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Kuguyo O, Mukona DM, Chikwasha V, Gwanzura L, Chirenda J, Matimba A. Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study. BMC Public Health 2024; 24:677. [PMID: 38439010 PMCID: PMC10910836 DOI: 10.1186/s12889-023-17610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/28/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe. METHODS This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom's cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05. RESULTS This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50-56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1-2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1-0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05). CONCLUSION This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.
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Affiliation(s)
- Oppah Kuguyo
- Department of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe.
| | - Doreen Macherera Mukona
- Department of Primary Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Vasco Chikwasha
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Joconiah Chirenda
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alice Matimba
- Department of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe
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Schmidt BM, Keeney-Bonthrone TP, Hawes AM, Karmakar M, Frydrych LM, Cinti SK, Pop-Busui R, Delano MJ. Comorbid status in patients with osteomyelitis is associated with long-term incidence of extremity amputation. BMJ Open Diabetes Res Care 2023; 11:e003611. [PMID: 38164707 PMCID: PMC10729224 DOI: 10.1136/bmjdrc-2023-003611] [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: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis. We sought to determine the incidence of amputation in patients with osteomyelitis over 2 years. RESEARCH DESIGN AND METHODS Observational cohort study of 1186 inpatients with osteomyelitis between 2004 and 2015 and stratified by osteomyelitis location status to evaluate the impact on amputation, mortality rates, readmission data, and inpatient days. RESULTS Persons with diabetes had 3.65 times greater probability of lower extremity amputation (p<0.001), readmission (p<0.001), and longer inpatient stay (p<0.001) and had higher 2-year mortality (relative risk (RR) 1.23, p=0.0027), adjusting for risk factors. Male gender (RR 1.57, p<0.001), black race (RR 1.41, p<0.05), former smoking status (RR 1.38, p<0.01), myocardial infarction (RR 1.72, p<0.001), congestive heart failure (RR 1.56, p<0.001), peripheral vascular disease (RR 2.25, p<0.001) and renal disease (RR 1.756, p<0.001) were independently associated with amputation. Male gender (RR 1.39, p<0.01), black race (RR 1.27, p<0.05), diabetes (RR 2.77, p<0.001) and peripheral vascular disease (RR 1.59, p<0.001) had increased risk of lower, not upper, extremity amputation. CONCLUSIONS Patients with osteomyelitis have higher rates of amputation and hospitalization. Clinicians must incorporate demographic and comorbid risk factors to protect against amputation.
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Affiliation(s)
- Brian M Schmidt
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Armani M Hawes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Karmakar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn M Frydrych
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandro K Cinti
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rodica Pop-Busui
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matthew J Delano
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Lazzarini PA, Raspovic A, Prentice J, Commons RJ, Fitridge RA, Charles J, Cheney J, Purcell N, Twigg SM. Australian evidence-based guidelines for the prevention and management of diabetes-related foot disease: a guideline summary. Med J Aust 2023; 219:485-495. [PMID: 37872875 DOI: 10.5694/mja2.52136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/23/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Diabetes-related foot disease (DFD) - foot ulcers, infection, ischaemia - is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence-based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC. MAIN RECOMMENDATIONS This article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including: prevention - screening, education, self-care, footwear, and treatments to prevent DFD; classification - classifications systems for ulcers, infection, ischaemia and auditing; peripheral artery disease (PAD) - examinations and imaging for diagnosis, severity classification, and treatments; infection - examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments; offloading - pressure offloading treatments for different ulcer types and locations; and wound healing - debridement, wound dressing selection principles and wound treatments for non-healing ulcers. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINE For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self-monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.
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Affiliation(s)
- Peter A Lazzarini
- Queensland University of Technology, Brisbane, QLD
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD
| | | | | | - Robert J Commons
- Grampians Rural Health Alliance, Ballarat, VIC
- Menzies School of Research, Charles Darwin University, Darwin, NT
| | - Robert A Fitridge
- Royal Adelaide Hospital, Adelaide, SA
- University of Adelaide, Adelaide, SA
| | - James Charles
- First Peoples Health Unit, Griffith University, Gold Coast, QLD
| | | | - Nytasha Purcell
- Diabetes Feet Australia, Australian Diabetes Society, Sydney, NSW
| | - Stephen M Twigg
- University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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Alahakoon C, Singh TP, Morris D, Charles J, Fernando M, Lazzarini P, Moxon JV, Golledge J. Cohort Study Examining the Presentation, Distribution, and Outcomes of Peripheral Artery Disease in Aboriginal, Torres Strait Islander, and Non-Indigenous Australians. Eur J Vasc Endovasc Surg 2023; 66:237-244. [PMID: 37209994 DOI: 10.1016/j.ejvs.2023.05.027] [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: 12/08/2022] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This retrospective cohort study investigated the anatomical distribution, severity, and outcome of peripheral artery disease (PAD) in Aboriginal and Torres Strait Islanders compared with non-indigenous Australians. METHODS The distribution, severity, and outcome of PAD were assessed using a validated angiographic scoring system and review of medical records in a cohort of Aboriginal and Torres Strait Islander and non-indigenous Australians. The relationship between ethnicity and PAD severity, distribution, and outcome were examined using non-parametric statistical tests, Kaplan-Meier and Cox proportional hazard analyses. RESULTS Seventy-three Aboriginal and Torres Strait Islanders and 242 non-indigenous Australians were included and followed for a median of 6.7 [IQR 2.7, 9.3] years. Aboriginal and Torres Strait Islander patients were more likely to present with symptoms of chronic limb threatening ischaemia (81% vs. 25%; p < .001), had greater median [IQR] angiographic scores for the symptomatic limb (7 [5, 10] vs. 4 [2, 7]) and tibial arteries (5 [2, 6] vs. 2 [0, 4]) and had higher risk of major amputation (HR 6.1, 95% CI 3.6 - 10.5; p < .001) and major adverse cardiovascular events (HR 1.5, 95% CI 1.0 - 2.3; p = .036) but not for revascularisation (HR 0.8, 95% CI 0.5 - 1.3; p = .37) compared with non-indigenous Australians. The associations with major amputation and major adverse cardiovascular events were no longer statistically significant when adjusted for limb angiographic score. CONCLUSION Compared with non-indigenous patients, Aboriginal and Torres Strait Islander Australians had more severe tibial artery disease and a higher risk of major amputation and major adverse cardiovascular events.
