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Dunlap LJ, Lew E, Gallegos R, Murdoch R, Mulvihill S. Management of Diabetic Foot Ulcers with Two Forefoot Offloading Techniques: Case Series. Adv Skin Wound Care 2024; 37:434-439. [PMID: 39037098 DOI: 10.1097/asw.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
ABSTRACT Offloading is a key principle to healing diabetic foot ulcers. Nonremovable knee-high offloading devices are considered the criterion standard for offloading plantar forefoot ulcers. However, patients exhibit a limited tolerance for these devices, which contributes to a lack of use. In this case series describing two patients, the authors share two alternative offloading modalities for the treatment of diabetic plantar forefoot ulcers. One patient was managed using a football offloading dressing, and the other was managed with a modified felted football dressing. The football and modified felted football offloading dressings provide a cost-effective, less time-consuming application and often are a better-tolerated alternative to nonremovable knee-high offloading devices. Clinical findings support further investigation into dressing options tolerated by patients with improved adherence and optimal healing outcomes.
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Affiliation(s)
- Leslie J Dunlap
- In the Department of Orthopaedics and Rehabilitation, Center for Healing in the Lower Extremity, Albuquerque, New Mexico, USA, Leslie J. Dunlap, DMSc, MSPA-C, CWS, is Physician Assistant, University of New Mexico Hospital; and Eric Lew, DPM, FACFAS, is Associate Professor, University of New Mexico Health Sciences Center. In the Department of Rehabilitation Services, University of New Mexico Hospital, Regina Gallegos, MPT, CWS, and Richard Murdoch, PT, CWS, are Physical Therapists and Simone Mulvihill, PTA, is Physical Therapy Assistant
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Lin YH, Lin CH, Lin YC, Huang YY, Tai AS, Fu SC, Lin SH. Sodium-Glucose Cotransporter 2 Inhibitors Reduce the Risk of Hospitalization for Heart Failure and Amputation Rate Compared With Incretin-Based Therapy in Patients With Diabetic Foot Disease: A Nationwide Population-Based Study. Endocr Pract 2024; 30:424-430. [PMID: 38325629 DOI: 10.1016/j.eprac.2024.01.016] [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: 11/17/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Major adverse cardiovascular event (MACE) outcomes associated with sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapies remain unclear in patients with type 2 diabetes and newly diagnosed diabetic foot complications (DFCs). This study examined the impact of SGLT2i and GLP-1 RA use on the rates of MACEs and amputations in patients with type 2 diabetes and without cardiovascular disease. METHODS Data from the Taiwan National Health Insurance Research Database (2004-2017) were analyzed, focusing on patients with type 2 diabetes without previous MACE and newly diagnosed DFCs. The primary outcome was the first MACE occurrence, and the secondary outcomes included MACE components, all-cause mortality, and lower extremity amputation (LEA) rates. RESULTS SGLT2i users showed a significant decrease in the MACE (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46-0.88) and hospitalization for heart failure (HR, 0.54; 95% CI, 0.35-0.83) rates compared with dipeptidyl peptidase-4 inhibitor users. The amputation rates were also lower in SGLT2i users without LEA at the first DFC diagnosis (HR, 0.28; 95% CI, 0.10-0.75) and did not increase in those with a history of peripheral artery disease or LEA. No significant differences were observed between dipeptidyl peptidase-4 inhibitor and GLP-1 RA users in terms of the primary or secondary outcomes. CONCLUSION In patients with type 2 diabetes initially diagnosed with DFC, SGLT2i are effective in significantly reducing the hospitalization for heart failure and MACE rates. SGLT2i lower the amputation rates, especially in patients who have not previously had a LEA, than the dipeptidyl peptidase-4 inhibitor therapy.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chih Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - An-Shun Tai
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Chen Fu
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan.
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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.
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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
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Moghaddam Ahmadi M, Ashoobi MT, Darabi Z, Ramezannezhad H, Moghaddam Ahmadi M. Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care. Int Wound J 2024; 21:e14859. [PMID: 38572803 PMCID: PMC10993353 DOI: 10.1111/iwj.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Diabetic foot ulcers (DFUs) pose a significant clinical challenge, often leading to amputations and hospitalisation. This study aimed to investigate the characteristics and outcomes of DFUs treated with surgical debridement and standardised wound care. This descriptive cross-sectional study focused on diabetic patients with appropriate vascular conditions, as determined by an Ankle Brachial Index >0.9. Based on their infection status, participants were admitted to Poursina Hospital in Rasht, Iran, and subjected to initial supportive measures, antibiotic therapy and surgical debridement. The study incorporated primary treatment with wet bandages, silver spray and fibrinolysin ointment. Statistical analysis employed SPSS 22 software. Most patients were male (54.7%) and under 60 years old (50.7%). Overweight status was prevalent in 69.3% of diabetic ulcer patients, amongst whom 48% underwent wrist debridement. The 64% and 36% of the cases had grade III and grade II Texas index. Moreover, 96% of patients exhibited signs of infection and were classified as Stage Texas B. Reoperation was necessary for 34.7% of patients. The mean hospital stay was 8.5 ± 7.55 days, and the average recovery time was 15.2 ± 15.19 days. Out of 75 patients, 10 were unable to return to limb function due to disability. In this study, around one-third of patients required secondary repair with grafts and flaps. A small number of them were unable to recover because of underlying disability, and the mean recovery time in other cases was 24 days. Future studies should follow up with patients for longer periods to assess long-term therapeutic outcomes and quality of life.
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Affiliation(s)
- Moein Moghaddam Ahmadi
- Poursina Clinical Research Development UnitGuilan University of Medical SciencesRashtIran
| | - Mohammad Taghi Ashoobi
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Zohreh Darabi
- Poursina Clinical Research Development UnitGuilan University of Medical SciencesRashtIran
| | - Hossein Ramezannezhad
- Poursina Clinical Research Development UnitGuilan University of Medical SciencesRashtIran
| | - Mahta Moghaddam Ahmadi
- Poursina Clinical Research Development UnitGuilan University of Medical SciencesRashtIran
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Hung SY, Yeh YM, Chiu CH, Armstrong DG, Lin CW, Yang HM, Huang SY, Huang YY, Huang CH. Microbiome of limb-threatening diabetic foot ulcers indicates the association of fastidious Stenotrophomonas and major amputation. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:156-163. [PMID: 37919171 PMCID: PMC11254454 DOI: 10.1016/j.jmii.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/05/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Proper identification of the polymicrobial microorganisms in patients with limb-threatening diabetic foot ulcers (LTDFUs) using conventional culture is insufficient. This prospective study evaluates the potential value of adjuvant molecular testing assisting in identify fastidious micro-organisms in LTDFUs compared to standard treatment alone. METHODS Ninety patients with LTDFUs received interdisciplinary and standard antibiotic treatment in a referral diabetic foot center. A simultaneous 16S amplicon sequencing (16S AS) specimen along with conventional culture collected at admission was used to retrospectively evaluate the microbiological findings and its association with amputation outcomes. RESULTS The microorganism count revealed by 16S AS overwhelmed that of conventional culturing (17 vs. 3 bacteria/ulcer respectively). The Stenotrophomonas spp. revealed in 29 patients were highly correlated with major (above ankle) amputation (OR: 4.76, 95% CI 1.01-22.56), while only one had been concomitantly identified by conventional culturing. Thus, there were 27 cases without proper antibiotics coverage during treatment. CONCLUSIONS Adjuvant molecular testing assisted identification of fastidious pathogens such as Stenotrophomonas infection and might be associated with major amputation in patients with LTDFUs.
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Affiliation(s)
- Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yuan-Ming Yeh
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, USA (D.G.A.)
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shu-Yu Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Wu YW, Wang CY, Cheng NC, Lin HJ, Huang HL, Huang JH, Chen CC, Lee JK, Chen PL, Hsu PC, Wu IH, Yeh JT, Tsai HY, Tzeng YS, Cheng CC, Lin CH, Wu SH, Tan JWH, Wu CH, Hsueh SK, Chang CH, Wu HP, Hsu CH, Yen HT, Lin PC, Lin CH, Tai HC, Chen WJ. 2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases. ACTA CARDIOLOGICA SINICA 2024; 40:1-44. [PMID: 38264067 PMCID: PMC10801419 DOI: 10.6515/acs.202401_40(1).20231220a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.
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Affiliation(s)
- Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Graduate Institute of Medicine, Yuan Ze University
| | - Chao-Yung Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Hsuan-Li Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien
| | - Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City
| | - Chun-Chi Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Jen-Kuang Lee
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Internal Medicine
- Department of Laboratory Medicine, National Taiwan University College of Medicine
- Telehealth Center, National Taiwan University Hospital, Taipei
| | - Po-Lin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiovascular Surgery, Department of Surgery, En Chu Kong Hospital, New Taipei City
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, Kaohsiung Medical University, Kaohsiung
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Department of Trauma Surgery, National Taiwan University Hospital, Taipei
| | - Jiun-Ting Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Hao-Yuan Tsai
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Department of Surgery, Zuoying Armed Forces General Hospital, Kaohsiung
| | - Cheng-Chung Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital
| | - Szu-Hsien Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Jimmy Wei Hwa Tan
- Department of Cardiovascular Surgery, An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Hsueh Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Hwa Chang
- Division of Cardiovascular Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County
| | - Hsu-Ping Wu
- Cardiovascular Center, MacKay Memorial Hospital, Taipei
| | - Chung-Ho Hsu
- Section of Peripheral Artery Disease, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Hsu-Ting Yen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Po-Chang Lin
- Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Chih-Hung Lin
- Department of Plastic Reconstructive Surgery, Chang Gung University of Science and Technology, Taoyuan
| | - Hao-Chih Tai
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Wen-Jone Chen
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Emergency Medicine, National Taiwan University College of Medicine and Hospital, Taipei
- Min-Sheng General Hospital, Taoyuan, Taiwan
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Baz A, Bakri A, Butcher M, Short B, Ghimire B, Gaur N, Jenkins T, Short RD, Riggio M, Williams C, Ramage G, Brown JL. Staphylococcus aureus strains exhibit heterogenous tolerance to direct cold atmospheric plasma therapy. Biofilm 2023; 5:100123. [PMID: 37138646 PMCID: PMC10149328 DOI: 10.1016/j.bioflm.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
The global clinical and socioeconomic impact of chronic wounds is substantial. The main difficulty that clinicians face during the treatment of chronic wounds is the risk of infection at the wound site. Infected wounds arise from an accumulation of microbial aggregates in the wound bed, leading to the formation of polymicrobial biofilms that can be largely resistant to antibiotic therapy. Therefore, it is essential for studies to identify novel therapeutics to alleviate biofilm infections. One innovative technique is the use of cold atmospheric plasma (CAP) which has been shown to possess promising antimicrobial and immunomodulatory properties. Here, different clinically relevant biofilm models will be treated with cold atmospheric plasma to assess its efficacy and killing effects. Biofilm viability was assessed using live dead qPCR, and morphological changes associated with CAP evaluated using scanning electron microscopy (SEM). Results indicated that CAP was effective against Candida albicans and Pseudomonas aeruginosa, both as mono-species biofilms and when grown in a triadic model system. CAP also significantly reduced viability in the nosocomial pathogen, Candida auris. Staphylococcus aureus Newman exhibited a level of tolerance to CAP therapy, both when grown alone or in the triadic model when grown alongside C. albicans and P. aeruginosa. However, this degree of tolerance exhibited by S. aureus was strain dependent. At a microscopic level, biofilm treatment led to subtle changes in morphology in the susceptible biofilms, with evidence of cellular deflation and shrinkage. Taken together, these results indicate a promising application of direct CAP therapy in combatting wound and skin-related biofilm infections, although biofilm composition may affect the treatment efficacy.
