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Su G, Yuan X, Yuan G, Sun Y, Zhang D, Liu W, Zhang J, Guo X. Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing. Front Endocrinol (Lausanne) 2024; 15:1441997. [PMID: 39175572 PMCID: PMC11339879 DOI: 10.3389/fendo.2024.1441997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024] Open
Abstract
Background Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Methods Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. Results and conclusions After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.
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Affiliation(s)
- Guanming Su
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- Department of Endocrinology, The Second Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xiaoyong Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Geheng Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Yalan Sun
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Donghui Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Wei Liu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Negussie YM, Komicha MA, Abebe TW. Incidence and predictors of diabetic foot ulcer among patients with diabetes mellitus in a diabetic follow-up clinic in Central Ethiopia: a retrospective follow-up study. BMJ Open 2024; 14:e085281. [PMID: 38908850 PMCID: PMC11328629 DOI: 10.1136/bmjopen-2024-085281] [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] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Diabetic foot ulcer is a major medical, social, and economic problem, and a leading cause of hospitalisations, increased morbidity, and mortality. Despite a rising occurrence, there is a dearth of data on the incidence and its predictors. OBJECTIVE To assess the incidence and predictors of diabetic foot ulcers among patients with diabetes mellitus in a diabetic follow-up clinic in Central Ethiopia. DESIGN Retrospective follow-up study design. PARTICIPANTS A total of 418 newly diagnosed diabetes mellitus patients from 1 January 2012 to 31 December 2022. A computer-generated simple random sampling method was used to select the study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi Info V.7.2 and exported to STATA V.14 for analysis. To estimate survival time, the Kaplan-Meier method was used, and the survival difference was tested using a log-rank test. OUTCOME MEASURES The Cox proportional hazard model was fitted to identify the predictors of diabetic foot ulcer development. The strength of the association was estimated using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI), and statistical significance was proclaimed at a p<0.05. RESULT The overall incidence of diabetic foot ulcer was 1.51 cases (95% CI 1.03 to 2.22) per 100 person-years of observation. The cumulative incidence was 6.2% (95% CI 4.1% to 8.6%) over 10 years. The median time of follow-up was 45 months (IQR 21-73). Diastolic blood pressure of 90 mm Hg or above (AHR 2.91, 95% CI 1.25 to 6.77), taking combined medication (AHR 3.24, 95% CI 1.14 to 9.19) and having a peripheral arterial disease (AHR 5.26, 95% CI 1.61 to 17.18) were statistically significant predictors of diabetic foot ulcer development. CONCLUSION The risk of occurrence of diabetic foot ulcer was relatively high. Diastolic blood pressure level, combined medication and peripheral arterial disease were independent predictors of diabetic foot ulcer development. Hence, close monitoring and proper interventions are essential.
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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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Shiraishi M, Lee H, Kanayama K, Moriwaki Y, Okazaki M. Appropriateness of Artificial Intelligence Chatbots in Diabetic Foot Ulcer Management. INT J LOW EXTR WOUND 2024:15347346241236811. [PMID: 38419470 DOI: 10.1177/15347346241236811] [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: 03/02/2024]
Abstract
Type 2 diabetes is a significant global health concern. It often causes diabetic foot ulcers (DFUs), which affect millions of people and increase amputation and mortality rates. Despite existing guidelines, the complexity of DFU treatment makes clinical decisions challenging. Large language models such as chat generative pretrained transformer (ChatGPT), which are adept at natural language processing, have emerged as valuable resources in the medical field. However, concerns about the accuracy and reliability of the information they provide remain. We aimed to assess the accuracy of various artificial intelligence (AI) chatbots, including ChatGPT, in providing information on DFUs based on established guidelines. Seven AI chatbots were asked clinical questions (CQs) based on the DFU guidelines. Their responses were analyzed for accuracy in terms of answers to CQs, grade of recommendation, level of evidence, and agreement with the reference, including verification of the authenticity of the references provided by the chatbots. The AI chatbots showed a mean accuracy of 91.2% in answers to CQs, with discrepancies noted in grade of recommendation and level of evidence. Claude-2 outperformed other chatbots in the number of verified references (99.6%), whereas ChatGPT had the lowest rate of reference authenticity (66.3%). This study highlights the potential of AI chatbots as tools for disseminating medical information and demonstrates their high degree of accuracy in answering CQs related to DFUs. However, the variability in the accuracy of these chatbots and problems like AI hallucinations necessitate cautious use and further optimization for medical applications. This study underscores the evolving role of AI in healthcare and the importance of refining these technologies for effective use in clinical decision-making and patient education.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Haesu Lee
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Kanayama
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuta Moriwaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Adebabay AA, Worede AG, Sume BW, Mihiret GT, Shimelash RA, Goshu BT. Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study. BMC Endocr Disord 2023; 23:265. [PMID: 38037014 PMCID: PMC10687907 DOI: 10.1186/s12902-023-01519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Diabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS Hospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity. RESULT The overall prevalence of foot deformity was 33.4% [95% CI: 28.9-38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity. CONCLUSION The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.