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Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
| | - Dylan Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
| | - James Charles
- First Peoples Health Unit, Griffith University, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.
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Boateng D, Ayellah BB, Adjei DN, Agyemang C. Contribution of diabetes to amputations in sub-Sahara Africa: A systematic review and meta-analysis. Prim Care Diabetes 2022; 16:341-349. [PMID: 35305899 DOI: 10.1016/j.pcd.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
Diabetes related amputations remain a major global problem, with devastating complications. We critically appraised relevant literature to quantify the prevalence of diabetes related amputations in sub-Saharan Africa (SSA). An electronic search was performed using the EMBASE and PubMed databases until 2020. Twenty-four out of 834 studies retrieved were included. The pooled prevalence of diabetic-related amputations was 36.9% (95%CI: 32.9%-40.8%). Complications of diabetes related amputations included infection, anaemia, foot deformity and mortality. The study revealed a substantial contribution of diabetes to the burden of amputations in SSA and suggests the need for further studies to assess how to reduce the incidence of diabetes, reduce the incidence of and or delay the progression of macro and microvascular complications of diabetes in SSA.
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Affiliation(s)
- Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - David Nana Adjei
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Lazzarini PA, Raspovic A, Prentice J, Commons RJ, Fitridge RA, Charles J, Cheney J, Purcell N, Twigg SM. Guidelines development protocol and findings: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:28. [PMID: 35440052 PMCID: PMC9017044 DOI: 10.1186/s13047-022-00533-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel’s and international guideline’s judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00533-8.
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Affiliation(s)
- Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. .,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
| | - Anita Raspovic
- School of Allied Health, Human Services and Sport College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
| | - Jenny Prentice
- Hall and Prior Health and Aged Care Group, Perth, Australia
| | - Robert J Commons
- Internal Medicine Services, Ballarat Health Services, Ballarat, Victoria, Australia.,Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Robert A Fitridge
- Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - James Charles
- First Peoples Health Unit, Faculty of Health, Griffith University, Gold Coast, Australia
| | | | - Nytasha Purcell
- Diabetes Feet Australia, Brisbane, Australia.,Australian Diabetes Society, Sydney, Australia
| | - Stephen M Twigg
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Australia
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Aritzmendi Pérez M, Bravo Ruiz E, Torre Puente R, Baraia-Etxaburu Artetxe JM, Etxeberria Martín E, Pascual Huerta J. Tratamiento y evolución de úlceras de pie diabético con sospecha de osteomielitis en una Unidad de Pie Diabético de nueva creación. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1624/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bellary S. The changing character of diabetes complications. Lancet Diabetes Endocrinol 2022; 10:5-6. [PMID: 34861152 DOI: 10.1016/s2213-8587(21)00313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
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Liu Y, Sun Y, Ewaleifoh O, Wei J, Mi R, Zhu J, Hoke A, Polydefkis M. Ethoxyquin is neuroprotective and partially prevents somatic and autonomic neuropathy in db/db mouse model of type 2 diabetes. Sci Rep 2021; 11:10749. [PMID: 34031437 PMCID: PMC8144207 DOI: 10.1038/s41598-021-89781-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Ethoxyquin (EQ), a quinolone-based antioxidant, has demonstrated neuroprotective properties against several neurotoxic drugs in a phenotypic screening and is shown to protect axons in animal models of chemotherapy-induced peripheral neuropathy. We assessed the effects of EQ on peripheral nerve function in the db/db mouse model of type II diabetes. After a 7 week treatment period, 12-week-old db/db-vehicle, db/+ -vehicle and db/db-EQ treated animals were evaluated by nerve conduction, paw withdrawal against a hotplate, and fiber density in hindlimb footpads. We found that the EQ group had shorter paw withdrawal latency compared to vehicle db/db group. The EQ group scored higher in nerve conduction studies, compared to vehicle-treated db/db group. Morphology studies yielded similar results. To investigate the potential role of mitochondrial DNA (mtDNA) deletions in the observed effects of EQ, we measured total mtDNA deletion burden in the distal sciatic nerve. We observed an increase in total mtDNA deletion burden in vehicle-treated db/db mice compared to db/+ mice that was partially prevented in db/db-EQ treated animals. These results suggest that EQ treatment may exert a neuroprotective effect in diabetic neuropathy. The prevention of diabetes-induced mtDNA deletions may be a potential mechanism of the neuroprotective effects of EQ in diabetic neuropathy.
