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Reaney M, Gladwin T, Churchill S. Information about foot care provided to people with diabetes with or without their partners: Impact on recommended foot care behavior. Appl Psychol Health Well Being 2021; 14:465-482. [PMID: 34761530 DOI: 10.1111/aphw.12314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many people with diabetes will develop foot ulcers. To reduce risk, it is recommended that the feet are protected against harm and checked daily. Spouses can help people with diabetes care for their feet. METHODS A randomized parallel arm design compared information sheets given to participants with diabetes and their spouses (dyad group; n = 64) to an information sheet given only to participants with diabetes (individual group; n = 69). The self-reported number of days that the participant with diabetes' feet were (1) checked for problems and (2) protected against problems occurring (by the person with diabetes and/or the spouse) were summed for the week after receiving the information sheet. ANCOVAs tested the effects of group. RESULTS Frequency of foot detection behavior (Participant + Spouse) was significantly higher in the dyad group compared with the individual group. This was not the case for foot protection behavior (Participant + Spouse). Findings revealed greater levels of spousal support (for both protection and detection behavior) in the dyad group compared to the individual group. CONCLUSIONS Clinical recommendations and advice on foot care delivered both to people with diabetes and their spouses can encourage greater foot care than if delivered to the patient alone.
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Affiliation(s)
- Matthew Reaney
- Institute of Education, Health, and Social Sciences, University of Chichester, Chichester, UK
| | - Thomas Gladwin
- Institute of Education, Health, and Social Sciences, University of Chichester, Chichester, UK.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Susan Churchill
- Institute of Education, Health, and Social Sciences, University of Chichester, Chichester, UK
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Elgzyri T, Apelqvist J, Lindholm E, Örneholm H, Annersten Gershater M. Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene. SAGE Open Med 2021; 9:20503121211029180. [PMID: 34262765 PMCID: PMC8246462 DOI: 10.1177/20503121211029180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3-234) weeks. Results Four hundred and seventy-six patients were included. The median age was 73 (35-95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3-234) weeks; for auto-amputated, 48 (10-228) weeks; for minor amputated, 48 (6-234) weeks; and for major amputation, 32 (3-116) weeks. Conclusion Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.
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Affiliation(s)
- Targ Elgzyri
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Eero Lindholm
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Hedvig Örneholm
- Department of Orthopaedic Surgery, Skåne University Hospital, Malmö, Sweden
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Reaney M, Gladwin T, Chmiel N, Churchill S. Encouraging foot care in people with and without diabetes through narrative communication. J Health Psychol 2021; 27:1993-2012. [PMID: 34000870 DOI: 10.1177/13591053211017206] [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] [Indexed: 11/16/2022] Open
Abstract
In order to minimize risk of infection and potential foot complications, it is recommended that people with and without diabetes check their feet regularly for problems such as cuts, sores, blisters or calluses. Hence, an understanding of how to craft effective messages to encourage people to check their feet is important. Two studies investigated the use of narrative stories to encourage foot problem detection behaviour; Study 1 in a general population sample (N = 193), and Study 2 in a sample of people with type 1 or type 2 diabetes (N = 129). In both studies participants were randomised to either (a) receive an information sheet written in first-person narrative; (b) the same in non-narrative format; or (c) no information sheet. Changes in weekly detection behaviour was the outcome of interest. In both studies, greater detection behaviour was observed in the narrative message condition vs. non-narrative condition and the non-narrative condition vs. no information condition. Our findings have implications for the design of health messages in delivering effective foot care education to people with and without diabetes, suggesting that narrative information sheets may be more effective than non-narrative information sheets.
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Affiliation(s)
| | - Thomas Gladwin
- University of Chichester, UK.,Radboud University, the Netherlands.,University of Greenwich, UK
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Factors Associated With Health-Related Quality of Life in People Living With Partial Foot or Transtibial Amputation. Arch Phys Med Rehabil 2020; 101:1711-1719. [DOI: 10.1016/j.apmr.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
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Gershater MA, Apelqvist J. Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency. Expert Rev Pharmacoecon Outcomes Res 2020; 21:277-284. [PMID: 32448021 DOI: 10.1080/14737167.2020.1773804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities. AIM To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer. METHOD Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%. RESULT Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing. CONCLUSION Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.