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Affiliation(s)
- Aderajew Agmass Adebabay
- Department of Biomedical science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Amanuel Girma Worede
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bickes Wube Sume
- Department of Biomedical science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Tilaye Mihiret
- Department of Midwifery, Medicine and College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Rahel Asres Shimelash
- Department of pediatric Nursing, Medicine and College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bahiru Tenaw Goshu
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Letta S, Goshu AT, Sertsu A, Nigussie K, Negash A, Yadeta TA, Bulti FA, Geda B, Dessie Y. Diabetes knowledge and foot care practices among type 2 diabetes patients attending the chronic ambulatory care unit of a public health hospital in eastern Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e070023. [PMID: 38016795 PMCID: PMC10685947 DOI: 10.1136/bmjopen-2022-070023] [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: 11/10/2022] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To assess diabetes knowledge and foot care practices among type 2 diabetes patients. DESIGN An institution-based cross-sectional study was undertaken from 1 January to 31 January 2021. SETTING Eastern Ethiopia. PARTICIPANTS Randomly selected type 2 diabetes patients who were available during the data collection period were included. OUTCOMES Patients' diabetes knowledge was assessed with the revised diabetes knowledge test questionnaire. Five items were used to evaluate foot self-care practices. RESULTS The study population comprised of 549 patients. About 52.5% of the patients had adequate diabetes knowledge (95% CI: 48.2% to 56.7%). Patients with an educational level of secondary school and above (adjusted OR (AOR): 2.04, 95% CI: 1.13 to 3.71), (AOR: 5.28, 95% CI: 2.28 to 12.22), and those with medium and above wealth status (AOR: 3.81, 95% CI: 2.24 to 6.47), (AOR: 3.46, 95% CI: 1.98 to 6.04), were found to have better odds of having adequate diabetes knowledge. However, those aged >55 years (AOR: 0.47, 95% CI: 0.22 to 0.99) were found to have lower odds of adequate diabetes knowledge.Of the total included patients, 20.2% (95% CI: 16.9% to 23.8%) had good foot care practices. Knowledge of the target fasting plasma glucose (AOR: 3.18, 95% CI: 1.94 to 5.22) and adequate diabetes knowledge (AOR: 3.40, 95% CI: 1.95 to 5.91) were significantly associated with good foot care practices. CONCLUSION According to this study, about half of individuals with type 2 diabetes have adequate levels of knowledge about the disease. In addition, only one out of every five patients has good foot care habits. Diabetes education should emphasise the significance of rigorous adherence to daily foot care practices.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, Asrat Weldeyes Health Science College, Debre Berhan University, Debre Berhan, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Fekadu Aga Bulti
- School of Nursing and Midwifery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Biftu Geda
- College of Health Sciences, Department of Nursing, Madda Walabu University, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
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Yin K, Qiao T, Zhang Y, Liu J, Wang Y, Qi F, Deng J, Zhao C, Xu Y, Cao Y. Unraveling shared risk factors for diabetic foot ulcer: a comprehensive Mendelian randomization analysis. BMJ Open Diabetes Res Care 2023; 11:e003523. [PMID: 37989345 PMCID: PMC10660165 DOI: 10.1136/bmjdrc-2023-003523] [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: 05/16/2023] [Accepted: 10/06/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) stands as a severe diabetic lower extremity complication, characterized by high amputation rates, mortality, and economic burden. We propose using Mendelian randomization studies to explore shared and distinct risk factors for diabetic lower extremity complications. RESEARCH DESIGN AND METHODS We selected uncorrelated genetic variants associated with 85 phenotypes in five categories at the genome-wide significance level as instrumental variables. Genetic associations with DFU, diabetic polyneuropathy (DPN), and diabetic peripheral artery disease (DPAD) were obtained from the FinnGen and UK Biobank studies. RESULTS Body mass index (BMI) emerged as the only significant risk factor for DPAD, DPN, and DFU, independent of type 2 diabetes, fasting glucose, fasting insulin, and HbA1c. Educational attainment stood out as the sole significant protective factor against DPAD, DPN, and DFU. Glycemic traits below the type 2 diabetes diagnosis threshold showed associations with DPAD and DPN. While smoking history exhibited suggestive associations with DFU, indicators of poor nutrition, particularly total protein, mean corpuscular hemoglobin, and mean corpuscular volume, may also signal potential DFU occurrence. CONCLUSIONS Enhanced glycemic control and foot care are essential for the diabetic population with high BMI, limited education, smoking history, and indicators of poor nutrition. By focusing on these specific risk factors, healthcare interventions can be better tailored to prevent and manage DFU effectively.
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Affiliation(s)
- Kangli Yin
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Diagnosis and Treatment Center of Peripheral Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Tianci Qiao
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongkang Zhang
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Diagnosis and Treatment Center of Peripheral Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Jiarui Liu
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Diagnosis and Treatment Center of Peripheral Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Yuzhen Wang
- Second Department of Vascular Anomalies Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Fei Qi
- Second Department of Vascular Anomalies Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Junlin Deng
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Diagnosis and Treatment Center of Peripheral Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Cheng Zhao
- Second Department of Vascular Anomalies Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Yongcheng Xu
- Second Department of Vascular Anomalies Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Yemin Cao
- Diagnosis and Treatment Center of Peripheral Vascular Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Dweib M, El Sharif N. Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine. J Clin Med 2023; 12:6719. [PMID: 37959185 PMCID: PMC10649955 DOI: 10.3390/jcm12216719] [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: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine. METHOD Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments. RESULTS Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot. CONCLUSIONS Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.