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Affiliation(s)
- Ying Liu
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yuan Sun
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Liaoning Laboratory of Cancer Genomics, Department of Cell Biology, College of Basic Medical Science, Dalian Medical University, Dalian, China
| | - Osefame Ewaleifoh
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Driskill Graduate Program, Northwestern University, Chicago, IL, USA
| | - Josh Wei
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Parker University, Dallas, TX, USA
| | - Ruifa Mi
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jing Zhu
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medical, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ahmet Hoke
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Polydefkis
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Singh TP, Moxon JV, Meehan MT, Jones R, Cadet-James Y, Golledge J. Major amputation rates and outcomes for Aboriginal and Torres Strait Islander and non-Indigenous people in North Queensland Australia between 2000 and 2015. BMC Endocr Disord 2021; 21:101. [PMID: 34020627 PMCID: PMC8139111 DOI: 10.1186/s12902-021-00764-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study estimated the incidence of major amputation for people in North Queensland, Australia, examined changes in amputation rates over time and investigated survival after major amputation. METHODS This was a retrospective study of patients who underwent a major amputation above the ankle between 2000 and 2015. Major amputation rates and incidence rate ratios (IRR) were calculated using census data to define the at-risk population. Associations between risk factors and calendar year with major amputation were assessed using quasipoisson regression. Kaplan-Meier survival and Cox-proportional hazard analyses estimated the incidence of and risk factors for all-cause mortality. RESULTS The annual incidence of major amputation was estimated to be greater in Aboriginal and Torres Strait Islanders than non-Indigenous people (IRR 2.75, 95 % CI 1.92 to 3.84). After adjusting for population growth, the annual incidence of major amputations did not change significantly over time for either groups. Aboriginal and Torres Strait Islander people were at greater risk of all-cause mortality after major amputation compared to non-Indigenous people, although this association was not significant after adjusting for other risk factors (hazard ratio 1.24, 95 % CI 0.82 to 1.90). CONCLUSIONS The incidence of major amputation in North Queensland has not reduced over time, indicating the need for better preventative treatments, particularly in Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Michael T Meehan
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Rhondda Jones
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia.
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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11
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Injectable Hydrogels for Chronic Skin Wound Management: A Concise Review. Biomedicines 2021; 9:biomedicines9050527. [PMID: 34068490 PMCID: PMC8150772 DOI: 10.3390/biomedicines9050527] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetic foot ulcers (DFU) are a predominant impediment among diabetic patients, increasing morbidity and wound care costs. There are various strategies including using biomaterials have been explored for the management of DFU. This paper will review the injectable hydrogel application as the most studied polymer-based hydrogel based on published journals and articles. The main key factors that will be discussed in chronic wounds focusing on diabetic ulcers include the socioeconomic burden of chronic wounds, biomaterials implicated by the government for DFU management, commercial hydrogel product, mechanism of injectable hydrogel, the current study of novel injectable hydrogel and the future perspectives of injectable hydrogel for the management of DFU.
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12
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Chiang N, Wang J, Marie N, Wu A, Ravindra R, Robinson D. Evaluation of Clinical Outcomes Following Minor Amputations in Australia - An Important Consideration for Timing of Revascularisation. Ann Vasc Surg 2021; 76:389-398. [PMID: 33905853 DOI: 10.1016/j.avsg.2021.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/06/2021] [Accepted: 03/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Vascular patients with tissue loss requiring minor amputations could be an early sign of a terminal event. The long-term outcomes and timing of revascularisation for these patients are not well-studied. The aim of this study was to determine the clinical outcomes following minor amputations. Primary outcomes were functional status, limb loss, and mortality. Secondary outcomes compared immediate and delayed revascularisation. METHODS A retrospective analysis of 200 vascular patients who required minor amputations at Austin Hospital, Melbourne was performed over 5 years. Demographics, details of revascularisation, functional status, and clinical outcomes such as recurrent tissue loss, limb loss and death were recorded. RESULTS Of the entire cohort requiring minor amputations, 118 (59%) patients underwent revascularisation. 111 (94%) revascularisation procedures were performed within 90 days of minor amputation. Over all 5-year limb preservation was 89.9%. Patients who required revascularisation were not statistically significantly more at risk for limb loss at 5 years [13.6% vs. 6.6%; P=0.08]. Limb salvage at 1 year was not different between groups revascularized before and after amputation [89.5% vs. 90.9%; P=0.70]. Over all 5-year mortality rate was 50%. In the diabetic subset, those who had revascularisation after minor amputation had a greater 5-year mortality [67.9% vs. 50%; P=0.03]. A scoring system based on risk factors was developed but was not reliable based on the study data. CONCLUSIONS The data from this study suggest that patients with diabetes who undergo revascularisation after minor amputation have worse outcomes than those revascularised prior to minor amputation. A predictive model applied at presentation could help detect high-risk patients but requires further work.