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Affiliation(s)
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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6
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Wang N, Yang BH, Wang G, Gao Y, Cao X, Zhang XF, Yan CC, Lian XT, Liu BH, Ju S. A meta-analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients. J Cell Biochem 2019; 120:9091-9096. [PMID: 30784095 DOI: 10.1002/jcb.28183] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients. METHODS Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. RESULTS A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies. Across the studies, the overall odds ratios (ORs) and 95% confidence intervals (CIs) of significant risk factors are ulcer reaching bone (OR, 11.796; 95% CI, 6.905-20.152), gangrene (OR, 6.487; 95% CI, 4.088-10.293), hindfoot position (OR, 3.913; 95% CI, 2.254-6.795), decreased ankle-brachial index (ABI) (OR, 2.522; 95% CI, 1.805-3.523), infection (OR, 2.516; 95% CI, 1.708-3.706), peripheral arterial disease (PAD) (OR, 2.114; 95% CI, 1.326-3.372). While there is no significant difference in the size of the ulcer, neuropathy, Charcot foot, osteomyelitis and intermittent claudication (OR, 1.15; 95% CI, 0.85-1.54). CONCLUSION Factors among local characteristics of the foot associated with major amputation in patients with diabetic foot are the ulcer reaching bone, gangrene, hindfoot position, decreased ABI, infection, and PAD, a negative risk factor for the risk of amputation. Further studies are required to provide more details of foot local characteristics.
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Affiliation(s)
- Ning Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Bo-Hua Yang
- Department of Peripheral Vascular, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
| | - Gang Wang
- Department of Peripheral Vascular, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
| | - Yu Gao
- Surgical Department, Beijing Nanyuan Hospital, Beijing, China
| | - Xin Cao
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Fu Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | | | | | - Bo-Hong Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Shang Ju
- Department of Peripheral Vascular, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
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Lenselink E, Holloway S, Eefting D. Outcomes after foot surgery in people with a diabetic foot ulcer and a 12-month follow-up. J Wound Care 2017; 26:218-227. [PMID: 28475445 DOI: 10.12968/jowc.2017.26.5.218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing. METHOD Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed. RESULTS A total of 129 cases in 121 patients were identified for inclusion. The results demonstrated that complete wound healing was reached in 52% (61/117) of the patients within 12 months. The need for additional surgery or for major amputation was 56% (n=72/129) and 30% (n=39/129) respectively. The need for an additional procedure was particularly high after surgical debridement (75%, 33/44) and transmetatarsal amputation (64%, 7/11). Risk factors for non-healing or for a major amputation were: infection (p=0.01), ischaemia (p=0.01), a history of peripheral arterial occlusive disease (p<0.01) and smoking (p=0.01). Additional findings were that not all patients underwent vascular assessment and in half of the patients there was a delay in undergoing revascularisation. CONCLUSION The results of the study reveal some areas for improvement including timely revascularisation and performance of multiple debridement procedures if needed in order to save a limb.
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Affiliation(s)
- E Lenselink
- Wound Expert Clinic, Haaglanden Medical Centre, The Hague, The Netherlands
| | - S Holloway
- Senior Lecturer, Centre for Medical Education, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff, Wales, UK
| | - D Eefting
- Vascular Surgeon; Wound Expert Clinic, Haaglanden Medical Centre, The Hague, The Netherlands
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Quigley M, Dillon MP. Quality of life in persons with partial foot or transtibial amputation: A systematic review. Prosthet Orthot Int 2016; 40:18-30. [PMID: 25185154 DOI: 10.1177/0309364614546526] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. BACKGROUND Common beliefs about quality of life in people with partial foot and transtibial amputation are often described as passing comments in the literature with seeming little research evidence. A clear understanding of the research evidence is important to inform decisions about amputation level from a quality of life perspective. OBJECTIVE To systematically gather and appraise research evidence comparing quality of life between persons with partial foot and transtibial amputation. METHODS A comprehensive suite of databases (e.g. Cochrane Library, MEDLINE and Web of Science) were searched using terms relating to amputation level and quality of life. Reference lists of articles that met the inclusion criteria were hand searched. Included studies reported quantitative data for persons with partial foot and transtibial amputation secondary to peripheral vascular disease and diabetes. Studies were appraised using the McMaster University Critical Review form. RESULTS There is insufficient evidence comparing quality of life in people with partial foot and transtibial amputation. The available evidence suggests that quality of life may be very similar in people with partial foot and transtibial amputation and the small differences are not likely to be clinically meaningful. CONCLUSION Without adequate evidence comparing quality of life in people with partial foot and transtibial amputation, it is difficult to inform decisions about amputation level from a quality of life perspective. CLINICAL RELEVANCE There is insufficient evidence about differences in QoL between persons with PFA or TTA. Contrary to common belief, the available evidence suggests that QoL may be similar in persons with PFA and TTA. Further research is needed to inform decisions about amputation level from a QoL perspective.