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Affiliation(s)
- Mohammad Dweib
- College of Pharmacy and Medical Sciences, Hebron University, P.O. Box 40, Hebron P720, Palestine;
- School of Public Health, Al-Quds University, Abu Dis, P.O. Box 51000, Jerusalem 20002, Palestine
| | - Nuha El Sharif
- School of Public Health, Al-Quds University, Abu Dis, P.O. Box 51000, Jerusalem 20002, Palestine
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Salad AM, Duale HA, Sheikh IM, Hassan GD, Farah AA, Gele A. Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia. Front Public Health 2023; 11:1195483. [PMID: 37564428 PMCID: PMC10411730 DOI: 10.3389/fpubh.2023.1195483] [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: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 08/12/2023] Open
Abstract
Background Diabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia. Methods An institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance. Result The mean age of the study's participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08-10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74-6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08-3.66). Conclusion Increased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs.
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Affiliation(s)
- Abdulwahab M. Salad
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
| | - Hodan A. Duale
- Somali Institute for Health Research (SIHR), Garoowe, Somalia
| | - Ismael M. Sheikh
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
| | - Gallad Dahir Hassan
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
| | | | - Abdi Gele
- Somali Institute for Health Research (SIHR), Garoowe, Somalia
- Norwegian Institute of Public Health, Garoowe, Somalia
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Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, Graham S. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; 402:235-249. [PMID: 37356447 PMCID: PMC11329296 DOI: 10.1016/s0140-6736(23)00909-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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11
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Shen JM, Chen J, Feng L, Feng C. A scientometrics analysis and visualisation of diabetic foot research from 1955 to 2022. Int Wound J 2023; 20:1072-1087. [PMID: 36164753 PMCID: PMC10031233 DOI: 10.1111/iwj.13964] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Diabetic foot (DF) has become a serious health problem in modern society, and it has been a hotspot of research for a long time. However, little scientometric analysis has been carried out on DF. In the present study, we analysed 8633 literature reports on DF in the Web of Science Core Collection from database inception until April 23, 2022. VOSviewer (Centre for Science and Technology Studies at Leiden University, Leiden, the Netherlands) and CiteSpace (College of Computing and Informatics, Drexel University, Philadelphia, United States) were employed to address high-impact countries and institutions, journals, references, research hotspots, and key research fields in DF research. Our analysis findings indicated that publications on DF have increased markedly since 2016 and were primarily published in the United States of America. The recent studies focus on the amniotic membrane, foot ulcers, osteomyelitis, and diabetic wound healing. The five keyword clusters, which included DF ulcer and wound healing therapies, management and guidelines, neuropathy and plantar pressure, amputation and ischemia, and DF infection and osteomyelitis, are helpful for enhancing prevention, standardising treatment, avoiding complications, and improving prognosis. These findings indicated a method for future therapies and research in DF.
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Affiliation(s)
- Jin-Ming Shen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jie Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Lei Feng
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Chun Feng
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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12
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Wei L, Xu Y, Zhang L, Yang L, Zhao RC, Zhao D. Mesenchymal Stem Cells Promote Wound Healing and Effects on Expression of Matrix Metalloproteinases-8 and 9 in the Wound Tissue of Diabetic Rats. Stem Cells Dev 2023; 32:25-31. [PMID: 36322784 DOI: 10.1089/scd.2021.0218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a multifactorial complication of diabetes, mainly manifested as infection, ulcer, or destruction of deep tissue, and there is currently no effective treatment. Several preclinical and clinical studies have proved that the transplantation of mesenchymal stem cells (MSCs) improved wound healing. In this study, we evaluated the therapeutic efficacy of human umbilical cord (hUC-MSCs) in DFU rat model. One dose of hUC-MSCs (1 × 106 cells) was subcutaneously injected around wounds in male Sprague-Dawley rats. Wound healing was evaluated macroscopically (wound closure) every 3 days. In addition, we measured growth factors and specific proteins [matrix metalloproteinases (MMPs)-9 and MMP-8] on Day 14 post hUC-MSC transplantation. Results showed significant differences in the wound healing kinetics of lesions that received hUC-MSCs compared to lesions that received vehicle (phosphate buffered saline; P < 0.05). Enzyme-linked immunosorbent assay analyses indicated that MMP-9 protein contents were significantly upregulated in DFU animals, while MMP-8 was downregulated compared to the diabetic rats (P < 0.05). After MSC treatment, the level of MMP-9 and MMP-8 decreased and increased compared to the vehicle group, respectively. These findings suggest that hUC-MSC transplantation can ameliorate the healing process of DFU rats and a potential mechanism through which MSCs enhance DFU wound healing by decreasing MMP-9 expression and increasing MMP-8 expression. This study represents a promising opportunity to gain insight into how MSCs mediate wound healing.