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Affiliation(s)
- Abdullah Baz
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Ahmed Bakri
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Mark Butcher
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Bryn Short
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Bhagirath Ghimire
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Nishtha Gaur
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Toby Jenkins
- Department of Chemistry, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Robert D. Short
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Marcello Riggio
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Craig Williams
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
- Microbiology Department, Lancaster Royal Infirmary, University of Lancaster, Lancaster, LA1 4YW, United Kingdom
| | - Gordon Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Jason L. Brown
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
- Corresponding author. Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
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Travis DJ, Bradbury J, Benkendorff K. Toward non-invasive collection methods for sampling the microbiome of diabetic foot ulcers. Int Wound J 2023; 20:3731-3737. [PMID: 37501084 PMCID: PMC10588311 DOI: 10.1111/iwj.14267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 07/29/2023] Open
Abstract
Identifying the microbiome within chronic diabetic foot ulcers is essential if effective antimicrobial therapies are to be administered. Using culture and 16S rRNA gene sequencing, the aim of this study was to compare the microbiome of paired tissue scraping samples with swab samples, collected from participants during attendance at a high-risk foot clinic. The mean richness of cultured swab and tissue scraping samples was consistent, with anaerobes infrequently isolated from both sample types. Comparing percentage frequencies of detection of selected genera of known and potential pathogens namely Staphylococcus, Streptococcus, Enterococcus, Corynebacterium, Enterobacteriaceae and Pseudomonas from cultured and sequenced swab and tissue scrapings indicated that both collection methods captured varying percentages of all the selected genera. The mean abundance of sequenced samples was not significantly different between swabs and tissue scrapings. The mean richness or number of distinct operational taxonomic units (OTUs) and Shannon's H diversity index were not significantly different between the two collection methods. The mean relative abundance of the selected genera of known and potential pathogens, including anaerobes Anaerococcus and Finegoldia, was higher in swabs compared with tissue scrapings and significantly so in Staphylococcus and Pseudomonas genera. Multivariate analyses confirmed no significant differences between the bacterial community compositions of the paired samples. These results suggest that tissue scrapings and swabs can effectively capture the microbiome of chronic DFUs using culture and 16S rRNA gene sequencing.
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Affiliation(s)
| | - Joanne Bradbury
- Faculty of HealthSouthern Cross UniversityGold CoastAustralia
| | - Kirsten Benkendorff
- National Marine Science Centre, Faculty of Environment, Science and EngineeringSouthern Cross UniversityCoffs HarbourNSWAustralia
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Yong E, Gong H, Liew H, Chan YM, Neo S, Pan Y, Pua U, Lo ZJ, Zhang L, Mak M, Chong L, Hong Q, Tan GWL, Chua MJ, Bin Mohd Fadil MF, Chandrasekar S. Getting a Foothold on Diabetic Foot Disease-Outcomes of a Multidisciplinary Clinical Pathway for Inpatient Diabetic Foot Care: A 17-Year Institutional Review. INT J LOW EXTR WOUND 2023:15347346231183740. [PMID: 37376875 DOI: 10.1177/15347346231183740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Diabetes foot disease (DFD) contributes to poor quality of life, clinical and economic burden. Multidisciplinary diabetes foot teams provide prompt access to specialist teams thereby improving limb salvage. We present a 17-year review of an inpatient multidisciplinary clinical care path (MCCP) for DFD in Singapore. METHODS This was a retrospective cohort study of patients admitted for DFD and enrolled in our MCCP to a 1700-bed university hospital from 2005 to 2021. RESULTS There were 9279 patients admitted with DFD with a mean of 545 (±119) admissions per year. The mean age was 64 (±13.3) years, 61% were Chinese, 18% Malay and 17% Indian. There was a higher proportion of Malay (18%) and Indian (17%) patients compared to the country's ethnic composition. A third of the patients had end stage renal disease and prior contralateral minor amputation. There was a reduction in inpatient major lower extremity amputation (LEA) from 18.2% in 2005 to 5.4% in 2021 (odds ratio 0.26, 95% confidence interval 0.16-0.40, P < .001) which was the lowest since pathway inception. Mean time from admission to first surgical intervention was 2.8 days and mean time from decision for revascularization to procedure was 4.8 days. The major-to-minor amputation rate reduced from 1.09 in 2005 to 0.18 in 2021, reflecting diabetic limb salvage efforts. Mean and median length of stay (LOS) for patients in the pathway was 8.2 (±14.9) and 5 (IQR = 3) days, respectively. There was a gradual trend of increase in the mean LOS from 2005 to 2021. Inpatient mortality and readmission rate was stable at 1% and 11%. CONCLUSION Since the institution of a MCCP, there was a significant improvement in major LEA rate. An inpatient multidisciplinary diabetic foot care path helped to improve care for patients with DFD.
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Affiliation(s)
- Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Haiqing Gong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yam Meng Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shufen Neo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ying Pan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Malcolm Mak
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lester Chong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Min Jia Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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10
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Lazzarini PA, Cramb SM, Golledge J, Morton JI, Magliano DJ, Van Netten JJ. Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century. Diabetologia 2023; 66:267-287. [PMID: 36512083 DOI: 10.1007/s00125-022-05845-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations. METHODS PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms 'diabetes', 'DFD', 'amputation', 'incidence' and 'nation'. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges). RESULTS Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4-36.6) for DFD conditions (5.1 [1.3-7.6] for ulceration; 5.6 [3.8-9.0] for infection; 2.5 [0.9-3.1] for PAD) and 3.1 (1.4-10.3) for amputations (1.2 [0.2-4.2] for major; 1.6 [0.3-4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively. CONCLUSIONS/INTERPRETATION These findings suggest that hospital admission rates for all DFD conditions are considerably higher than those for amputations alone and, thus, the more common practice of reporting admission rates only for amputations may substantially underestimate the burden of DFD. While major amputation rates appear to be largely decreasing, this is not the case for hospital admissions for DFD conditions or minor amputation in many populations. However, true global conclusions are limited because of a lack of consistent definitions used to identify admission rates for DFD conditions and amputations, alongside a lack of data from low- and middle-income countries. We recommend that these areas are addressed in future studies. REGISTRATION This review was registered in the Open Science Framework database ( https://doi.org/10.17605/OSF.IO/4TZFJ ).
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Affiliation(s)
- Peter A Lazzarini
- Australian Centre for Health Services Innovation, Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Susanna M Cramb
- Australian Centre for Health Services Innovation, Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
| | - Jedidiah I Morton
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jaap J Van Netten
- Australian Centre for Health Services Innovation, Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Rehabilitation Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Programme Rehabilitation, Amsterdam, the Netherlands
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11
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A Designed Host Defense Peptide for the Topical Treatment of MRSA-Infected Diabetic Wounds. Int J Mol Sci 2023; 24:ijms24032143. [PMID: 36768463 PMCID: PMC9917076 DOI: 10.3390/ijms24032143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Diabetes mellitus is a chronic disease characterized by metabolic dysregulation which is frequently associated with diabetic foot ulcers that result from a severely compromised innate immune system. The high levels of blood glucose characteristic of diabetes cause an increase in circulating inflammatory mediators, which accelerate cellular senescence and dampen antimicrobial activity within dermal tissue. In diabetic wounds, bacteria and fungi proliferate in a protective biofilm forming a structure that a compromised host defense system cannot easily penetrate, often resulting in chronic infections that require antimicrobial intervention to promote the healing process. The designed host defense peptide (dHDP) RP557 is a synthesized peptide whose sequence has been derived from naturally occurring antimicrobial peptides (AMPs) that provide the first line of defense against invading pathogens. AMPs possess an amphipathic α-helix or β-sheet structure and a net positive charge that enables them to incorporate into pathogen membranes and perturb the barrier function of Gram-positive and Gram-negative bacteria along with fungi. The capacity of skin to resist infections is largely dependent upon the activity of endogenous AMPs that provided the basis for the design and testing of RP557 for the resolution of wound infections. In the current study, the topical application of RP557 stopped bacterial growth in the biofilm of methicillin-resistant Staphylococcus aureus (MRSA) USA300 infected wounds on the flanks of clinically relevant diabetic TALLYHO mice. Topical application of RP557 reduced bacterial load and accelerated wound closure, while wound size in control diabetic mice continued to expand. These studies demonstrate that RP557 reduces or eliminates an infection in its biofilm and restores wound-healing capacity.
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12
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Su HY, Yang CY, Ou HT, Chen SG, Chen JC, Ho HJ, Kuo S. Cost-effectiveness of Novel Macrophage-Regulating Treatment for Wound Healing in Patients With Diabetic Foot Ulcers From the Taiwan Health Care Sector Perspective. JAMA Netw Open 2023; 6:e2250639. [PMID: 36633847 PMCID: PMC9856772 DOI: 10.1001/jamanetworkopen.2022.50639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Diabetic foot ulcers (DFUs) and subsequent amputation incur enormous health and economic burdens to patients, health care systems, and societies. As a novel macrophage-regulating drug, ON101 is a breakthrough treatment for DFUs, which demonstrated significant complete wound healing effects in a phase 3 randomized clinical trial, but its economic value remains unknown. OBJECTIVE To assess the cost-effectiveness of an ON101 cream added on to general wound care (GWC; ie, conventional treatments for DFUs, which comprised initial and regular foot examinations, ulcer management, comorbidity control, patient education, and multidisciplinary care) vs GWC alone for DFUs from the Taiwan health care sector perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a hypothetical cohort of patients with diabetes, with characteristics mirroring those of the participants in the ON101 trial. A Markov state-transition simulation model was constructed to estimate costs and health outcomes associated with the ON101 with GWC and GWC alone strategies over a 5-year time horizon, discounting costs and effectiveness at 3% annually. Costs were in 2021 US dollars. Data were sourced from the ON101 trial and supplemented from published literature. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of input parameters and study generalizability. The analysis was designed and conducted from September 1, 2020, to January 31, 2022. EXPOSURES ON101 with GWC vs GWC alone. MAIN OUTCOMES AND MEASURES DFU-related complications, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. RESULTS Patients in the hypothetical cohort had a mean age of 57 years and an uninfected DFU of 1 to 25 cm2 that was present for 4 or more weeks with a Wagner grade of 1 or 2. Over 5 years, the ON101 with GWC group vs the GWC alone group experienced more healing events, stayed for a longer time in the healing state, and had fewer infected DFUs, gangrene, and amputations (eg, 2787 additional healing events and 2766 fewer infected DFU, 72 fewer amputation, and 7 fewer gangrene events in the ON101 with GWC group vs GWC alone group). The ON101 with GWC strategy vs GWC alone yielded an additional 0.038 QALYs at an incremental cost of $571, resulting in $14 922/QALY gained. Economic results were most sensitive to healing efficacy, drug cost, and health utility of the healing state. Cost-saving results were observed in patient subgroups with poor glycemic control, larger ulcer sizes, longer ulcer durations, and current smoking. The ON101 with GWC strategy was considered cost-effective in 60% to 82% of model iterations against willingness-to-pay thresholds of $32 787/QALY gained to $98 361/QALY gained. CONCLUSIONS AND RELEVANCE In this economic evaluation study using a simulated patient cohort, the ON101 with GWC strategy represented good value compared with GWC alone for patients with DFUs from the Taiwan health care sector perspective and may be prioritized for those with high risks for disease progression of DFUs.