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Affiliation(s)
- Matthew Quigley
- National Centre for Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Michael P Dillon
- National Centre for Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
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Annersten Gershater M, Pilhammar E, Apelqvist J, Alm-Roijer C. Patient education for the prevention of diabetic foot ulcers. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.189] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Highlander P, Shinabarger AB. Perioperative laboratory assessment of diabetic foot infections undergoing amputation: a systematic review. Foot Ankle Spec 2013; 6:465-70. [PMID: 23925790 DOI: 10.1177/1938640013496845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes is the leading cause of nontraumatic amputations. Although laboratory assessment may not alone determine the optimal level of amputation thorough assessment of a variety of laboratory values is critical to overall care of the patient and may place the patient into risk category. This systematic review analyzes publications related to diabetic lower extremity amputations and associated laboratory values, including lymphocyte count, albumin, hemoglobin, and glycemic control.
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Affiliation(s)
- Peter Highlander
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (PH)
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Gershater MA, Löndahl M, Nyberg P, Larsson J, Thörne J, Eneroth M, Apelqvist J. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia 2009; 52:398-407. [PMID: 19037626 DOI: 10.1007/s00125-008-1226-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/28/2008] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS We sought to identify factors related to short-term outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. METHODS Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n = 2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31. The characteristics of the remaining 2,480 patients were: 1,465 men, age 68 +/- 15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. RESULTS The healing rate without major amputation in surviving patients was 90.6% (n = 1,867). Sixty-five per cent (n = 1,617) were healed primarily, 9% (n = 250) after minor amputation and 8% after major amputation; 17% (n = 420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to co-morbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. CONCLUSIONS/INTERPRETATION Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.
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Affiliation(s)
- M A Gershater
- Faculty of Health and Society, Malmö University, 20506, Malmö, Sweden.
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Bengtsson L, Jonsson M, Apelqvist J. Wound-related pain is underestimated in patients with diabetic foot ulcers. J Wound Care 2008; 17:433-5. [DOI: 10.12968/jowc.2008.17.10.31306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L. Bengtsson
- Diabetes Foot Centre, Department of Endocrinology, University Hospital of Malmö, Sweden
| | - M. Jonsson
- Diabetes Foot Centre, Department of Endocrinology, University Hospital of Malmö, Sweden
| | - J. Apelqvist
- Diabetes Foot Centre, Department of Endocrinology, University Hospital of Malmö, Sweden
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Nabuurs-Franssen MH, Sleegers R, Huijberts MSP, Wijnen W, Sanders AP, Walenkamp G, Schaper NC. Total contact casting of the diabetic foot in daily practice: a prospective follow-up study. Diabetes Care 2005; 28:243-7. [PMID: 15677773 DOI: 10.2337/diacare.28.2.243] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection. RESEARCH DESIGN AND METHODS Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications. RESULTS Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P < 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P < 0.05). Median duration of cast treatment was 34 days. New ulcers, all superficial, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days. CONCLUSIONS In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
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Affiliation(s)
- Marrigje H Nabuurs-Franssen
- University Hospital Maastricht, Department of Internal Medicine and Endocrinology, P.O. Box 5800, Maastricht 6200 AZ, Netherlands.
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Tseng CH. Prevalence and risk factors of diabetic foot problems in Taiwan: a cross-sectional survey of non-type 1 diabetic patients from a nationally representative sample. Diabetes Care 2003; 26:3351. [PMID: 14633829 DOI: 10.2337/diacare.26.12.3351] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Girod I, Valensi P, Laforêt C, Moreau-Defarges T, Guillon P, Baron F. An economic evaluation of the cost of diabetic foot ulcers: results of a retrospective study on 239 patients. DIABETES & METABOLISM 2003; 29:269-77. [PMID: 12909815 DOI: 10.1016/s1262-3636(07)70036-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the cost of foot ulcers in diabetic patients. METHODS Retrospective pharmacoeconomic study using direct and indirect costs (sick leave days) from the perspective of French social security system. RESULTS 239 patients were included in the study by 80 physicians who treat diabetic patients suffering from foot ulcers. Initially identified by telephone survey, these physicians were primarily endocrinologists/diabetologists, general practitioners and surgeons. Average monthly costs in the treatment of foot ulcers were 697 euro; for outpatient care, 1556.20 euro; for hospital care (day treatment and short stays), and 34.76 euro; for sick leaves. When hospitalization was required, it represented approximately 70% of the average cost for foot ulcers. The portion of outpatient costs was principally generated by medical and paramedical treatments, and interventions carried out by healthcare personnel. On the other hand, medication only represented 10% of total costs. The initial severity of the pathology was a determinant clinical factor of high healthcare costs. In addition, the more recent the lesion was, the higher the cost of treatment. Amputation and follow-up by specialists were correlated to high costs as well, a logical result of these clinical factors. CONCLUSION This analysis is the first to evaluate the cost of treating foot ulcers in such a large population of diabetic patients. The economic outcomes should help direct public authorities in their choices, particularly as regards the interest of treating these diabetes-related complications as early as possible.