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Affiliation(s)
- Lingling Wei
- Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Yongsong Xu
- Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Lijie Zhang
- Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Longyan Yang
- Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Robert Chunhua Zhao
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Lu He Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
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13
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Tanasescu D, Sabau D, Moisin A, Gherman C, Fleaca R, Bacila C, Mohor C, Tanasescu C. Risk assessment of amputation in patients with diabetic foot. Exp Ther Med 2022; 25:12. [PMID: 36561621 PMCID: PMC9748709 DOI: 10.3892/etm.2022.11711] [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: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin ≥7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known.
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Affiliation(s)
- Denisa Tanasescu
- Department of Nursing and Dentistry, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania,Proctoven Clinic, 550112 Sibiu, Romania
| | - Dan Sabau
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Andrei Moisin
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Correspondence to: Dr Andrei Moisin, Department of Surgery, Sibiu County Emergency University Clinical Hospital, 2-4 Corneliu Coposu Bvd, 550245 Sibiu, Romania
| | - Claudia Gherman
- 2nd Department of Surgery, Cluj-Napoca County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania,Surgical Clinical Department, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, Faculty of General Medicine, 400012 Cluj-Napoca, Romania
| | - Radu Fleaca
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Ciprian Bacila
- Department of Nursing and Dentistry, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania,Clinical Hospital of Psychiatry, ‘Dr. Gheorghe Preda’, 550082 Sibiu, Romania
| | - Calin Mohor
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Preclinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- Proctoven Clinic, 550112 Sibiu, Romania,Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
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14
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Akhtar S, Ali A, Ahmad S, Khan MI, Shah S, Hassan F. The prevalence of foot ulcers in diabetic patients in Pakistan: A systematic review and meta-analysis. Front Public Health 2022; 10:1017201. [PMID: 36388315 PMCID: PMC9640936 DOI: 10.3389/fpubh.2022.1017201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
We aimed to determine the pooled prevalence of diabetic foot ulcers in Pakistan. MEDLINE (PubMed), Web of Science, Google scholars, and local databases were systematically searched for studies published up to August 10, 2022, on the prevalence of foot ulcers among diabetic patients in Pakistan. Random-effects meta-analysis was used to generate summary estimates. Subgroup analysis and meta-regression models were used to address the issue of high heterogeneity. Two authors independently identified eligible articles, collected data, and performed a risk of bias analysis. Twelve studies were included in the meta-analysis (14201, range 230-2199, diabetic patients), of which 7 were of "high" quality. The pooled prevalence of diabetic foot ulcers was 12.16% (95% CI: 5.91-20.23%). We found significant between-study heterogeneity (I2 = 99.3%; p < 0.001) but no statistical evidence of publication bias (p = 0.8544). Subgroup meta-analysis found significant differences in foot ulcer prevalence by publication year and by the duration of diabetes. An increasing trend was observed during the last two decades, with the prevalence of diabetic foot ulcers being the highest in the latest period from 2011 to 2022 (19.54%) than in the early 2000 s (4.55%). This study suggests that the prevalence of diabetic foot ulcers in Pakistan is relatively high, with significant variation between provinces. Further study is required to identify ways for early detection, prevention, and treatment in the population.
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Affiliation(s)
- Sohail Akhtar
- Department of Mathematics and Statistics, University of Haripur, Haripur, Pakistan,*Correspondence: Sohail Akhtar
| | - Aqsa Ali
- Department of Statistics, Government College University, Lahore, Pakistan
| | - Sadique Ahmad
- EIAS, Data Science and Blockchain Laboratory, College of Computer and Information Sciences, Prince Sultan University, Riyadh, Saudi Arabia
| | - Muhammad Imran Khan
- Department of Mathematics and Statistics, University of Haripur, Haripur, Pakistan
| | - Sajid Shah
- EIAS, Data Science and Blockchain Laboratory, College of Computer and Information Sciences, Prince Sultan University, Riyadh, Saudi Arabia
| | - Fazal Hassan
- Department of Mathematics and Statistics, University of Haripur, Haripur, Pakistan
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15
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Abuhay HW, Yenit MK, Wolde HF. Incidence and predictor of diabetic foot ulcer and its association with change in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia, 2021. PLoS One 2022; 17:e0274754. [PMID: 36227947 PMCID: PMC9560537 DOI: 10.1371/journal.pone.0274754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Diabetes mellitus is one of the global public health problems and fasting blood sugar is an important indicator of diabetes management. Uncontrolled diabetes can lead to diabetic foot ulcers, which is a common and disabling complication. The association between fasting blood glucose level and the incidence of diabetic foot ulcers is rarely considered, and knowing its predictors is good for clinical decision-making. Therefore, the aim of this study was to determine the incidence and predictors of diabetic foot ulcers and its association with changes in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia. Methods A multicenter retrospective follow-up study was conducted at a referral hospital in Northwest Ethiopia. A total of 539 newly diagnosed DM patients who had follow-up from 2010 to 2020 were selected using a computer-generated simple random sampling technique. Data was entered using Epi-Data 4.6 and analyzed in R software version 4.1. A Cox proportional hazard with a linear mixed effect model was jointly modeled and 95% Cl was used to select significant variables. AIC and BIC were used for model comparison. Result A total of 539 diabetes patients were followed for a total of 28727.53 person-month observations. Overall, 65 (12.1%) patients developed diabetic foot ulcers with incidence rate of 2.26/1000-person month observation with a 95% CI of [1.77, 2.88]. Being rural (AHR = 2.30, 95%CI: [1.23, 4.29]), being a DM patient with Diabetic Neuropathy (AHR = 2.61, 95%CI: [1.12, 6.06]), and having peripheral arterial disease(PAD) (AHR = 2.96, 95%CI: [1.37, 6.40]) were significant predictors of DFU. The time-dependent lagged value of fasting blood sugar change was significantly associated to the incident of DFU (α = 1.85, AHR = 6.35, 95%CI [2.40, 16.79]). Conclusion and recommendation In this study, the incidence of DFU was higher than in previous studies and was influenced by multiple factors like rural residence, having neuropathy, and PAD were significant predictors of the incidence of DFU. In addition, longitudinal changes in fasting blood sugar were associated with an increased risk of DFU. Health professionals and DM patients should give greater attention to the identified risk factors for DFU were recommended.