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Affiliation(s)
- Hsuan-Yu Su
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yi Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyi-Gen Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
- Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Jui-Ching Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Hui-Ju Ho
- Department of Clinical Research, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Shihchen Kuo
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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13
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Pan C, Xu P, Zheng Y, Wang Y, Chen C, Fu S, Liu Z, Chen Y, Xue K, Zhou Q, Liu K. Preparation of therapy-grade extracellular vesicles from adipose tissue to promote diabetic wound healing. Front Bioeng Biotechnol 2023; 11:1129187. [PMID: 37034267 PMCID: PMC10076785 DOI: 10.3389/fbioe.2023.1129187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Treatment of diabetic wounds is a major challenge in clinical practice. Extracellular vesicles (EVs) from adipose-derived stem cells have shown effectiveness in diabetic wound models. However, obtaining ADSC-EVs requires culturing vast numbers of cells, which is hampered by the need for expensive equipment and reagents, extended time cost, and complicated procedures before commercialization. Therefore, methods to extract EVs from discarded tissue need to be developed, for immediate application during surgery. For this reason, mechanical, collagenase-digestive, and constant in-vitro-collective methods were designed and compared for preparing therapy-grade EVs directly from adipose tissue. Methods: Characteristics and quantities of EVs were detected by transmission electron microscopy, nanoparticle tracking analysis, and Western blotting firstly. To investigate the biological effects of EVs on diabetic wound healing, angiogenesis, proliferation, migration, and inflammation-regulation assays were then evaluated in vitro, along with a diabetic wound healing mouse model in vivo. To further explore the potential therapeutic mechanism of EVs, miRNA expression profile of EVs were also identified and analyzed. Results: The adipose tissue derived EVs (AT-EVs) were showed to qualify ISEV identification by nanoparticle tracking analysis and Western blotting and the AT-EVs yield from three methods was equal. EVs also showed promoting effects on biological processes related to diabetic wound healing, which depend on fibroblasts, keratinocytes, endothelial cells, and macrophages both in vitro and in vivo. We also observed enrichment of overlapping or unique miRNAs originate from different types of AT-EVs associated with diabetic wound healing for further investigation. Conclusion: After comparative analyses, a mechanical method was proposed for preparing immediate clinical applicable EVs from adipose tissue that would result in reduced preparation time and lower cost, which could have promising application potential in treating diabetic wounds.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kai Liu
- *Correspondence: Qimin Zhou, ; Kai Liu,
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14
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Ezzatvar Y, García-Hermoso A. Global estimates of diabetes-related amputations incidence in 2010-2020: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 195:110194. [PMID: 36464091 DOI: 10.1016/j.diabres.2022.110194] [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: 08/15/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS This study sought to provide up-to-date pooled global estimates of diabetes-related amputation incidence from 2010 to 2020. METHODS Embase and Medline databases were searched for studies reporting the incidence rate (IR) of diabetes-related amputations from 2010 to 2020. IR estimates of diabetes-related amputations with associated 95% confidence interval (CI) per 100,000 individuals with diabetes were calculated. RESULTS 23 studies were included, reporting 505,390 diabetes-related lower extremity amputations. IR of minor amputations was 139.97 (95% CI 88.18-222.16) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 148.59 (95% CI 65.00-339.68) and in type 2 diabetes was 75.53 (95% CI 29.94-190.54). IR of major amputations was 94.82 (95% CI 56.62-158.80) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 100.76 (95% CI 53.71-189.01) and among type 2 diabetes was 40.58 (95% CI 11.03-149.28). There were 83.84 annual amputations (95% CI 41.67-168.65) per 100,000 women with diabetes and 178.04 (95% CI 81.16-390.55) per 100,000 men. CONCLUSIONS Globally, annual incidence of diabetes-related amputations from 2010 to 2020 has shown to disproportionately affect men and individuals with type 1 diabetes mellitus, although its incidence is not uniform across countries.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain.
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
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15
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Arfaoui A, Sallem RB, Fernández-Fernández R, Eguizábal P, Dziri R, Abdullahi IN, Sayem N, Ben Khelifa Melki S, Ouzari HI, Torres C, Klibi N. Methicillin-Resistant Staphylococcus aureus from Diabetic Foot Infections in a Tunisian Hospital with the First Detection of MSSA CC398-t571. Antibiotics (Basel) 2022; 11:antibiotics11121755. [PMID: 36551412 PMCID: PMC9774551 DOI: 10.3390/antibiotics11121755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022] Open
Abstract
This study sought to analyze the antimicrobial resistant phenotypes and genotypes as well as the virulence content of S. aureus isolates recovered from patients with diabetic foot infections (DFIs) in a Tunisian hospital. Eighty-three clinical samples of 64 patients were analyzed, and bacterial isolates were identified by MALDI-TOF. The antimicrobial resistance phenotypes were determined by the Kirby-Bauer disk diffusion susceptibility test. Resistance and virulence genes, agr profile, spa and SCCmec types were determined by PCR and sequencing. S. aureus was detected in 14 of the 64 patients (21.9%), and 15 S. aureus isolates were recovered. Six out of the fifteen S. aureus isolates were methicillin-resistant (MRSA, mecA-positive) (40%). The isolates harbored the following resistance genes (number of isolates): blaZ (12), erm(B) (2), erm(A) (1), msrA (2), tet(M) (2), tet(K) (3), tet(L) (1), aac(6')-aph(2″) (2), ant(4″) (1) and fexA (1). The lukS/F-PV and tst genes were detected in three isolates. Twelve different spa-types were identified and assigned to seven clonal complexes with the predominance of agr-type III. Furthermore, the SCCmec types III, IV and V were found among the MRSA isolates. Moreover, one MSSA CC398-t571-agr-III isolate was found; it was susceptible to all antimicrobial agents and lacked luk-S/F-PV, tst, eta and etb genes. This is the first report on the prevalence and molecular characterization of S. aureus from DFIs and also the first detection of the MSSA-CC398-t571 clone in human infections in Tunisia. Our findings indicated a high prevalence S. aureus in DFIs with genetic diversity among the MSSA and MRSA isolates.
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Affiliation(s)
- Ameni Arfaoui
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Rym Ben Sallem
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
| | | | - Paula Eguizábal
- Biochemistry and Molecular Biology, University of La Rioja, 26006 Logroño, Spain
| | - Raoudha Dziri
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
| | | | - Noureddine Sayem
- Service of Biology, Carthagene International Hospital of Tunisia, Tunis 1082, Tunisia
| | | | - Hadda-Imen Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Carmen Torres
- Biochemistry and Molecular Biology, University of La Rioja, 26006 Logroño, Spain
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Correspondence: ; Tel.: +216-70860553
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16
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Quigley M, Morton JI, Lazzarini PA, Zoungas S, Shaw JE, Magliano DJ. Trends in diabetes-related foot disease hospitalizations and amputations in Australia, 2010 to 2019. Diabetes Res Clin Pract 2022; 194:110189. [PMID: 36442544 DOI: 10.1016/j.diabres.2022.110189] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
AIM To determine trends in the incidence of hospitalizations and amputations for diabetes-related foot disease (DFD) in Australia. METHODS We included 70,766 people with type 1, and 1,087,706 with type 2 diabetes from the Australian diabetes registry from 2010 to 2019, linked to hospital admissions databases. Trends in age-adjusted incidence were summarized as annual percent changes (APC). RESULTS In people with type 1 diabetes, total DFD hospitalizations increased from 20.8 to 30.5 per 1,000 person-years between 2010 and 2019 (APC: 5.1% (95% CI: 3.5, 6.8)), including increases for ulceration (13.3% (2.9, 24.7)), osteomyelitis (5.6% (2.7, 8.7)), peripheral arterial disease (7.7% (3.7, 11.9)), and neuropathy (8.7% (5.5, 12.0)). In people with type 2 diabetes, DFD hospitalizations changed from 18.6 to 24.8 per 1,000 person-years between 2010 and 2019 (APC: 4.5% (3.6, 5.4); 2012-2019), including increases for ulceration (8.7% (4.0, 13.7)), cellulitis (5.4% (3.7, 7.0)), osteomyelitis (6.7% (5.7, 7.7)), and neuropathy (6.9% (5.2, 8.5)). Amputations were stable in type 1, whereas in type 2, above knee amputations decreased (-6.0% (-9.1, -2.7). Adjustment for diabetes duration attenuated the magnitude of most increases, but many remained significant. CONCLUSIONS DFD hospitalizations increased markedly in Australia, mainly driven by ulceration and neuropathy, highlighting the importance of managing DFD to prevent hospitalizations.
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Affiliation(s)
- Matthew Quigley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Jedidiah I Morton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan E Shaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
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17
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Lin CW, Armstrong DG, Huang CH, Lin CH, Hung SY, Liu PH, Huang YY. Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat. Diabetes Res Clin Pract 2022; 193:110134. [PMID: 36349589 DOI: 10.1016/j.diabres.2022.110134] [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: 04/17/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
AIMS To disclose prevalence, demographic, foot characteristics as well as management and lower-extremity amputations (LEAs) of subjects with end-stage renal disease (ESRD) on diabetic foot diseases (DFDs). METHODS Data were derived from the Taiwan National Health Insurance Research Database between 2004 and 2017. DFDs were defined as ulcers, infections, or severe peripheral arterial diseases (PADs) in patients with type 2 diabetes. Clinical characteristics were analyzed between subjects with and without ESRD. RESULTS Subjects with ESRD have increased impacts on the DFD population either from annual prevalence (2.7 % to 10.42 %, P for trend < 0.001), or proportional representation in LEAs (7.91 % to 26.37 %, P < 0.001) over 14 years. The annual trends for major-LEAs rates have decreased in both subjects with and without ESRD (13.67 % to 5.82 % and 3.48 % to 1.47 %, both P < 0.001). Notably, the concomitant increase of endovascular treatments (EVTs) (7.09 % to 29.41 %, P < 0.001) was associated with the decrease of major-LEAs (P for interaction < 0.001) in subjects with ESRD. CONCLUSIONS As the annual prevalence of subjects with ESRD has increased 3.9-fold over years, they now account for more than 30% of annual major-LEA of the total DFD population. Interdisciplinary team approach and aggressive EVTs might reduce major-LEAs in these patients.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, USA (D.G.A.)