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Otiniano ME, Du X, Ottenbacher K, Black SA, Markides KS. Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates. J Diabetes Complications 2003; 17:59-65. [PMID: 12614970 DOI: 10.1016/s1056-8727(02)00175-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.
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Affiliation(s)
- Max E Otiniano
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Jorge BH, Borges MDF, Brito VND, Santos TGD, Thirone ACP. Análise clínica e evolução de 70 casos de lesões podais infectadas em pacientes diabéticos. ACTA ACUST UNITED AC 1999. [DOI: 10.1590/s0004-27301999000500009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O presente trabalho tem como objetivo analisar 70 pacientes diabéticos portadores de lesões podais infectadas, internados para tratamento no Hospital Escola da Faculdade Federal de Medicina do Triângulo Mineiro no período compreendido entre 1989 e 1998. As lesões foram analisadas considerando-se o tipo de diabetes mellitus (DM) apresentado pelo paciente, tempo decorrido entre o diagnóstico de DM e a internação, agentes etiológicos mais freqüentemente encontrados nas culturas das secreções, tipo de tratamento requerido e evolução clínica dos pacientes. A maioria dos pacientes estudados (87%) era portadora de DM tipo 2. Não se observou diferença estatística quanto ao sexo, com predomínio nas 6ª e 7ª décadas de vida. As lesões foram mais freqüentes nos pacientes com mais de 5 anos de diagnóstico de DM. As bactérias mais comumente encontradas nas culturas das secreções foram Proteus mirabilis e Staphylococcus sp. Os pacientes receberam terapia antibiótica específica, curativos diários e desbridamentos, quando necessários. Sessenta e um por cento dos pacientes requererem amputação e 15,7% foram a óbito por septicemia. As internações foram prolongadas, com duração média de 38 dias. As lesões podais em pacientes diabéticos são um grande problema de saúde pública. O tratamento é prolongado, podendo trazer mudanças drásticas na qualidade de vida dos pacientes. A prevenção ainda é a melhor maneira de combatermos este problema.
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Nilsson L, Apelqvist J, Edvinsson L. Effects of alpha-trinositol on peripheral circulation in diabetic patients with critical limb ischaemia. A pilot study using laser Doppler fluxmetry, transcutaneous oxygen tension measurements and dynamic capillaroscopy. Eur J Vasc Endovasc Surg 1998; 15:331-6. [PMID: 9610346 DOI: 10.1016/s1078-5884(98)80037-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate whether alpha-trinositol may have an effect on the microcirculation in patients with diabetes mellitus and critical ischaemia. MATERIAL AND METHODS Ten patients with previously known diabetes mellitus and with critical limb ischaemia were given alpha-trinositol during a 24 h infusion, resulting in a total dose of 2400 mg. Microcirculation was evaluated by means of laser doppler fluxmetry (LDF), transcutaneous oxygen tension (tcPO2) and dynamic capillaroscopy (CBV). RESULTS Plasma concentration of alpha-trinositol reached a steady state level after 1 h following the start of the administration. There were no detectable changes in blood pressure or heart rate. Laser Doppler flux increased from 41% to 57.5% and tcPO2 changed from 116 to 91 s in "half time recovery" after occlusion. Capillary blood flow showed an increase in resting velocity from 0.1 to 0.5 mm/s at 24 h. CONCLUSIONS The infusion of alpha-trinositol did not cause any changes in the haemodynamics in general, but resulted in changes in LDF(rest value), tcO2(half-time recovery) and CBV(rest flow) during or following the infusion suggesting improved microcirculation.
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Affiliation(s)
- L Nilsson
- Department of Surgery, University Hospital, Lund, Sweden
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