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Affiliation(s)
- Nathaniel Chiang
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Judy Wang
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia.
| | - Natalie Marie
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Angela Wu
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Raevin Ravindra
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Domenic Robinson
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
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13
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Chao CT, Lee SY, Wang J, Chien KL, Hung KY. The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis. Cardiovasc Diabetol 2021; 20:86. [PMID: 33894776 PMCID: PMC8070330 DOI: 10.1186/s12933-021-01279-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. Methods We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. Results From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06–1.14), heart failure (HF) (HR 1.282, 95% CI 1.19–1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04–1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08–1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. Conclusions The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01279-6.
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Affiliation(s)
- Chia-Ter Chao
- Neprology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Ying Lee
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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14
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Zhang Y, van Netten JJ, Baba M, Cheng Q, Pacella R, McPhail SM, Cramb S, Lazzarini PA. Diabetes-related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations. J Foot Ankle Res 2021; 14:8. [PMID: 33468226 PMCID: PMC7816323 DOI: 10.1186/s13047-021-00447-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations. Methods We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators. Results Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0–58.8%, of DFD from 1.2–1.5%, and the incidence of diabetes-related amputation ranged from 5.2–7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2–36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3–43.3%, DFD from 7.0–15.1% and amputation during hospitalisation from 1.4–5.8%. Conclusions Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00447-x.
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Affiliation(s)
- Yuqi Zhang
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Jaap J van Netten
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mendel Baba
- Podiatry Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Qinglu Cheng
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Peter A Lazzarini
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia. .,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
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15
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ALAY H, YILMAZ S, KESMEZ CAN F, PARLAK M. An evaluation of risk factors affecting amputation in patients with diabetic foot Infection. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.809986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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16
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Sainsbury E, Shi Y, Flack J, Colagiuri S. The diagnosis and management of diabetes in Australia: Does the "Rule of Halves" apply? Diabetes Res Clin Pract 2020; 170:108524. [PMID: 33164851 DOI: 10.1016/j.diabres.2020.108524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 01/17/2023]
Abstract
The Rule of Halves (ROH) is a theoretical framework which states that roughly half of all people with a condition are diagnosed; half of those diagnosed receive care; half of those who receive care achieve their treatment targets; and half of those who reach their targets achieve the desired treatment outcomes. This review examined the applicability of the ROH to diabetes in Australia. Five databases were searched for articles and government reports published between January 2000 and August 2019. Data was extracted for each level of the framework, and pooled sample proportions calculated for the total population and sub-group analysis by ethnicity and type of diabetes. The results showed that 72% of people with diabetes are diagnosed. Approximately 50% are receiving standard care, and 40-60% are meeting treatment targets for HbA1c, blood pressure and lipid levels. Overall, Australia is doing better than the ROH when it comes to achieving treatment outcomes; prevalence of microvascular complications was 20-30% and cardiovascular disease 62%. Indigenous people were less likely to meet treatment targets and more likely to experience adverse complications of diabetes. This review indicates the ROH does generally apply for diabetes care and management in Australia, highlighting the need for further improvement.
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Affiliation(s)
- Emma Sainsbury
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Yumeng Shi
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Jeff Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney NSW, Australia.
| | - Stephen Colagiuri
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
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17
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Alzaid A, Ladrón de Guevara P, Beillat M, Lehner Martin V, Atanasov P. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses. Expert Rev Pharmacoecon Outcomes Res 2020; 21:785-798. [PMID: 32686530 DOI: 10.1080/14737167.2020.1782748] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.
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Affiliation(s)
- Aus Alzaid
- Consultant Diabetologist, Riyadh, Saudi Arabia
| | - Patricia Ladrón de Guevara
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maud Beillat
- Global Market Access, Health Economics & Outcomes Research, Servier Global Market Access & HEOR, France
| | | | - Petar Atanasov
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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18
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Alves FLMT, Laporta GZ. Prevalence and factors associated with lower limb amputation in individuals with type II diabetes mellitus in a referral hospital in Fortaleza, Ceará, Brazil: A hospital-based cross-sectional study. Heliyon 2020; 6:e04469. [PMID: 32715137 PMCID: PMC7372145 DOI: 10.1016/j.heliyon.2020.e04469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/03/2022] Open
Abstract
AIMS To analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. METHODS A cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. RESULTS The prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05-2.21). CONCLUSIONS LLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.
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Affiliation(s)
- Francisca Lesse Mary Teixeira Alves
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC (FMABC), Fundação ABC, Santo André, São Paulo, Brazil
- Hospital Geral de Fortaleza (HGF), Secretaria de Estado da Saúde State, Fortaleza, Ceará, Brazil
| | - Gabriel Zorello Laporta
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC (FMABC), Fundação ABC, Santo André, São Paulo, Brazil
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19
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Hussain MA, Al-Omran M, Salata K, Sivaswamy A, Forbes TL, Sattar N, Aljabri B, Kayssi A, Verma S, de Mestral C. Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease. CMAJ 2020; 191:E955-E961. [PMID: 31481423 DOI: 10.1503/cmaj.190134] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The evolving clinical burden of limb loss secondary to diabetes and peripheral artery disease remains poorly characterized. We sought to examine secular trends in the rate of lower-extremity amputations related to diabetes, peripheral artery disease or both. METHODS We included all individuals aged 40 years and older who underwent lower-extremity amputations related to diabetes or peripheral artery disease in Ontario, Canada (2005-2016). We identified patients and amputations through deterministic linkage of administrative health databases. Quarterly rates (per 100 000 individuals aged ≥ 40 yr) of any (major or minor) amputation and of major amputations alone were calculated. We used time-series analyses with exponential smoothing models to characterize secular trends and forecast 2 years forward in time. RESULTS A total of 20 062 patients underwent any lower-extremity amputation, of which 12 786 (63.7%) underwent a major (above ankle) amputation. Diabetes was present in 81.8%, peripheral artery disease in 93.8%, and both diabetes and peripheral artery disease in 75.6%. The rate of any amputation initially declined from 9.88 to 8.62 per 100 000 between Q2 of 2005 and Q4 of 2010, but increased again by Q1 of 2016 to 10.0 per 100 000 (p = 0.003). We observed a significant increase in the rate of any amputation among patients with diabetes, peripheral artery disease, and both diabetes and peripheral artery disease. Major amputations did not significantly change among patients with diabetes, peripheral artery disease or both. INTERPRETATION Lower-extremity amputations related to diabetes, peripheral artery disease or both have increased over the last decade. These data support renewed efforts to prevent and decrease the burden of limb loss.