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Shi L, Xue J, Zhao W, Wei X, Zhang M, Li L, Xu Z, Wang A. The Prognosis of Diabetic Foot Ulcer is Independent of age? A Comparative Analysis of the Characteristics of Patients with Diabetic Foot Ulcer in Different age Groups: A Cross-Sectional Study from China. INT J LOW EXTR WOUND 2022:15347346221125844. [PMID: 36184913 DOI: 10.1177/15347346221125844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: With younger onset age of type 2 diabetes mellitus (T2DM), the incidence of diabetic foot ulcer (DFU) in young and middle-aged adults is also increasing. Elucidating the distinctive characteristics of DFU in different ages and exploring the influence of age on the prognosis of DFU are crucial to the improvement of DFU treatments. Methods: 684 patients hospitalized for DFU in the department of endocrinology were recruited and assigned into the young and middle-aged group (age <65 years old) and the elderly group (age ≥65 years old). Demographic data and clinical features were compared between two groups. Results: Compared with the elderly group, the young and middle-aged group had higher proportion of males (72.3% vs 49.6%, P < .01) and smokers (52.5% vs 35.8%, P < .01), shorter duration of diabetes mellitus (155 months vs 196 months, P < .01), higher levels of glycosylated hemoglobin (9.3% vs 8.7%, P < .01), lower ratio of ankle-brachial index <0.9 (25.8% vs 51.1%, P < .01) and higher levels of c-reactive protein and erythrocyte sedimentation rate (14 mg/L vs 10 mg/L, P < .05; 36 mm/h vs 30 mm/h, P < .05). The prevalence of diabetic peripheral neuropathy and Wagner Grade were similar in two groups. Of note, the prognosis was similar in different age groups, as there were no significant differences in the healing rate (59.7% vs 60.1%, P > .05), healing time (30 days vs 22 days, P > .05) and minor amputation rate (11.9% vs 8.7%, P > .05). Conclusions: We found that no evidence to suggest a better prognosis with younger DFU patients. Compared with elderly ones, young and middle-aged patients were characterized by a higher proportion of smoking, worse glycemic control, higher inflammatory biomarkers but less severe lower limb ischemia, indicating that smoking cessation, strict blood glucose control and early detection of infection were crucial for improving the prognosis of young and middle-aged diabetic DFU patients.
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Affiliation(s)
- Lintao Shi
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Jing Xue
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
| | - Weibo Zhao
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
| | - Xiaowei Wei
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Mei Zhang
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Lijun Li
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Zhangrong Xu
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Aihong Wang
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
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Impact of time in range during hospitalization on clinical outcomes in diabetic patients with toe amputation: a propensity score matching analysis. BMC Surg 2022; 22:314. [PMID: 35962366 PMCID: PMC9373526 DOI: 10.1186/s12893-022-01762-1] [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: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose In recent years, time in range (TIR), defined as a percentage within a target time range, has attracted much attention. This study was aimed to investigate the short-term effects of Time in Rang on diabetic patients undergoing toe amputation in a more specific and complete manner. Methods A retrospective analysis on patients with diabetic foot ulcer (DFU) treated by toe amputation or foot amputation at the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2019 were evaluated. A 1:1 match was conducted between the TIR < 70% group and the TIR ≥ 70% group using the nearest neighbor matching algorithm. Data were analyzed using Chi-squared, Fisher’s exact, and Mann–Whitney U tests. Results Compared with patients in the TIR ≥ 70% group, patients in the TIR < 70% had a higher rate of re-amputation, and a higher rate of postoperative infection. Multivariate analysis revealed that smoking, lower extremity arterial disease and TIR < 70% were risk factors for surgery of re-amputation. The results of subgroup analysis found that the TIR < 70% was associated with a greater risk of re-amputation in patients with HbA1c < 7.5%, lower extremity arterial disease, and non-smokers. Conclusions TIR can be used as a short-term glycemic control indicator in patients with DFUs and should be widely accepted in clinical practice. However, a future multicenter prospective study is needed to determine the relationship between TIR and toe re-amputation in diabetic foot patients.
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Chen YC, Liao YH, Ku LJE, Wang JD. Pay-for-performance and continuity of care synergistically reduced amputation of lower extremity in patients with diabetes: a population-based cohort study. BMC Health Serv Res 2022; 22:748. [PMID: 35659668 PMCID: PMC9167521 DOI: 10.1186/s12913-022-08075-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/11/2022] [Indexed: 12/14/2022] Open
Abstract
Abstracts
Background
Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.
Methods
This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.
Results
During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (n = 153) was significantly lower than that of the non-P4P group (n = 1663) (hazard ratio = 0.37, 95% CI = 0.31–0.43, p < 0.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the P4P group was 0.35, (p < 0.0001). With the low COCI (< 0.360) group as the reference, the aHR of LEA was 0.49 (p < 0.0001) for the middle COCI group, (p < 0.0001), and the aHR of LEA for the high COCI (≥0.643) group was 0.23 (p < 0.0001).
Conclusions
Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically.
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Mayo AL, Viana R, Dilkas S, Payne M, Devlin M, MacKay C, Cimino SR, Guilcher SJT, Hitzig SL. Self-reported health condition severity and ambulation status postmajor dysvascular limb loss. Prosthet Orthot Int 2022; 46:239-245. [PMID: 35315834 DOI: 10.1097/pxr.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals with dysvascular lower limb amputations (LLA) secondary to complications of peripheral arterial disease (PAD) and/or diabetes have high rates of co-morbidities. OBJECTIVES To describe self-reported health condition severity and their association with sociodemographic factors and ambulations status among individuals with major dysvascular LLA. STUDY DESIGN Cross sectional telephone and in person survey with adults with major dysvascular LLA living in the community setting in Ontario, Canada. METHODS Survey by phone/in person, and completion of the Dysvascular Conditions Scale and Special Interest in Amputee Medicine Mobility (SIGAM) Grade by each participant. RESULTS Two hundred thirty-one individuals with major dysvascular LLAs participated in the study. Most of them were male individuals (80.5%) and had undergone a transtibial amputation (74%). On average, participants were 3.4 years postlimb loss and had five identified Dysvascular Conditions Scale health conditions. The top five reported health conditions were diabetes, hypertension, phantom limb pain, musculoskeletal pain, and back pain. With the exclusion of hypertension, these conditions were also perceived by respondents to be quite severe for their impact. Vision impairment was also rated as being severe in nature. Lower mobility Special Interest Group in Amputee Medicine grades were associated with higher health condition severity scores. CONCLUSIONS Individuals with dysvascular limb loss experience high multimorbidity with perceived negative impact on their overall wellness and function. Rehabilitation and self-management strategies to help patients with dysvascular LLAs to manage chronic health conditions may improve outcomes.
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Affiliation(s)
- Amanda L Mayo
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine & Rehabilitation, Temerty Faculty of Medicine, University of Toronto Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ricardo Viana
- Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Steven Dilkas
- Division of Physical Medicine & Rehabilitation, Temerty Faculty of Medicine, University of Toronto Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Michael Payne
- Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Crystal MacKay
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tokarski AR, Barton EC, Wagner JT, Elliott AD, Simonson DC, Hordyk PJ, Rademaker M. Are Transmetatarsal Amputations a Durable Limb Salvage Option? A Single-Institution Descriptive Analysis. J Foot Ankle Surg 2022; 61:537-541. [PMID: 34794876 DOI: 10.1053/j.jfas.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/01/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
In limb and life-threatening diabetic foot infections, transmetatarsal amputations are often indicated as a limb salvage procedure. The aim of this study is to analyze the long-term durability of initially successful transmetatarsal amputations in the diabetic population. We defined a successful transmetatarsal amputation as one which had clinical healing 1 year after surgery. A retrospective review of transmetatarsal amputations completed at our institution over an 11-year period was performed. We identified 83 amputations that met inclusion criteria. The mean follow-up was 4 years. The mean time to surgical healing was 109.8 days. After successfully healing the transmetatarsal amputation the long-term outcomes were analyzed. Re-ulcerations occurred in 44% of the transmetatarsal amputations a mean of 15 months after surgical healing. Patients who re-ulcerated were noted to be significantly younger (p value 0.02) with a significantly higher preprocedure hemoglobin A1c (p value < .001). Additional procedures after successful healing included 13 (15.66%) revision surgeries and 12 (14.46%) more proximal amputations. While transmetatarsal amputations remain a viable and durable limb preserving surgery, all patients who have undergone a transmetatarsal amputation should be monitored lifelong as they remain at risk for re-ulceration and more proximal amputation.
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Affiliation(s)
- Alexander R Tokarski
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI.