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Affiliation(s)
- Habtamu Wagnew Abuhay
- Epidemiology Program, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Negash W, Assefa T, Sahiledengle B, Tahir A, Regassa Z, Feleke Z, Regasa T, Tekalegn Y, Mamo A, Teferu Z, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Atlaw D, Wilfong T. Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia. J Int Med Res 2022; 50:3000605221129028. [PMID: 36224759 PMCID: PMC9561672 DOI: 10.1177/03000605221129028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia. METHODS We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice. RESULTS The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice. CONCLUSION The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.
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Affiliation(s)
- Wogene Negash
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Feleke
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tadele Regasa
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tara Wilfong
- School of Public Health, Haramaya University College of Health
and Medical Sciences, Harar, Ethiopia
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17
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Aga F, Dunbar SB, Kebede T, Guteta S, Higgins MK, Gary RA. Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure. Nurs Open 2022; 9:2473-2485. [PMID: 35678585 PMCID: PMC9374405 DOI: 10.1002/nop2.1265] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/15/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To compare the correlates of foot self-care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF). DESIGN Cross-sectional, correlational, comparative design. METHODS A 210 T2D adults (105 with HF and 105 without HF) participated from August-December 2020. Foot self-care behaviour was measured using the foot care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self-care behaviour. RESULTS The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF-comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid T2D adults. Marital status, social support and body mass index predicted foot self-care behaviour in the non-HF group.
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Affiliation(s)
- Fekadu Aga
- School of Nursing & Midwifery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Tedla Kebede
- Department of Internal Medicine, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Senbeta Guteta
- Department of Internal Medicine, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Rebecca A. Gary
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
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18
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Shaheen MMA, Al Dahab S, Abu Fada M, Idieis R. Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate. Int J Diabetes Dev Ctries 2022; 42:529-537. [PMID: 34522073 PMCID: PMC8431256 DOI: 10.1007/s13410-021-00997-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/23/2021] [Indexed: 10/25/2022] Open
Abstract
Background Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus with devastating outcomes. Poorly treated DFU leads to osteomyelitis, gangrene and limb amputation. There is an increased risk of mortality for the amputees and increased number of bacterial resistance in survived patients. Struggle on choice of the best antibiotic(s) for DFU is escalating. Objectives To determine risk factors associated with mortality in patients with DFU. To investigate bacterial drug resistance in survived or deceased patients around amputation. Methodology This is a retrospective cohort study that involved all diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020. Antibiotic use and bacterial isolates along with culture and sensitivity test results were retrieved from patients' profiles and laboratory records. Major outcome of study was survival rate around amputation. Patients who missed test results for FBS or HbAc1, or who had no wound culture were excluded. SPSS version 22 was used to analyze data. Results Eighty four subjects were included in this study, 64.8 ± 12.58 years old, 63.1% males who had diabetic foot ulcer, minor or major limb amputation between 2013 and 2020 at Hebron Governmental Hospital. Forty tow patients (50%) had diabetic foot ulcer, 28 patients (33.3%) had major limb amputation, and 14 patients (16.7%), succumbed to minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 ± 1.89%. Mortality rate was 9.5%. Using the Chi square test, we found a significant relationship between mortality and type of isolated bacteria, p = 0.033 and between diabetic complications (nephropathy) and mortality, p = 0.033. There was a significant relationship between antibiotic use and mortality, p = 0.04, especially with metronidazole and colistin, if they were used around limb amputation. Conclusions Mortality of diabetic patients with DFU was associated with nephropathy and Acinetobacter or E. coli infections.