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Affiliation(s)
- Mohamad A Hussain
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Mohammed Al-Omran
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Konrad Salata
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Atul Sivaswamy
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Thomas L Forbes
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Naveed Sattar
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Badr Aljabri
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Ahmed Kayssi
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Subodh Verma
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Charles de Mestral
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont.
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20
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Manning L, Hamilton EJ, Raby E, Norman PE, Davis W, Wood F, Carville K, Baba M, Hiew J, Ryan E, Ferreira I, Gittings P, Ritter JC. Spray on skin for diabetic foot ulcers: an open label randomised controlled trial. J Foot Ankle Res 2019; 12:52. [PMID: 31788029 PMCID: PMC6858641 DOI: 10.1186/s13047-019-0362-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/30/2019] [Indexed: 12/24/2022] Open
Abstract
Background One Australian loses a limb every 3 h as a result of infected diabetic foot ulcers (DFU). This common condition accounts for substantial morbidity and mortality for affected individuals and heavy economic costs for the health sector and the community. There is an urgent need to test interventions that improve wound healing time, prevent amputations and recurrent ulceration in patients presenting with DFU whilst improving quality of life and reducing health care costs. Methods One hundred and fifty eligible participants will be randomised to receive an autologous skin cell suspension, also termed 'spray-on' skin (ReCell®) or standard care interventions for their DFU. The primary outcome is complete wound healing at 6 months, but participants will be followed up for a total of 12 months to enable secondary outcomes including total overall costs, ulcer free days at 12 months and quality of life to be assessed. Discussion Outpatient costs for dressings, home nursing visits and outpatient appointments are key cost drivers for DFU. If spray-on skin is effective, large cost savings to WA Health will be realised immediately through a shortened time to healing, and through a higher proportion of patients achieving complete healing. Shortened healing times may enable participants to return to work earlier. Any economic benefits are likely to be amplified across Australia and other similar demographic settings where aging populations with increased diabetes rates are considered major future challenges. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000511235. Registered on 9 April 2018.
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Affiliation(s)
- Laurens Manning
- 1Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Emma J Hamilton
- 2Endocrinology Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Edward Raby
- 1Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Paul E Norman
- 3Medical School, University of Western Australia, Crawley, WA 6009 Australia.,4Department of Vascular Surgery, Fremantle Hospital, Alma Street, Fremantle, WA 6160 Australia
| | - Wendy Davis
- 3Medical School, University of Western Australia, Crawley, WA 6009 Australia
| | - Fiona Wood
- 5State Burns Unit, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Keryln Carville
- 6Silver Chain Group and School of Nursing and Midwifery, Curtin University, Bentley, WA 6102 Australia
| | - Mendel Baba
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Jonathan Hiew
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Erica Ryan
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Ivana Ferreira
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Paul Gittings
- 8Burns Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Jens C Ritter
- 9Department of Vascular Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
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21
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Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. J Foot Ankle Res 2019; 12:34. [PMID: 31223342 PMCID: PMC6570910 DOI: 10.1186/s13047-019-0345-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. Methods The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. Results One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P < 0.001), PAD (P < 0.001), Wagner grade ≥ 4 (P < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055–26.132), PAD (O.R. 2.8, 95% C.I. 1.520–5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930–10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. Conclusion We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.