| | - Ellen C Barton
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI
| | - Jacob T Wagner
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI
| | | | | | | | - Marc Rademaker
- Undergraduate Student, University of Wisconsin-La Crosse, La Crosse, WI
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Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, de-Miguel-Diez J, de-Miguel-Yanes JM, Omaña-Palanco R, Carabantes-Alarcon D. Time trends (2001-2019) and sex differences in incidence and in-hospital mortality after lower extremity amputations among patients with type 1 diabetes in Spain. Cardiovasc Diabetol 2022; 21:65. [PMID: 35505344 PMCID: PMC9066863 DOI: 10.1186/s12933-022-01502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background We examined trends in incidence (2001–2019), clinical characteristics, and in-hospital outcomes following major and minor lower extremity amputations (LEAs) among type 1 diabetes mellitus (T1DM) patients in Spain and attempted to identify sex differences. Methods Retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of the LEA procedure stratified by type of LEA. Joinpoint regression was used to estimate incidence trends, and logistic regression was used to estimate factors associated with in-hospital mortality (IHM). Results LEA was coded in 6011 patients with T1DM (66.4% minor and 33.6% major). The incidence of minor LEA decreased by 9.55% per year from 2001 to 2009 and then increased by 1.50% per year, although not significantly, through 2019. The incidence of major LEA decreased by 13.39% per year from 2001 to 2010 and then remained stable through 2019. However, incidence increased in men (26.53% per year), although not significantly, from 2017 to 2019. The adjusted incidence of minor and major LEA was higher in men than in women (IRR 3.01 [95% CI 2.64–3.36] and IRR 1.85 [95% CI 1.31–2.38], respectively). Over the entire period, for those who underwent a minor LEA, the IHM was 1.58% (2.28% for females and 1.36% for males; p = 0.045) and for a major LEA the IHM was 8.57% (10.52% for females and 7.59% for males; p = 0.025). IHM after minor and major LEA increased with age and the presence of comorbid conditions such as peripheral arterial disease, ischemic heart disease or chronic kidney disease. Female sex was associated with a higher IHM after major LEA (OR 1.37 [95% CI 1.01–1.84]). Conclusions Our data show a decrease in incidence rates for minor and major LEA in men and women with T1DM and a slight, albeit insignificant, increase in major LEA in men with T1DM in the last two years of the study. The incidence of minor and major LEA was higher in men than in women. Female sex is a predictor of IHM in patients with T1DM following major LEA. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01502-y.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty. Rey Juan Carlos University. Alcorcón, Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de-Miguel-Yanes
- Internal Medicine Department. Hospital General, Universitario Gregorio MarañónUniversidad Complutense de MadridInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ricardo Omaña-Palanco
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Ou CY, Wu MS, Lin MC, Chang CM. Short-term and long-term outcomes of free flap reconstruction versus amputation for diabetic foot reconstruction in patients with end-stage renal disease. J Plast Reconstr Aesthet Surg 2022; 75:2511-2519. [PMID: 35643595 DOI: 10.1016/j.bjps.2022.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Taiwan, the prevalence of diabetes mellitus complicated by end-stage renal disease (ESRD) has been increasing and diabetes-related foot amputation is commonplace. In recent years, limb salvage has become top priority. The long-term outcomes of patients on hemodialysis undergoing diabetic foot reconstruction using free flaps remain unknown. METHODS Data from the National Health Insurance Research Database on hemodialysis patients with type 2 diabetes who received amputation or free flap reconstruction surgery for diabetic foot ulcer were analyzed from 2000 to 2013 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. After 1:4 propensity score matching, 86 and 344 patients were assigned to the free flap reconstruction and amputation groups, respectively. RESULTS The 5-year survival rate was significantly higher in patients who received free flap compared to the amputated group (1-year survival rate = 80.0% vs. 67.6%, p = 0.030; 3-year survival rate = 49.7% vs. 35.5%, p = 0.024; 5-year rate=30.1% vs. 19.9%, p = 0.018; however, after 5 years, the overall long-term survival rate was similar in both groups (p = 0.064). Patients who had lower limb amputation after flap reconstruction were susceptible to mortality (adjusted HR = 1.39; p = 0.069). Peripheral arterial disease was a dependent risk factor (HR = 1.45; p = 0.037) for long-term survival, whereas old age (> 75 years; HR = 1.65; p = 0.004), cerebrovascular disease (adjusted HR = 1.36; p = 0.011), and sepsis (adjusted HR = 1.85; p = 0.035) served as independent risk factors. Hemodialysis patients with diabetic foot ulcer who had limb salvaged showed a higher 5-year survival rate as compared to the amputated group.
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Affiliation(s)
- Chia-Yu Ou
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Meng-Si Wu
- Division of Plastic surgery, Department of surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chang
- Division of General Surgery, Department of surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan.
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25
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Brown JL, Townsend E, Short RD, Williams C, Woodall C, Nile CJ, Ramage G. Assessing the inflammatory response to in vitro polymicrobial wound biofilms in a skin epidermis model. NPJ Biofilms Microbiomes 2022; 8:19. [PMID: 35393409 PMCID: PMC8991182 DOI: 10.1038/s41522-022-00286-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/24/2022] [Indexed: 01/13/2023] Open
Abstract
Wounds can commonly become infected with polymicrobial biofilms containing bacterial and fungal microorganisms. Microbial colonization of the wound can interfere with sufficient healing and repair, leading to high rates of chronicity in certain individuals, which can have a huge socioeconomic burden worldwide. One route for alleviating biofilm formation in chronic wounds is sufficient treatment of the infected area with topical wound washes and ointments. Thus, the primary aim here was to create a complex in vitro biofilm model containing a range of microorganisms commonly isolated from the infected wound milieu. These polymicrobial biofilms were treated with three conventional anti-biofilm wound washes, chlorhexidine (CHX), povidone-iodine (PVP-I), and hydrogen peroxide (H2O2), and efficacy against the microorganisms assessed using live/dead qPCR. All treatments reduced the viability of the biofilms, although H2O2 was found to be the most effective treatment modality. These biofilms were then co-cultured with 3D skin epidermis to assess the inflammatory profile within the tissue. A detailed transcriptional and proteomic profile of the epidermis was gathered following biofilm stimulation. At the transcriptional level, all treatments reduced the expression of inflammatory markers back to baseline (untreated tissue controls). Olink technology revealed a unique proteomic response in the tissue following stimulation with untreated and CHX-treated biofilms. This highlights treatment choice for clinicians could be dictated by how the tissue responds to such biofilm treatment, and not merely how effective the treatment is in killing the biofilm.
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Affiliation(s)
- Jason L Brown
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK. .,Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Eleanor Townsend
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK.,Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.,School of Life Sciences, Gibbet Hill Campus, The University of Warwick, Coventry, CV4 7AL, UK
| | - Robert D Short
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, UK
| | - Craig Williams
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.,Microbiology Department, Lancaster Royal Infirmary, University of Lancaster, Lancaster, LA1 4YW, UK
| | - Chris Woodall
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.,Blutest Laboratories, 5 Robroyston Oval, Nova Business Park, Glasgow, G33 1AP, UK
| | - Christopher J Nile
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.,School of Dental Sciences, Newcastle University, Newcastle, NE2 4BW, UK
| | - Gordon Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK. .,Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
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26
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Aguirre A, Sharma K, Arora A, Humphries MD. Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers. Ann Vasc Surg 2022; 79:65-71. [PMID: 34656726 PMCID: PMC9889134 DOI: 10.1016/j.avsg.2021.08.015] [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: 05/06/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation. METHODS We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation. RESULTS Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (<30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07). CONCLUSIONS Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.
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Affiliation(s)
- Angela Aguirre
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Kritika Sharma
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Aman Arora
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, University of California Davis Health, Sacramento, CA.
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27
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Hung S, Chiu C, Huang C, Lin C, Yeh J, Yang H, Huang Y. Impact of wound microbiology on limb preservation in patients with diabetic foot infection. J Diabetes Investig 2022; 13:336-343. [PMID: 34418309 PMCID: PMC8847138 DOI: 10.1111/jdi.13649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the association between specific bacterial pathogens and treatment outcome in patients with limb-threatening diabetic foot infection (LT-DFI). MATERIALS AND METHODS Consecutive patients treated for LT-DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 and 2017. Patients with positive wound culture results at first aid were enrolled. Clinical factors, laboratory data, and wound culture results were compared. Lower-extremity amputations and in-hospital mortality were defined as a poor outcome. RESULTS Among the 558 patients, 272 (48.7%) patients had lower extremity amputation and 22 (3.9%) patients had in-hospital mortality. Gram-negative bacterial (GNB) infection was the independent factor following factors adjustment. When all the 31 microorganisms were analyzed, only E. coli (adjusted odds ratio [aOR], 3.01; 95% CI, 1.60-5.65), Proteus spp. (aOR, 2.99; 95% CI, 1.69-5.29), and Pseudomonas aeruginosa (aOR, 2.00; 95% CI 1.20-3.32) were associated with poor outcome. The analysis of specific GNB species in association with major- or minor- amputation have been reported. No specific pathogen was associated with cause of death in patients with mortality within 30 days. The antimicrobial-resistant strains were not associated with a poor treatment outcome. CONCLUSIONS The presence of GNB was associated with limb amputations. This study provides insight into more timely and appropriate management of the diabetic foot infection.
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Affiliation(s)
- Shih‐Yuan Hung
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Cheng‐Hsun Chiu
- Division of Pediatric Infectious DiseasesDepartment of PediatricsChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Chung‐Huei Huang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Cheng‐Wei Lin
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Jiun‐Ting Yeh
- Division of Trauma Plastic SurgeryDepartment of Plastic and Reconstructive SurgeryChang Gung Memorial HospitalChang Gung UniversityTaoyuan CityTaiwan
| | - Hui‐Mei Yang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Yu‐Yao Huang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalTaoyuan CityTaiwan
- College of MedicineChang Gung UniversityTaoyuan CityTaiwan
- Department of Medical Nutrition TherapyChang Gung Memorial HospitalTaoyuan CityTaiwan
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28
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Almohammadi AA, Alnashri MM, Abdulrahman T Harun R, Alsamiri SM, Alkhatieb MT. Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study. Ann Med Surg (Lond) 2022; 73:103174. [PMID: 34976392 PMCID: PMC8689050 DOI: 10.1016/j.amsu.2021.103174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetic foot complications constitute a major public health problem worldwide, especially in Jeddah, Saudi Arabia, where the prevalence of diabetes is high. Our study was designed to determine the pattern and type of amputations performed on patients with diabetic foot admitted to a tertiary center in Jeddah, Saudi Arabia; we also aimed to determine the 7-year mortality rate of patients with diabetic foot at the same institution. Materials and methods This retrospective study was conducted between January 2013 and September 2020 at a tertiary center in Jeddah, Saudi Arabia. It included all patients previously diagnosed with diabetes mellitus who presented to the hospital with either diabetic foot ulcers or foot gangrene (dry/wet/gas). The medical records of 358 patients were reviewed to acquire information regarding demographics, admission history regarding diabetes and its outcome, medical and surgical history, the level of amputation, and the presence of infection. Results Among the participants, 84.9% underwent amputation, 38.2% underwent minor amputations, 40.1% underwent major amputations, and 21.7% underwent both types of amputation. The most common cause of amputation was infection (50.3%). There were 75 deaths and a 7-year mortality rate of 20%. Low mean hemoglobin and high mean creatinine levels were significantly associated with mortality (p < 0.05). Conclusion Efforts to decrease the risk of amputation and mortality among patients with diabetic foot complications are required. Early detection of the risk factors and intervention in specialist centers with a multidisciplinary approach is essential. Diabetic foot complications are a serious health problem, especially in our society. The risk for lower limb amputation increased significantly with a high hemoglobin A1c. Once infection occurs, the risk of diabetic foot–related amputation significantly increases. Premature death was identified among patients underwent amputation.
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Affiliation(s)
| | | | | | | | - Maram Taha Alkhatieb
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Bundó M, Vlacho B, Llussà J, Puig-Treserra R, Mata-Cases M, Cos X, Jude EB, Franch-Nadal J, Mauricio D. Prevalence and risk factors of diabetic foot disease among the people with type 2 diabetes using real-world practice data from Catalonia during 2018. Front Endocrinol (Lausanne) 2022; 13:1024904. [PMID: 36353236 PMCID: PMC9637660 DOI: 10.3389/fendo.2022.1024904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain). METHODS We undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018. RESULTS During the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72). CONCLUSIONS In this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD.