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Affiliation(s)
- Muamar M. A. Shaheen
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Sewar Al Dahab
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Maryiam Abu Fada
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Rawand Idieis
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
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19
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Bekele F, Kelifa F, Sefera B. A male’s foot is being shot by an ulcer, not a gunshot! The magnitude and associated factors of diabetic foot ulcer among diabetes mellitus patients on chronic care follow-up of southwestern Ethiopian hospital: A cross-sectional study. Ann Med Surg (Lond) 2022; 79:104003. [PMID: 35860152 PMCID: PMC9289305 DOI: 10.1016/j.amsu.2022.104003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Diabetic foot ulcer (DFU) is one of the main complications of diabetes mellitus associated with major morbidity and mortality. DFU is the major cause of infection and lower extremity amputations in diabetic patients. Despite this, there was a scanty finding on associated factors of foot ulcer among diabetes mellitus. Methods Facility-based cross-sectional study was conducted among diabetes mellitus patients at BGH from August 1, 2021 - 30, 2021. The validated tool of the Nottingham Assessment of Functional Footcare (NAFF) was used to assess the diabetic foot self-care practice. Multivariate logistic regression was used to analyze the associations between the dependent variables and independent variables. Data were analyzed using a statistical package for social science (SPSS version 23). Results A total of 162 respondents with a response rate of 100% have participated in the study. Of the respondents, 88 (54.3%) were females and the mean and SD of the age were 35.8 and 12.70. The prevalence of diabetic foot ulcers in our study area was 24(14.81%). The results of the multivariable logistic regression analysis revealed that being a male (AOR = 2.143; 95% CI: 0.691–6.65), poor diabetic foot care practice (AOR = 3.761; 95CI: 1.188–11.90), and having a co-morbidity (AOR = 2.507; 95CI: 3.270–5.95)were more likely to experience a diabetic foot ulcer than their counterparts. Conclusion The prevalence of diabetic foot ulcers among diabetic patients in BGH was found to be high. The presence of comorbidity, being a male, and foot care practice were factors that predict the occurrences of diabetic foot ulcers. Therefore, the ongoing medical education on the foot care practices should be given to diabetes mellitus patients. Diabetic foot ulcer is one of the main complications in diabetes mellitus. Diabetic foot is defined as the presence of infection, ulceration and/or destruction of deep tissues. Diabetic foot ulcer is a major cause of infection and lower extremity amputations in diabetic patients.
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20
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Fan RR, Gibson AK, Smeds MR, Zakhary E. Impact of Socioeconomic Status on Major Amputation in Patients with Peripheral Vascular Disease and Diabetes Mellitus. Ann Vasc Surg 2022; 87:78-86. [DOI: 10.1016/j.avsg.2022.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
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21
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Rismayanti IDA, Nursalam N, Farida VN, Dewi NWS, Utami R, Aris A, Agustini NLPIB. Early detection to prevent foot ulceration among type 2 diabetes mellitus patient: A multi-intervention review. J Public Health Res 2022; 11. [PMID: 35315261 PMCID: PMC8973203 DOI: 10.4081/jphr.2022.2752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
Foot ulceration is one of the biggest complications experienced by type 2 diabetes patients. The severity and prevention of new wounds can be overcome through early detection interventions. This systematic review aims to explain and provide a comparison of various interventions that have been developed to prevent the occurrence of Diabetes Foot Ulcers (DFU). We searched Scopus, Science Direct, PubMed, CINAHL, SAGE, and ProQuest for English, experimental studies, published between 2016-2021 that tested early detection for preventing diabetic foot ulcers in diabetic patients. The Joanna Briggs Institute guidelines were used to assess eligibility, and PRISMA quality and a checklist to guide this review. 25 studies were obtained that matched the specified inclusion criteria. The entire article has an experimental study design. Majority of respondents were type 2 diabetes patients who have not experienced ulceration. Based on the results of the review, there were 3 main types of interventions used in the early detection of DFU. The types of intervention used are 1) conventional intervention/physical assessment, 2) 3D thermal camera assessment system, and 3) DFU screening instrument. The three types of interventions have advantages and disadvantages, so their use needs to be adjusted to the conditions and needs of the patient. the development of DFU risk early detection intervention needs to be developed. Integration with modern technology can also be done to increase the accuracy of the results and the ease of examination procedures. Significance for public health This systematic review aims to explain various digital and conventional-based early detection interventions along with their advantages and disadvantages that can be used to assess risk factors for DFU in DM patients. It is because several existing studies only discuss one model of early detection of DFU in DM patients, however, studies that describe various interventions that can be carried out for early detection in DM patients have not been found. By knowing several DFU prevention interventions, it is expected to increase the independence of patients and families in preventing complications such as diabetic foot.
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Affiliation(s)
| | | | | | | | - Resti Utami
- Faculty of Nursing, Universitas Airlangga, Surabaya, East Java.
| | - Arifal Aris
- Faculty of Nursing, Universitas Airlangga, Surabaya, East Java.
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Olowo S, Iramiot JS, Ssenyonga LV. Knowledge of diabetic foot complication, self-care beliefs and practices among patients attending a tertiary hospital in Eastern Uganda. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Guarnotta V, Radellini S, Vigneri E, Cernigliaro A, Pantò F, Scondotto S, Almasio PL, Guercio G, Giordano C. Diabetic foot ulcers: Retrospective comparative analysis from Sicily between two eras. PLoS One 2021; 16:e0259405. [PMID: 34874944 PMCID: PMC8651101 DOI: 10.1371/journal.pone.0259405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022] Open
Abstract
Aim The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008–2013 and 2014–2019. Methods We compared the two eras, era1: 2008–13, era2: 2014–19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results In the population hospitalized for DFU in 2008–2013, 59.1% of males and 40.9% of females died, whilst in 2014–2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p < 0.001), just as CKD was severe (14.5% vs. 4%, p < 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07–2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37–2.95, p <0.001) and eGFR less than 92 ml/min (OR 2.84, 95% CI 1.51–5.34, p 0.001) were independently associated with risk of death. Conclusions Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality.