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Affiliation(s)
- Ejiofor Ugwu
- 1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Olufunmilayo Adeleye
- 2Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Lagos State University, Lagos, Nigeria
| | - Ibrahim Gezawa
- 3Department of Medicine, Division of endocrinology, Diabetes and Metabolism, Bayero University, Kano, Nigeria
| | - Innocent Okpe
- 4Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Ahmadu Bello University, Zaria, Nigeria
| | - Marcelina Enamino
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical Center, Keffi, Nigeria
| | - Ignatius Ezeani
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical Center, Umuahia, Nigeria
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22
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Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med 2019; 170:764-769. [PMID: 31060053 DOI: 10.7326/m19-0085] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been associated with Fournier gangrene (FG), a rare urologic emergency characterized by necrotizing infection of the external genitalia, perineum, and perianal region. OBJECTIVE To describe and compare reported cases of FG in diabetic adults receiving treatment with SGLT2 inhibitors or other antiglycemic agents. DESIGN Descriptive case series. SETTING U.S. Food and Drug Administration (FDA) Adverse Event Reporting System and published case reports. PATIENTS Adults receiving SGLT2 inhibitors or other antiglycemic agents. MEASUREMENTS Clinical and laboratory data. RESULTS The FDA identified 55 unique cases of FG in patients receiving SGLT2 inhibitors between 1 March 2013 and 31 January 2019. The patients ranged in age from 33 to 87 years; 39 were men, and 16 were women. Time to onset after initiation of SGLT2-inhibitor therapy ranged from 5 days to 49 months. All patients had surgical debridement and were severely ill. Reported complications included diabetic ketoacidosis (n = 8), sepsis or septic shock (n = 9), and acute kidney injury (n = 4). Eight patients had fecal diversion surgery, 2 patients developed necrotizing fasciitis of a lower extremity that required amputation, and 1 patient required a lower-extremity bypass procedure because of gangrenous toes. Three patients died. For comparison, the FDA identified 19 FG cases associated with other antiglycemic agents between 1984 and 31 January 2019: metformin (n = 8), insulin glargine (n = 6), short-acting insulin (n = 2), sitagliptin plus metformin (n = 2), and dulaglutide (n = 1). These patients ranged in age from 42 to 79 years; 12 were men, and 7 were women. Two patients died. LIMITATION Inability to establish causality or incidence, variable quality of reports, possible underreporting, and confounding by indication. CONCLUSION FG is a newly identified safety concern in patients receiving SGLT2 inhibitors. Physicians prescribing these agents should be aware of this possible complication and have a high index of suspicion to recognize it in its early stages. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Susan J Bersoff-Matcha
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Christine Chamberlain
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Christian Cao
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - Cindy Kortepeter
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
| | - William H Chong
- U.S. Food and Drug Administration, Silver Spring, Maryland (S.J.B., C.C., C.C., C.K., W.H.C.)
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23
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Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria. World J Diabetes 2019; 10:200-211. [PMID: 30891155 PMCID: PMC6422858 DOI: 10.4239/wjd.v10.i3.200] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/23/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nigeria bears the greatest burden of diabetes prevalence in Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially life-threatening complication of diabetes. Significant improvements in diabetic foot incidence and outcomes have been recorded in many Western countries in the past decade. However, the current burden of DFU in Nigeria is largely unknown.
AIM To evaluate the patients’ profile, ulcer characteristics, associated co-morbidities and outcome of patients with DFU in Nigeria.
METHODS Multicenter evaluation of diabetic foot ulcer in Nigeria was a one year multicenter observational study of patients hospitalized for DFU in six tertiary health institutions in Nigeria from March 2016 to March 2017. Demographic and diabetes information, ulcer characteristics and associated co-morbidities were assessed. Relevant laboratory and imaging studies were performed. All patients received appropriate multi-disciplinary care and were followed up until discharge or death. Outcome variables of interest were ulcer healing, lower extremity amputation (LEA), duration of hospitalization and mortality.
RESULTS A total of 336 patients (55.1% male) with mean age of 55.9 ± 12.5 years were enrolled into this study. Majority (96.1%) had type 2 diabetes. Only 25.9% of the subjects had prior foot care knowledge. Most of the subjects presented late to the hospital and median (IQR) duration of ulcer at presentation was 39 (28-54) d. Ulcers were already advanced (Wagner grades ≥ 3) in 79.2% of the subjects while 76.8% of the ulcers were infected at the time of admission. The commonest co-morbidities were systemic hypertension, anemia and hyperglycemic emergencies. One hundred and nineteen subjects (35.4%) suffered LEA while 10.4% left against medical advice. The median (IQR) duration of hospitalization was 52.0 (29-66) d with case fatality rate of 20.5%.
CONCLUSION The burden of DFU in Nigeria is very high. The major gaps include low level of foot care knowledge among diabetic patients, overdependence on self-medication and unorthodox medicine following development of foot ulceration, late hospital presentation, and high amputation and mortality rates. Extensive foot care education within the framework of a multi-disciplinary foot care team is highly desirable.
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Affiliation(s)
- Ejiofor Ugwu
- Department of Medicine, Enugu State University of Science and Technology Enugu, Enugu 400001, Nigeria
| | | | - Ibrahim Gezawa
- Department of Medicine, Bayero University Kano, Kano 700001, Nigeria
| | - Innocent Okpe
- Department of Medicine, Ahmadu Bello University Zaria, Kaduna 800001, Nigeria
| | - Marcelina Enamino
- Department of Medicine, Federal Medical Center Keffi, Nasarawa 961101, Nigeria
| | - Ignatius Ezeani
- Department of Medicine, Federal Medical Center Umuahia, Abia 440001, Nigeria
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24
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Wright MA, Steffens D, Huilgol RL. Vascular surgery trends in Australia: 2001-2015: less open surgery, less limb loss and more endovascular intervention. ANZ J Surg 2018; 89:309-313. [PMID: 30321911 DOI: 10.1111/ans.14878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/04/2018] [Accepted: 08/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of peripheral arterial disease (PAD) in Australia is currently poorly characterized. The risk factor profile for PAD is changing with the population ageing, diabetes increasing and smoking rates declining. The management of PAD is also evolving, with advances in medical management and endovascular technique. The trends in PAD prevalence and surgical management have implications for preventative medicine, the Australian health system and vascular surgery. We report and analyse trends in PAD surgical intervention performed between 2001 and 2015. METHODS Data was extracted from the National Hospital Morbidity Database procedural item code records. Procedural numbers of endovascular lower extremity revascularization (LER); open LER; minor and major lower extremity amputations (LEA) between 2001 and 2015 in adults ≥45 years were included. Results were population-adjusted and age-stratified using census information from the Australian Bureau of Statistics to analyse changes in intervention rates. Linear regression analyses were performed to calculate the average annual change in procedures per capita (100 000). RESULTS From 2001 and 2015, per capita (100 000 population) volume of endovascular LER increased 89%, open LER decreased 70%, major LEA decreased 65% and minor LEA increased 14%. The most remarkable changes were in the ≥85-year-old cohort, with endovascular procedures per capita increasing 188%; coinciding with both open LER and major LEA decreasing by 73% between 2001 and 2015. CONCLUSIONS Australian hospital data between 2001 and 2015 shows that endovascular LER interventions and minor LEA have significantly increased per capita in Australians ≥45 years. In contrast, both open LER and major LEA rates have significantly decreased in the same cohort.