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Affiliation(s)
- Magdalena Bundó
- Diabetes des de Atención Primaria-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
| | - Bogdan Vlacho
- Diabetes des de Atención Primaria-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 Pharmacology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, 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
| | - Ramon Puig-Treserra
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manel Mata-Cases
- Diabetes des de Atención Primaria-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
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xavier Cos
- Diabetes des de Atención Primaria-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 Sant Martí de Provençals, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Innovation Office, Institut Català de la Salut, Barcelona, Spain
| | - Edward B. Jude
- Tameside and Glossop Integrated Care National Health Service (NHS) Foundation Trust, Tameside on Lyne, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - Josep Franch-Nadal
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
| | - Dídac Mauricio
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
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30
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Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia 2022; 65:3-13. [PMID: 34837505 PMCID: PMC8660730 DOI: 10.1007/s00125-021-05585-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 12/16/2022]
Abstract
International trends in traditional diabetes complications (cardiovascular, renal, peripheral vascular, ophthalmic, hepatic or neurological diseases) and mortality rates are poorly characterised. An earlier review of studies published up to 2015 demonstrated that most data come from a dozen high-income countries (HICs) in North America, Europe or the Asia-Pacific region and that, in these countries at least, rates of acute glycaemic fluctuations needing medical attention and amputations, myocardial infarction and mortality were all declining over the period. Here, we provide an updated review of published literature on trends in type 2 diabetes complications and mortality in adults since 2015. We also discuss issues related to data collection, analysis and reporting that have influenced global trends in type 2 diabetes and its complications. We found that most data on trends in type 2 diabetes, its complications and mortality come from a small number of HICs with comprehensive surveillance systems, though at least some low- and middle-income countries (LMICs) from Africa and Latin America are represented in this review. The published data suggest that HICs have experienced declines in cardiovascular complication rates and all-cause mortality in people with diabetes. In parallel, cardiovascular complications and mortality rates in people with diabetes have increased over time in LMICs. However, caution is warranted in interpreting trends from LMICs due to extremely sparse data or data that are not comparable across countries. We noted that approaches to case ascertainment and definitions of complications and mortality (numerators) and type 2 diabetes (the denominator) vary widely and influence the interpretation of international data. We offer four key recommendations to more rigorously document trends in rates of type 2 diabetes complications and mortality, over time and worldwide: (1) increasing investments in data collection systems; (2) standardising case definitions and approaches to ascertainment; (3) strengthening analytical capacity; and (4) developing and implementing structured guidelines for reporting of data.
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Affiliation(s)
- Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
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31
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Huang ZX, Zhang HH, Huang Y, Ye SL, Ma YN, Xin YH, Chen XQ, Zhao S. Association of time in range with postoperative wound healing in patients with diabetic foot ulcers. Int Wound J 2021; 19:1309-1318. [PMID: 34931460 PMCID: PMC9493226 DOI: 10.1111/iwj.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/22/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022] Open
Abstract
Time in range (TIR) is a novel indicator of glycaemic control that has been reported to have an association with diabetic complications. The objective of the study was to explore the association of TIR with postoperative wound healing in patients with diabetic foot ulcers (DFUs). We retrospectively analysed the data of DFU patients who had undergone surgical treatment from 2015 to 2019. A 1:1 ratio in propensity score matching (PSM) was adopted to compare patients with TIR ≥50% with those <50%. Data were summarised using chi-squared, Fisher's exact, and Mann-Whitney U tests. Patients with TIR <50% underwent a higher rate of secondary surgery within a month (P = .032) and had a longer hospital stay (P = .045) with greater hospital charges (P < .001) than the TIR ≥50% group. Multivariate analysis revealed that TIR (P = .034), Wagner score (P = .009), diabetes treatment (P = .006), and type of surgery (P = .013) were independent risk factors for secondary surgery. Additionally, patient subgroups with TIR <50% and baseline HbA1c < 7.5% (P = .025), albumin level ≥ 30 g/L (P = .039), HDL < 1.16 (P = .021), or Wagner score ≥ 3 (P = .048) also experienced a higher incidence of secondary surgery. TIR was correlated with postoperative wound healing in patients with DFUs. Strict glycaemic targets should be established for surgical patients.
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Affiliation(s)
- Ze-Xin Huang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui-Hui Zhang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Huang
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Infection, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng-Lie Ye
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu-Ning Ma
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying-Huan Xin
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Qian Chen
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng Zhao
- Department of Burns Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Lin CH, Armstrong DG, Liu PH, Lin CW, Huang CH, Huang YY. Survival of Patients Following First Diagnosis of Diabetic Foot Complications: A Nationwide 15-Year Longitudinal Analysis. Front Endocrinol (Lausanne) 2021; 12:801324. [PMID: 34966361 PMCID: PMC8711267 DOI: 10.3389/fendo.2021.801324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Aims The long-term survival in people with type 2 diabetes following first diagnosis of diabetic foot complications (FDDFC) is unclear. The object is to evaluate the mortality rate in subjects with type 2 diabetes following FDDFC and the impacts of the major cardiovascular comorbidities. Methods Nationwide data were analyzed for subjects with T2D and DFC between 2003 and 2017 according to ICD-9 coding. DFC was defined with the codes of ulcers, infections, or severe peripheral artery disease that required intervention (PAD) to mimic the real world diagnosis. Criteria of FDDFC were preceded by a period without any DFC for at least 5 years. Major cardiovascular comorbidities: established PAD and cardiovascular diseases (CVD: including coronary heart disease (CHD), stroke, or heart failure) before the index date as well as lower-extremity amputations (LEA) at the index episode were analyzed. Results Among 300,115 subjects with DFC, a total of 103,396 patients had FDDFC. The mean 5-year survival rate of these subjects was 81.05%. Using subjects without associated major cardiovascular comorbidity as baseline, the adjusted hazard ratios (aHR) were1.43 (95% confidence interval 1.38-1.49) in group PAD-/CVD+, followed by 1.70 (1.59-1.80) in PAD+/CVD- and 1.98 (1.89-2.08) in PAD+/CVD+. The aHR was further increased in patients with PAD who additionally had heart failure (3.77, 3.50-4.05), stroke (2.06, 1.95-2.18), or CHD (1.89, 1.79-2.00). Subjects with PAD rather than other CVD were associated with LEA at FDDFC. Patients with major LEA (above the ankle) at FDDFC episode had lower 5-year survival rate (65.01%) followed by those with minor LEA (72.24%) and without LEA (81.61%). Conclusions Cardiovascular comorbidity as well as LEA status at the event of FDDFCs were both associated with patient survival outcomes. Earlier identification of this large population could lead to higher survival rates.
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Affiliation(s)
- Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, United States
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
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Weissler EH, Clare RM, Lokhnygina Y, Buse JB, Goodman SG, Katona B, Iqbal N, Pagidipati NJ, Sattar N, Holman RR, Hernandez AF, Mentz RJ, Patel MR, Jones WS. Predicting major adverse limb events in individuals with type 2 diabetes: Insights from the EXSCEL trial. Diabet Med 2021; 38:e14552. [PMID: 33690915 PMCID: PMC8429063 DOI: 10.1111/dme.14552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
AIMS Although models exist to predict amputation among people with type 2 diabetes with foot ulceration or infection, we aimed to develop a prediction model for a broader range of major adverse limb events (MALE)-including gangrene, revascularization and amputation-among individuals with type 2 diabetes. METHODS In a post-hoc analysis of data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial, we compared participants who experienced MALE with those who did not. A multivariable model was constructed and translated into a risk score. RESULTS Among the 14,752 participants with type 2 diabetes in EXSCEL, 3.6% experienced MALE. Characteristics associated with increased risk of MALE were peripheral artery disease (PAD) (HRadj 4.83, 95% CI: 3.94-5.92), prior foot ulcer (HRadj 2.16, 95% CI: 1.63-2.87), prior amputation (HRadj 2.00, 95% CI: 1.53-2.64), current smoking (HRadj 2.00, 95% CI: 1.54-2.61), insulin use (HRadj 1.86, 95% CI: 1.52-2.27), coronary artery disease (HRadj 1.67, 95% CI: 1.38-2.03) and male sex (HRadj 1.64, 95% CI: 1.31-2.06). Cerebrovascular disease, former smoking, age, glycated haemoglobin, race and neuropathy were also associated significantly with MALE after adjustment. A risk score ranging from 6 to 96 points was constructed, with a C-statistic of 0.822 (95% CI: 0.803-0.841). CONCLUSIONS The majority of MALE occurred among participants with PAD, but participants without a history of PAD also experienced MALE. A risk score with good performance was generated. Although it requires validation in an external dataset, this risk score may be valuable in identifying patients requiring more intensive care and closer follow-up.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular Surgery, Duke University School of Medicine, Durham, NC
| | - Robert M. Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John B. Buse
- Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, and St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Katona
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Nayyar Iqbal
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Neha J. Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
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Salava A, Oker-Blom A, Remitz A. The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study. SKIN HEALTH AND DISEASE 2021; 1:e53. [PMID: 35663141 PMCID: PMC9060089 DOI: 10.1002/ski2.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
Background Skin‐related conditions are the frequent cause of doctors’ consultations in primary care. Methods Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD‐10 category of all general practitioners’ visits in the public health care in Finland over the years 2015–2019. Results The total amount of doctor’s visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin‐related condition as the main diagnosis. The most frequent skin‐related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin‐related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes. Conclusions The results demonstrate that a limited amount of conditions comprises most of the skin‐related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.
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Affiliation(s)
- A Salava
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Oker-Blom
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Remitz
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
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Chin YF, Huang TT, Yu HY, Yang HM, Hsu BRS. Factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. Int J Nurs Pract 2021; 27:e12950. [PMID: 33915598 DOI: 10.1111/ijn.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/09/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
AIMS To explore the factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. BACKGROUND The 30-day readmission rate of patients with diabetes-related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self-monitoring blood glucose promotes optimal glycaemic control. DESIGN A comparative descriptive study. METHODS In this study, 200 participants, who had been hospitalized due to diabetes-related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self-efficacy and knowledge) and pre-hospitalization self-monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self-monitoring blood glucose behaviour delivery was collected again. RESULTS Five variables explained 47% of the variance in the delivery of self-monitoring of blood glucose at home. The delivery of hospital-to-home transitional self-monitoring blood glucose behaviour was more likely for individuals with higher pre-discharge self-efficacy, higher post-discharge self-efficacy, more attention to pre-hospitalization glycaemic status and post-discharge insulin usage and those without an insensitive foot. CONCLUSION Self-monitoring blood-glucose behaviour should be promoted among post-discharge patients with diabetes-related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan.
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Affiliation(s)
- Yen-Fan Chin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Ting Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-Yi Yu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Child Ophthalmology, Department of Ophthalmology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Mei Yang
- Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Brend Ray-Sea Hsu
- Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Aragón-Hernández J, Rojas-Bonilla JM, Murillo-Vargas C. Long-term Mortality of a Cohort of Patients Undergoing Surgical Treatment for Diabetic Foot Infections. An 8-year Follow-up Study. INT J LOW EXTR WOUND 2021; 22:314-320. [PMID: 33909492 DOI: 10.1177/15347346211009425] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We analyzed a retrospective cohort of 150 patients with diabetic foot infections (DFIs) who underwent surgical treatment to determine long-term outcomes. The median follow-up of the series was 7.6 years. Cox's proportional hazards model for survival time was performed and hazard ratios (HRs) were estimated. Survival times were plotted using the Kaplan-Meier method. Fifteen patients (10%) required readmission after discharge from the hospital for a recurrence of the infection. Ninety patients (60%) had re-ulcerations. Forty-nine (54.4% of those re-ulcerated) required new admission and 24 of them (26.6% of those re-ulcerated) finally required a new amputation. Overall cumulative survival rates at 1, 5, and 8 years were 95%, 78%, and 64%, respectively. Predictive variables of long-term mortality were insulin treatment (HR: 2.0, 95% CI: 1.1-3.6, P = .01), female sex (HR: 3.1, 95% CI: 1.7-5.3, P<.01) and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (HR: 2.2, 95% CI: 1.1-4.2, P = .01). In conclusion, patients undergoing surgical treatment for DFIs had a high rate of recurrences and mortality. Women, patients who underwent treatment with insulin, and those with eGFR <60 ml/min/1.73 m2 had a higher risk of long-term mortality.