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Affiliation(s)
- Valentina Guarnotta
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
- * E-mail: (CG); (VG)
| | - Stefano Radellini
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | - Enrica Vigneri
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | | | - Felicia Pantò
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
| | | | - Piero Luigi Almasio
- Sezione di Gastroenterologia ed Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Giovanni Guercio
- Sezione di Chirurgia d’Urgenza, Dipartimento di Chirurgia, Oncologia e Scienza Orale, DICHIRONS, Università degli Studi di Palermo, Palermo, Italy
| | - Carla Giordano
- Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), Università di Palermo, Palermo, Italy
- * E-mail: (CG); (VG)
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Abdelbagi OM, Musa IR, Altigani SA, Osman A, Adam I. Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross-sectional study. Int J Clin Pract 2021; 75:e14892. [PMID: 34541736 DOI: 10.1111/ijcp.14892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence and associated factors for diabetic foot (DF) amongst patients with diabetes Mellites (DM) in Nahr an Nil State (River Nile State), Sudan. METHODS We conducted a cross-sectional study between May and August 2018. DM patients were examined for DF, and clinical data were collected through a questionnaire. RESULTS A total of 2048 DM patients were enrolled in the study. Their median (interquartile range) age was 58 (15) years. Over half (54.2%) of the patients were female. The median (interquartile range) of the duration of diabetes was 5 (6) years. In this sample, 70.1% of the patients had type 2 DM and 47.6% had hypertension as well. Of all enrolled patients, 21.2% had normal weight, 1.2% were underweight, 37.2% were overweight and 40.4% were obese. Two hundred and sixty (12.7%) patients had DF. Multivariate regression analyses showed that age [adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI): 1.18-1.24] and duration of DM (AOR = 1.09; 95% CI: 1.05-1.14) were positively associated with DF. Moreover, type 2 DM (AOR = 1.77; 95% CI: 1.17-2.68), family history of DM (AOR = 1.5; 95% CI: 1.07-2.09), hypertension (AOR = 2.93; 95% CI: 2.07-4.16) and obesity (AOR = 2.86; 95% CI: 1.70-4.81) were associated with DF. There was no significant association between DF and gender or overweight status. CONCLUSION This study found a high prevalence of DF. Older age, type 2 DM, duration of DM, family history of DM and hypertension are associated with DF.
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Affiliation(s)
- Omer M Abdelbagi
- Department of Pathology, Faculty of Medicine, Umm-Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Imad R Musa
- Department of Medicine, Royal Commission Hospital in Al Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Salim A Altigani
- College of Computer Science and Information Technology, Elsheikh Abdallah Elbadri University, Barbar, Sudan
| | - Abdelrhaman Osman
- College of Computer Science and Information Technology, Elsheikh Abdallah Elbadri University, Barbar, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Arab-Zozani M, Safari H, Dori Z, Afshari S, Ameri H, Namiranian N, Hoseini E, Jafari A. Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO. INT J LOW EXTR WOUND 2021; 21:41-49. [PMID: 33939495 DOI: 10.1177/15347346211014392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample t-test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55(SD 0.21) and 0.67(SD 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.
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Affiliation(s)
- Morteza Arab-Zozani
- 125609Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Hossein Safari
- 440827Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Zoha Dori
- 48516Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Somayeh Afshari
- 48439Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Hosein Ameri
- 48516Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- 48516Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elham Hoseini
- 48516Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abdolkhalegh Jafari
- 48516Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Maranna H, Lal P, Mishra A, Bains L, Sawant G, Bhatia R, Kumar P, Beg MY. Negative pressure wound therapy in grade 1 and 2 diabetic foot ulcers: A randomized controlled study. Diabetes Metab Syndr 2021; 15:365-371. [PMID: 33524646 DOI: 10.1016/j.dsx.2021.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/16/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Foot ulcers are one of the major causes of morbidity and mortality among diabetics in India. Early diagnosis and timely management is vital in preventing the progression of the disease which may require amputation. Conventional methods take a long time for healing. This study aims to compare negative pressure wound therapy (NPWT) and conventional saline dressings in diabetic foot ulcer (DFU) healing. METHODS This prospective randomized study was conducted in 45 patients with grade 1 and 2 DFUs. 22 patients in group A received NPWT and 23 patients in group B received saline dressings. The formation of granulation tissue, reduction in ulcer size, duration of hospital stay and time for complete healing of wounds were assessed. RESULTS The formation of granulation tissue (91.14 vs 52.61%, p < 0.001) and reduction in ulcer size (40.78 vs 21.18%, p = 0.008) at 14 days was significantly more in group A. The duration of hospital stay (15.68 vs 29.00 days, p < 0.001) and time for 100% coverage of the wound with granulation tissue (14.82 ± 7.30 vs 44.57 ± 7.11 days, p < 0.001) was significantly less in group A. Complete healing of wounds at 3 months was observed in 20 patients (90.9%) in group A and 6 patients (26.1%) in group B (p = 0.006). CONCLUSION In our study NPWT led to early reduction in ulcer size, more granulation tissue formation, shorter hospital stay and complete wound healing. In lower and middle income countries like India with high prevalence of DFUs, early recovery is a boon to the patients to resume their daily activities.