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Affiliation(s)
- Melissa Anne Wright
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia.,The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ravi Lee Huilgol
- The University of Notre Dame Australia, Sydney, New South Wales, Australia.,Department of Vascular Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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25
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Marin-Luevano P, Trujillo V, Rodriguez-Carlos A, González-Curiel I, Enciso-Moreno JA, Hancock REW, Rivas-Santiago B. Induction by innate defence regulator peptide 1018 of pro-angiogenic molecules and endothelial cell migration in a high glucose environment. Peptides 2018; 101:135-144. [PMID: 29353019 DOI: 10.1016/j.peptides.2018.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/03/2018] [Accepted: 01/14/2018] [Indexed: 02/06/2023]
Abstract
Synthetic innate defence regulator (IDR) peptides such as IDR-1018 modulate immunity to promote key protective functions including chemotaxis, wound healing, and anti-infective activity, while suppressing pro-inflammatory responses to non-pathological levels. Here we demonstrated that IDR-1018 induced, by up to 75-fold, pro-angiogenic VEGF-165 in keratinocytes but suppressed this isoform in endothelial cells. It also induced early angiogenin and prolonged anti-inflammatory TGFβ expression on endothelial cells, while suppressing early pro-inflammatory IL-1β expression levels. IDR-1018 also down-regulated the hypoxia induced transcription factor HIF-1α in both keratinocytes and endothelial cells. Consistent with these data, in an in vitro wound healing scratch assay, IDR-1018 induced migration of endothelial cells under conditions of hypoxia while in epithelial cells migration increased only under conditions of normoxia.
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Affiliation(s)
- Paulina Marin-Luevano
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico; Department of Immunology, School of Medicine, Universidad Autonoma de San Luis Potosi, Mexico
| | - Valentin Trujillo
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico; Department of Immunology, School of Medicine, Universidad Autonoma de San Luis Potosi, Mexico
| | - Adrian Rodriguez-Carlos
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | | | - Jose A Enciso-Moreno
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | - Robert E W Hancock
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, 2259 Lower Mall Research Station, Vancouver, BC, Canada
| | - Bruno Rivas-Santiago
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico.
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26
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Kiburg KV, Ward GM, O'Neal DN, MacIsaac RJ. Lipid-lowering therapy use and achievement of cholesterol targets in an Australian diabetes clinic. Intern Med J 2018; 48:201-204. [PMID: 29415350 DOI: 10.1111/imj.13691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
We documented temporal changes in the use of lipid-lowering medications and achievement of cholesterol targets in an Australian diabetes clinic. The number of patients using lipid-lowering therapy for primary or secondary cardiovascular prevention increased from 6 to 69% between 1993-1995 and 2014-2016, which corresponded to a decrease in low-density lipoprotein cholesterol levels from 3.7 to 2.4 mmol/L (P < 0.01).
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Affiliation(s)
- Katerina V Kiburg
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology and Diabetes, St Vincent's Institute of Medical Research, Melbourne, Victoria, Australia
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David N O'Neal
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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27
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Tanaka A, Node K. Increased amputation risk with canagliflozin treatment: behind the large cardiovascular benefit? Cardiovasc Diabetol 2017; 16:129. [PMID: 29025400 PMCID: PMC5639481 DOI: 10.1186/s12933-017-0611-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 01/14/2023] Open
Abstract
A growing body of evidence suggests that sodium-glucose cotransporter 2 (SGLT2) inhibitors appear to be a powerful option to improve the cardiovascular (CV) prognosis in high CV-risk patients with type 2 diabetes. Despite a significant reduction in major adverse CV events with SGLT2 inhibitor treatment, however, an unexpected increased risk of amputation was observed in the CANVAS program and the subsequent pharmacovigilance analysis. Although the underlying mechanisms are currently unknown, because amputation has a large negative impact on patient clinical course, clinicians want to know the exact reason for the increased amputation in the canagliflozin treatment. We herein discuss a need to elucidate the actual reasons with more appropriate statistical consideration, taking into account individual clinical course potentially involved in the diabetes-related amputation. Decreases in the hardendpoints by canagliflozin might result in an alternate increase in the other diabetes-related complications, including amputation. In addition, if amputation occurred after stopping canagliflozin, the incidence might be caused by worsened glycemic control and a decrease in hematocrit, accompanied by a subsequent worsening of diabetic foot disease. More detailed approach considering individual clinical course potentially involved in the amputation, would help to further unravel the cause for suspected risk of amputation with canagliflozin.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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28
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Freisinger E, Malyar NM, Reinecke H, Lawall H. Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardiovasc Diabetol 2017; 16:41. [PMID: 28376797 PMCID: PMC5379505 DOI: 10.1186/s12933-017-0524-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/25/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany. METHODS We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs. RESULTS Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38-1.67); Rutherford grade 6: HR 1.33 (1.25-1.41); p < 0.001], but not for death. CONCLUSIONS Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.