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Wang PC, Chen TH, Chung CM, Chen MY, Chang JJ, Lin YS, Chu PH, Peng YS, Lin MS. The effect of deep vein thrombosis on major adverse limb events in diabetic patients: a nationwide retrospective cohort study. Sci Rep 2021; 11:8082. [PMID: 33850207 PMCID: PMC8044219 DOI: 10.1038/s41598-021-87461-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Little is known about the association between deep vein thrombosis (DVT) and arterial complications in patients with type 2 diabetes (T2DM). The aim of this retrospective cohort study was to assess the influence of prior DVT on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in T2DM. A total of 1,628,675 patients with T2DM with or without a history of DVT from 2001 to 2013 were identified in the National Health Insurance Research Database of Taiwan. Before matching, the patients in the DVT group (n = 2020) were older than the control group (66.3 vs. 58.3 years). Patients in the DVT group were more likely to be female than the control group (54.3% vs. 47.5%). Before matching, the DVT group had higher prevalence of most comorbidities, more prescription of antiplatelet, antihypertensive agents and insulins, but less prescription of metformin and sulfonylurea. During a mean follow-up of 5.2 years (standard deviation: 3.9 years), the matched DVT group (n = 2017) have a significantly increased risk of MALE (8.4% vs. 5.2%; subdistribution hazard ratio [SHR] 1.60, 95% CI 1.34-1.90), foot ulcer (5.2% vs. 2.6%, SHR 1.96, 95% CI 1.57-2.45), gangrene (3.4% vs. 2.3%, SHR 1.44, 95% CI 1.10-1.90) and amputation (2.5% vs. 1.7%; SHR 1.42, 95% CI 1.03-1.95) than the 10,085 matched controls without DVT. They also tended to have a greater risk of all-cause mortality (38.1% vs. 33.1%; hazard ratio [HR] 1.18, 95% CI 1.09-1.27) and systemic thromboembolism (4.2% vs. 2.6%; SHR 1.56, 95% CI 1.22-1.99), respectively. We showed the presence of DVT may be associated with an increased risk of MALEs, major amputation, and thromboembolism, contributing to a higher mortality rate in T2DM.
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Affiliation(s)
- Po-Chang Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chang-Min Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Shing Peng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Kaneko M, Fujihara K, Harada MY, Osawa T, Yamamoto M, Kitazawa M, Matsubayashi Y, Yamada T, Seida H, Kodama S, Sone H. Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database. J Foot Ankle Res 2021; 14:29. [PMID: 33836779 PMCID: PMC8034178 DOI: 10.1186/s13047-021-00474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/03/2021] [Indexed: 01/30/2023] Open
Abstract
Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00474-8.
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Affiliation(s)
- Masanori Kaneko
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
| | - Mayuko Yamada Harada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masahiko Yamamoto
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | | | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
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Vander Horst MA, Raeman CH, Dalecki D, Hocking DC. Time- and Dose-Dependent Effects of Pulsed Ultrasound on Dermal Repair in Diabetic Mice. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1054-1066. [PMID: 33454160 PMCID: PMC7897308 DOI: 10.1016/j.ultrasmedbio.2020.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 05/15/2023]
Abstract
Chronic wounds, including diabetic, leg and pressure ulcers, impose a significant health care burden worldwide. Some evidence indicates that ultrasound can enhance soft tissue repair. However, therapeutic responses vary among individuals, thereby limiting clinical translation. Here, effects of pulsed ultrasound on dermal wound healing were assessed using a murine model of chronic, diabetic wounds. An ultrasound exposure system was developed to provide daily ultrasound exposures to full-thickness, excisional wounds in genetically diabetic mice. Wounds were exposed to 1 MHz ultrasound (2 ms pulse, 100 Hz pulse repetition frequency, 0-0.4 MPa) for 2 or 3 wk. Granulation tissue thickness and wound re-epithelialization increased as a function of increasing ultrasound pressure amplitude. At 2 wk after injury, significant increases in granulation tissue thickness and epithelial ingrowth were observed in response to 1 MHz pulsed ultrasound at 0.4 MPa. Wounds exposed to 0.4 MPa ultrasound for 3 wk were characterized by collagen-dense, revascularized granulation tissue with a fully restored, mature epithelium. Of note, only half of wounds exposed to 0.4 MPa ultrasound showed significant granulation tissue deposition after 2 wk of treatment. Thus, the db+/db+ mouse model may help to identify biological variables that influence individual responses to pulsed ultrasound and accelerate clinical translation.
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Affiliation(s)
| | - Carol H Raeman
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Diane Dalecki
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Denise C Hocking
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA; Department of Pharmacology and Physiology, University of Rochester, Rochester, New York, USA.
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Berlanga-Acosta J, Fernández-Mayola M, Mendoza-Marí Y, García-Ojalvo A, Playford RJ, Guillen-Nieto G. Intralesional Infiltrations of Cell-Free Filtrates Derived from Human Diabetic Tissues Delay the Healing Process and Recreate Diabetes Histopathological Changes in Healthy Rats. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:617741. [PMID: 36994347 PMCID: PMC10012095 DOI: 10.3389/fcdhc.2021.617741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/03/2021] [Indexed: 12/22/2022]
Abstract
Lower limb ulcers in type-2 diabetic patients are a frequent complication that tributes to amputation and reduces survival. We hypothesized that diabetic healing impairment and other histopathologic hallmarks are mediated by a T2DM-induced tissue priming/metabolic memory that can be transferred from humans to healthy recipient animals and consequently reproduce diabetic donor’s phenotypes. We examined the effect of human T2DM tissue homogenates injected into non-diabetic rat excisional wounds. Fresh granulation tissue, popliteal artery, and peroneal nerve of patients with T2DM were obtained following amputation. Post-mammoplasty granulation and post-traumatic amputation-tissue of normal subjects acted as controls. The homogenates were intralesionally injected for 6–7 days into rats’ excisional thickness wounds. Infiltration with the different homogenates caused impaired wound closure, inflammation, nerve degeneration, and arterial thickening (all P < 0.01 vs relevant control) resembling histopathology of diabetic donor tissues. Control materials caused marginal inflammation only. Infiltration with glycated bovine albumin provoked inflammation and wound healing delay but did not induce arterial thickening. The reproduction of human diabetic traits in healthy recipient animals through a tissue homogenate support the notion on the existence of tissue metabolic memory-associated and transmissible factors, involved in the pathogenesis of diabetic complications. These may have futuristic clinical implications for medical interventions.
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Affiliation(s)
- Jorge Berlanga-Acosta
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Cuba
- *Correspondence: Jorge Berlanga-Acosta,
| | - Maday Fernández-Mayola
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Cuba
| | - Yssel Mendoza-Marí
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Cuba
| | - Ariana García-Ojalvo
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Cuba
| | - Raymond J. Playford
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Gerardo Guillen-Nieto
- Tissue Repair, Wound Healing and Cytoprotection Research Group, Biomedical Research Direction, Center for Genetic Engineering and Biotechnology, Playa, Cuba
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Perng CK, Chou HY, Chiu YJ. Identifying major predictors of lower-extremity amputation in patients with diabetic foot ulcers. J Chin Med Assoc 2021; 84:285-289. [PMID: 33323684 DOI: 10.1097/jcma.0000000000000473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the risk factors for amputation in patients with diabetic foot ulcer (DFU). METHODS Between 2012 and 2017, 646 patients with DFU were admitted to our diabetic foot care center. A retrospective chart review was performed, and the end point was limb salvage and minor or major amputation. Chi-square test, dependent t test, and a multivariate logistic regression analysis were performed to identify risk factors in patients with DFUs. RESULTS A total of 399 male and 247 female patients (mean age 64.6 years) were included in this study, of whom 159 (24.6%) underwent lower limb amputation (minor, 17.5; major, 7.1%). Independent risk factors of amputation were peripheral arterial disease (PAD) (odds ratio [OR], 3.196; p < 0.001), C-reactive protein (CRP) level (OR, 1.046; p = 0.001), and hospital stay (OR, 1.019; p = 0.001). Subgroup analysis based on all patients with PAD who underwent amputation showed that endovascular intervention (OR, 0.271; p = 0.049) was a protective factor for major amputation in addition to CRP level (OR, 1.116; p = 0.008). CONCLUSION DFU remains a major medical and public health issue. PAD, CRP level, and hospital stay are independent risk factors for amputation. Endovascular intervention is an independent protective factor against major amputation among patients with PAD who underwent amputation.
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Affiliation(s)
- Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsuan-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Ceja Rodriguez M, Mark JR, Gosdin M, Humphries MD. Perceptions of patients with wounds due to chronic limb-threatening ischemia. Vasc Med 2021; 26:200-206. [PMID: 33606967 DOI: 10.1177/1358863x20987896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with chronic limb-threatening ischemia (CLTI) face numerous barriers to caring for lower extremity wounds. We explored the perceptions of CLTI patients to their wound/management and sought to determine attitudes towards their vascular provider as well as willingness for management through telemedicine. Patients admitted to hospital for treatment of Rutherford Grade 5 and 6 CLTI were asked complete a wound evaluation survey and took part in a semi-structured interview. Semi-structured interviews were recorded, transcribed, and analyzed using an inductive coding strategy. Codes were grouped for thematic analysis and aggregated into assertions. Eleven patients with a mean age of 60 years (35-79 years) were interviewed. All patients had peripheral artery disease (PAD) and eight patients had diabetes as well. Three overarching themes were identified. First, patients appear to have limited coping mechanisms and are overwhelmed by the care of their wounds. Second, in this cohort of patients, many had become passive observers of their care as demonstrated by a limited understanding of their disease processes and detachment from wound management. The third theme was how strong the desire to do everything to prevent limb loss was, but patients acknowledged this is hard to translate into real life with limited resources. Patients with CLTI have concerns that vascular providers must recognize and address to build strong patient-provider relationships and increase activation for management of their wounds and other medical conditions. Patients who have access to technology and with guidance may be able to understand getting care through remote medicine.