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Affiliation(s)
- Haraesh Maranna
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Pawan Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Gaurish Sawant
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Rahul Bhatia
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Pritesh Kumar
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Mohd Yasir Beg
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
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Tayebi Z, Fazeli M, Hashemi A, Abdi S, Dadashi M, Nasiri MJ, Goudarzi M. Molecular characterization of invasive Staphylococcus aureus strains isolated from patients with diabetes in Iran: USA300 emerges as the major type. INFECTION GENETICS AND EVOLUTION 2020; 87:104679. [PMID: 33326876 DOI: 10.1016/j.meegid.2020.104679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/29/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023]
Abstract
There have been few studies focused on the molecular characterization of invasive Staphylococcus aureus strains in patients with diabetes in Iran. In the present study, 20 invasive S. aureus strains recovered from the patients with diabetes characterized by the virulence and resistance analysis, biofilm formation, staphylocoagulase (SC) typing, S. aureus protein A locus (spa) typing staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing (MLST). Virulence gene detection indicated a high prevalence of strains encoding the pvl genes (50%), a low prevalence of the tst and seg gene (each of them was 5%) and a markedly high prevalence of fnbB (95%), fnbA (85%), icaD (75%), icaA (65%). A total of 3 coagulase types (III, 85%; II, 10%; V, 5%), 2 agr types (I, 90%; II 10%) and 2 SCCmec types (IV, 65%; III, 35%) and four different clones namely ST8-MRSA-IV/t008 (50%) (USA300), ST239-MRSA-III/t030 (35%), ST5-MRSA-IV/t002 (10%), and ST45-MRSA-IV/t038 (5%) were detected in this study. Eighty-five percent of the isolates were biofilm producers. All the 4 high-level mupirocin resistance (HLMUPR) strains belonged to CC/ST8-MRSA-IV/t008 clone and carried mupA gene. Fusidic acid-resistant isolate belonged to ST239-SCCmec III/t030 clone. One vancomycin-intermediate resistance isolates was detected in our study, which belonged to ST5-MRSA-IVt002. Circulating clone in MRSA strains (USA300) isolated from the patients with diabetes highlighting the possibility of transmission of these microorganisms' clones between hospital, community, and environments. However, further studies require providing critical insights into the importance of continued controlling and treatment of S. aureus infections in patients with diabetes.
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Affiliation(s)
- Zahra Tayebi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Microbiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maryam Fazeli
- Department of Virology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abate TW, Enyew A, Gebrie F, Bayuh H. Nurses' knowledge and attitude towards diabetes foot care in Bahir Dar, North West Ethiopia. Heliyon 2020; 6:e05552. [PMID: 33294694 PMCID: PMC7695951 DOI: 10.1016/j.heliyon.2020.e05552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/09/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
A diabetes foot ulcer is the commonest non-traumatic reason for the amputation of the lower extremities. All adults with diabetes should undergo comprehensive foot evaluation at least annually, but for high-risk individuals with diabetes more frequently by a health care provider and daily by the people themselves. Nurses' knowledge and attitude are fundamental to conduct a diabetes foot risk assessment and provide foot care for known diabetes person. Knowledge and attitude of nurses about the assessment and risk, identification of diabetes foot are not well studied in Ethiopia, especially in the study area. Therefore, this study aimed to assess nurses' knowledge and attitude towards diabetes foot ulcer in Bahir Dar, North West Ethiopia. An institution-based cross-sectional study was conducted in Bahir Dar city administration hospitals from January 1st to 5th, 2019. The study participants were selected using a simple random sampling technique. Nurses' level of knowledge and attitude towards diabetes foot ulcer assessment and management determined by using multiple-choice questions of nurse's knowledge and attitude questionnaires. The association between the independent and dependent variables was assessed. In this study, the overall proportions of nurses' knowledge and attitude towards diabetes foot assessment and management were 54.4% and 43.3% respectively. Age less than 30 years old (AOR = 2.15, 95%CI: 1.10, 4.19; P = 0.025), the nurse who graduates from a governmental institution (AOR = 3.05, 95% CI: 1.64, 5.69; P < 0.001) and use the internet as a source of knowledge (AOR = 0.55, 95%CI: 0.31, 0.96; P = 0.035) was significantly associated with nurses' knowledge towards diabetes foot care. Age less than 30 years old (AOR = 1.98, 95% CI: 1.16, 3.35; P = 0.012)and the nurse level of qualification (AOR = 0.39, 95% CI: 0.20, 0.78; P = 0.007)were significantly associated with nurses' level of attitude towards diabetes foot care. In conclusion, this study demonstrated the important gaps in nurses' knowledge and attitude towards diabetes foot care. Nurses' insufficient knowledge and non-favorable attitude towards diabetes foot care compromise health care standard diabetes care. Therefore, a comprehensive revision of nursing curricula across local tertiary learning institutes required qualified instructors and a strengthened regulatory body (especially private ones), and validated source of information for allowing nurses to update their knowledge is warranted.
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Affiliation(s)
- Teshager Woldegiorgis Abate
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Alamirew Enyew
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Feleke Gebrie
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Haregnesh Bayuh
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
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