, or neuro-ischemic origin. Descriptive analyses were performed to characterize study subjects, foot-related factors, and healing outcome and time. Duration of healing was assessed using the Kaplan-Meier method. Healing time among the three types was compared using the log rank test. RESULTS The number of patients manifesting neuropathic, ischemic, and neuro-ischemic ulcers was 30, 20, and 14, respectively. Differences were identified for age, diabetes duration, body mass index, hypertension, and estimated glomerular filtration rate. Patients with neuro-ischemic ulcers had better ankle-brachial index, skin perfusion pressure (SPP), and transcutaneous oxygen pressure values compared to those with ischemic ulcers. The average time in which 50% of patients had healed wounds was 70, 113, and 233 days for neuropathic, neuro-ischemic, and ischemic ulcers, respectively. Main factors associated with healing were age and SPP values. CONCLUSIONS Based on the etiological ulcer type, DFU healing course and several patient factors differed. Failure to consider the differences in DFU etiology may have led to heterogeneity of results in previous studies on DFUs.
Collapse
Affiliation(s)
- Rie Roselyne Yotsu
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Ngoc Minh Pham
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Makoto Oe
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takeshi Nagase
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hisao Hara
- Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Fujitani
- Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ritsuko Yamamoto-Honda
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Tamaki
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|