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Affiliation(s)
- Maria Ceja Rodriguez
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - John R Mark
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Melissa Gosdin
- Center for Health Policy, University of California Davis Health, Sacramento, CA, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
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Prevalence and Medical Resource of Patients with Diabetic Foot Ulcer: A Nationwide Population-Based Retrospective Cohort Study for 2001-2015 in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041891. [PMID: 33669255 PMCID: PMC7920020 DOI: 10.3390/ijerph18041891] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 01/13/2023]
Abstract
Diabetic foot ulcer (DFU) is one of the common complications of diabetes. DFU can cause a huge medical and financial burden due to infections, compromise the quality of life, and increase the mortality rate in patients. However, the consumption of medical resources for DFU is rarely mentioned. A retrospective cohort study was performed. Data were obtained from the National Health Insurance Research Database of Taiwan, and the prevalence and medical utilization data for DFU in 2001–2015 were extracted, followed by the analysis for high-risk populations. Between 2001 and 2015, there were 7511 new DFU patients. A higher proportion in these patients was male, elderly with a low education level, and low income. Between 2001 and 2015, the prevalence of DFU was 0.5–0.8%, and the number of DFU patients showed stable growth. Every year, 12.6–19.3% and 1.2–7.0% of patients underwent debridement and amputation, respectively. The hospitalization fees increased year on year. Our study showed that the DFU prevalence increased year on year, and the DFU medical expenditure increased. DFU tends to occur in males, patients with low socioeconomic status, low education level, those with multiple comorbidities, and old age. Therefore, DFU care and prevention require the entire healthcare system to jointly formulate a prevention plan.
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Peng B, Min R, Liao Y, Yu A. Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer. J Diabetes Res 2021; 2021:6621035. [PMID: 33511218 PMCID: PMC7822701 DOI: 10.1155/2021/6621035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). METHODS AND MATERIALS In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. RESULTS 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. CONCLUSION Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.
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Affiliation(s)
- Bocheng Peng
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Rui Min
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, China
| | - Aixi Yu
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Lin CW, Yang HM, Hung SY, Chen IW, Huang YY. The analysis for time of referral to a medical center among patients with diabetic foot infection. BMC FAMILY PRACTICE 2021; 22:16. [PMID: 33422005 PMCID: PMC7797140 DOI: 10.1186/s12875-020-01363-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/27/2020] [Indexed: 12/30/2022]
Abstract
Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Guishan Dist, 333, Taoyuan City, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Guishan Dist, 333, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Guishan Dist, 333, Taoyuan City, Taiwan
| | - I-Wen Chen
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Guishan Dist, 333, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Guishan Dist, 333, Taoyuan City, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan City, Taiwan. .,Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Domingos SA, França CN, Tuleta I, Rezende Barbosa MPDC, Bachi ALL, Neves LM. Self-Care in Type 2 Diabetes Patients with Urgency Lower Limb Amputation: The Influence of Sex, Marital Status and Previous Amputations. Patient Prefer Adherence 2021; 15:1083-1090. [PMID: 34079228 PMCID: PMC8163731 DOI: 10.2147/ppa.s298537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Lower limb amputation (LLA) is a severe consequence of type 2 diabetes mellitus (T2DM), and can affect up to 1% of T2DM patients, leading to an increased risk of premature mortality. Among the factors to predict LLA, it has been highlighted sex, marital status, and previous amputation. However, there is a lack of information about the association between these predictive factors, self-care, and urgency LLA in T2DM patients. PURPOSE To verify the behavior of self-care and to relate it with the predictive factors (sex, marital status, and previous amputation) in urgency LLA T2DM patients. PATIENTS AND METHODS Non-interventional study, with 106 T2DM patients who were in the postoperative period of urgency LLA caused by complications resulting from T2DM. A structured questionnaire was used for sociodemographic and clinical characterization of the sample as well as the Summary of Diabetes Self-Care Activities (SDSCA) tool. It was used the Wilcoxon, Friedman, and Mann-Whitney tests (median, nonparametric populations) to assess the significance of the differences between groups (sex, marital status, and previous amputation), also Spearman correlation coefficient to assess the association between the data (comparison between diagnostic time, sex, previous amputation, ethnicity and systolic arterial hypertension) and a logistic regression analysis considering the item SDSCA related to sex, age and marital status (with partner). RESULTS Significant differences (p<0.05) in the questions "Specific Food" and "Foot care" were found when the participants were grouped by sex. In the relation to marital status, significant differences (p<0.05) were observed for the question "Specific Food". No differences were found between groups with or without previous amputation. CONCLUSION By SDSCA tool, we were able to report that T2DM patients submitted to urgency LLA presented differences in self-care, particularly for sex and marital status.
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Affiliation(s)
| | | | - Izabela Tuleta
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | | | | | - Lucas Melo Neves
- Program in Health Sciences, Santo Amaro University, São Paulo, Brazil
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Correspondence: Lucas Melo Neves Program in Health Sciences, Santo Amaro University, Rua Prof. Enéas de Siqueira Neto, 340. Building F1 - Health Sciences Room - Jardim Das Imbuias, São Paulo, SP, 04829-300, BrazilTel +55 11 2141-8584 Email
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Seghieri G, De Bellis A, Seghieri M, Gualdani E, Policardo L, Franconi F, Francesconi P. Gender Difference in the Risk of Adverse Outcomes After Diabetic Foot Disease: A Mini-Review. Curr Diabetes Rev 2021; 17:207-213. [PMID: 32674734 DOI: 10.2174/1573399816666200716195600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022]
Abstract
Diabetic foot disease (DFD) is a complication of diabetes mellitus, characterized by multiple pathogenetic factors, bearing a very high burden of disability as well as of direct and indirect costs for individuals or healthcare systems. A further characteristic of DFD is that it is associated with a marked risk of subsequent hospitalizations for incident cardiovascular events, chronic renal failure or of allcause mortality. Additionally, DFD is strongly linked to the male sex, being much more prevalent among men. However, even if DFD mainly affects males, several past reports suggest that females are disadvantaged as regards the risk of subsequent adverse outcomes. This review aims to clarify this point, attempting to provide an explanation for this apparent oddity: being DFD a typically male complication of diabetes but, seemingly, with a greater load of subsequent consequences for females.
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Affiliation(s)
| | - Alessandra De Bellis
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Marta Seghieri
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio" Hospital, Florence, Italy
| | | | | | - Flavia Franconi
- National Laboratory of Gender Medicine and Gender Pharmacology of National Institute of Biostructures and Biosystems, University of Sassari, Italy
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Gandhi SK, Waschbusch M, Michael M, Zhang M, Li X, Juhaeri J, Wu C. Age- and sex-specific incidence of non-traumatic lower limb amputation in patients with type 2 diabetes mellitus in a U.S. claims database. Diabetes Res Clin Pract 2020; 169:108452. [PMID: 32949656 DOI: 10.1016/j.diabres.2020.108452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023]
Abstract
AIM To estimate age- and sex-specific incidence rates (IRs) of non-traumatic lower limb amputations (LLA) in patients with type 2 diabetes mellitus (T2DM) using a claims database from the United States (US). METHODS Patients with T2DM 18 years and older were identified using the Truven Health MarketScan database from January 1, 2007 to September 30, 2018. The overall and age- and sex-specific IRs of all non-traumatic LLA, minor LLA (amputation at or below the ankle), and major LLA (amputation above ankle) were calculated. RESULTS Among the 6,117,981 patients with T2DM, 14,627 LLA events occurred (minor LLA; 72.8%; major LLA: 27.2%). The IRs (95% CI) of all LLA, minor LLA, and major LLA per 1000 person-years or PY were 0.86 (0.85, 0.88), 0.63 (0.62, 0.64), and 0.23 (0.23, 0.24), respectively. The IR (95% CI) of all LLA per 1000 PY in males was higher compared to females [1.24 (1.22, 1.26) vs. 0.46 (0.45, 0.48)]. The incidence of all LLA increased with an increasing age (highest IR in age-group of ≥80 years). CONCLUSIONS This study identified males and older patients with T2DM at higher risk of developing LLA in the US, warranting further exploration of risk factors of LLA in these subgroups.
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Affiliation(s)
- Sampada K Gandhi
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA.
| | - Max Waschbusch
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Madlen Michael
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Meng Zhang
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Xinyu Li
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Juhaeri Juhaeri
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Chuntao Wu
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
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Xiong XF, Wei L, Xiao Y, Han YC, Yang J, Zhao H, Yang M, Sun L. Family history of diabetes is associated with diabetic foot complications in type 2 diabetes. Sci Rep 2020; 10:17056. [PMID: 33051498 PMCID: PMC7555504 DOI: 10.1038/s41598-020-74071-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022] Open
Abstract
To investigate the relationship between diabetic foot complications (DFCs) and clinical characteristics, especially the number and types of first-degree family members with diabetes. A total of 8909 type 2 diabetes patients were enrolled. The clinical characteristics of these patients, including DFCs and family history of diabetes (FHD), were collected from medical records. Multiple regression was used to investigate the association between FHD and DFCs after adjusting for confounding factors. The patients with one and more than one first-degree family member with diabetes accounted for 18.7% and 12.8%, respectively. The proportions of the participants with a father with diabetes, a mother with diabetes, both parents with diabetes, siblings with diabetes, father and siblings with diabetes, mother and siblings with diabetes, and both parents and siblings with diabetes were 3.5%, 6.2%, 1.1%, 14.4%, 1.5%, 4%, and 0.7%, respectively. The multiple regression analysis showed that the number of family members with diabetes was positively associated with DFCs. However, among the different types of FHD, only the patients with a mother with diabetes showed a statistical association with DFCs. In addition to FHD, other factors, including gender, body mass index, platelet count, hemoglobin levels, albumin levels, high-density cholesterol levels, diabetic peripheral neuropathy, and the use of lipid-lowering agents, oral hypoglycemic agents, and insulin, were also associated with DFCs. DFCs were associated with different numbers of family members with diabetes and types of FHD. This association reveals the importance of genetic and environmental factors in DFCs and highlights the importance of adding FHD to public health strategies targeting detecting and preventing the disease.
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Affiliation(s)
- Xiao-Fen Xiong
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Ling Wei
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Ying Xiao
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Ya-Chun Han
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Jinfei Yang
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Hao Zhao
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Ming Yang
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Lin Sun
- Department of Nephrology, The Second Xiangya Hospital at Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China.
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Dettori P, Mangoni AA, Zinellu A, Carru C, Paliogiannis P. Blood Cell Count Biomarkers, Risk, and Outcomes of Ischemia-Related Lower Limb Amputations: Systematic Review. INT J LOW EXTR WOUND 2020; 21:354-363. [PMID: 33045850 DOI: 10.1177/1534734620961785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Lower limb amputations due to ischemia represent an important health care and social issue. However, there are currently no specific biomarkers able to predict the risk of amputation and postamputation complications and prognosis. We conducted a systematic review of studies investigating whether blood cell count indexes of systemic inflammation are linked to the risk and the outcome of lower limb amputations due to ischemia. Overall, in 22 studies involving 8832 patients selected for review, several blood cell count indexes, particularly the neutrophil lymphocyte ratio, showed some promise in terms of predicting amputations and general outcomes of conservative and surgical treatments, as well as postamputation complications and prognosis. However, largely due to methodological limitations, further prospective studies are required to establish the clinical utility and applicability of blood cell indexes in the routine management of patients with ischemia-related lower limb amputations.
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Affiliation(s)
- Paola Dettori
- Center for Cure and Health, Platamona, Sassari, Italia
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