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Affiliation(s)
- Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany.
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen und Akademie für Gefaeßkrankheiten, Ettlingen, Germany
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29
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de Jesus-Silva SG, de Oliveira JP, Brianezi MHC, Silva MADM, Krupa AE, Cardoso RS. Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário. J Vasc Bras 2017; 16:16-22. [PMID: 29930618 PMCID: PMC5829687 DOI: 10.1590/1677-5449.008916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Contexto As amputações dos membros inferiores, sejam definidas como maiores ou menores, são um grave problema de saúde, com altos índices de morbimortalidade e de relevante impacto social. Diferentes características clínicas dos pacientes parecem estar relacionadas aos diferentes tipos de amputação realizados. Objetivos Analisar os fatores de risco presentes em pacientes submetidos a amputações de membros inferiores em hospital terciário. Métodos Estudo retrospectivo, transversal, envolvendo 109 pacientes submetidos a amputação de membro inferior em um período de 31 meses, através da análise de gênero e idade, 15 dados clínicos e cinco parâmetros laboratoriais presentes no momento da admissão. Os dados foram submetidos a estatística descritiva e comparativa através do teste t de Student não pareado (para variáveis numéricas), e dos testes de Mann-Whitney e exato de Fisher (para variáveis categóricas). Resultados Das 109 amputações realizadas, 59 foram maiores e 50 menores. A maioria dos pacientes era do gênero masculino (65%), e a média de idade foi de 65 anos (mín. 39, máx. 93). Dentre os fatores de risco observados, idade avançada, acidente vascular encefálico, isquemia, sepse e níveis baixos de hemoglobina e hematócrito estavam estatisticamente mais relacionados às amputações maiores (p < 0,05). Diabetes melito, neuropatia e pulsos distais palpáveis foram fatores mais associados às amputações menores. Conclusões Os níveis das amputações de membros inferiores estão relacionados a diferentes fatores de risco. Os quadros isquêmicos mais graves e de maior morbidade estiveram associados a amputações maiores, enquanto a neuropatia e perfusão preservada, mais relacionados às amputações menores.
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30
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. Foot Complications in a Representative Australian Inpatient Population. J Diabetes Res 2017; 2017:4138095. [PMID: 29164152 PMCID: PMC5661067 DOI: 10.1155/2017/4138095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
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Affiliation(s)
- Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Suzanne S. Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Faculty of Health Sciences, School of Physiotherapy, Australian Catholic University, Brisbane, QLD, Australia
| | - Maarten C. Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD, Australia
| | - Ewan M. Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Michael C. d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J 2016; 14:716-728. [PMID: 27696693 DOI: 10.1111/iwj.12683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self-reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) [95% confidence interval (CI):7·2-11·3%] had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes-related literature. The overall inpatient foot disease burden is similar in size to well-known medical conditions and should receive similar attention.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD,, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD,, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD,, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD,, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD,, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Michael C d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Epps JA, Smart NA. Remote ischaemic conditioning in the context of type 2 diabetes and neuropathy: the case for repeat application as a novel therapy for lower extremity ulceration. Cardiovasc Diabetol 2016; 15:130. [PMID: 27613524 PMCID: PMC5018170 DOI: 10.1186/s12933-016-0444-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023] Open
Abstract
An emerging treatment modality for reducing damage caused by ischaemia–reperfusion injury is ischaemic conditioning. This technique induces short periods of ischaemia that have been found to protect against a more significant ischaemic insult. Remote ischaemic conditioning (RIC) can be administered more conveniently and safely, by inflation of a pneumatic blood pressure cuff to a suprasystolic pressure on a limb. Protection is then transferred to a remote organ via humoral and neural pathways. The diabetic state is particularly vulnerable to ischaemia–reperfusion injury, and ischaemia is a significant cause of many diabetic complications, including the diabetic foot. Despite this, studies utilising ischaemic conditioning and RIC in type 2 diabetes have often been disappointing. A newer strategy, repeat RIC, involves the repeated application of short periods of limb ischaemia over days or weeks. It has been demonstrated that this improves endothelial function, skin microcirculation, and modulates the systemic inflammatory response. Repeat RIC was recently shown to be beneficial for healing in lower extremity diabetic ulcers. This article summarises the mechanisms of RIC, and the impact that type 2 diabetes may have upon these, with the role of neural mechanisms in the context of diabetic neuropathy a focus. Repeat RIC may show more promise than RIC in type 2 diabetes, and its potential mechanisms and applications will also be explored. Considering the high costs, rates of chronicity and serious complications resulting from diabetic lower extremity ulceration, repeat RIC has the potential to be an effective novel advanced therapy for this condition.
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Affiliation(s)
- J A Epps
- School of Science and Technology, The University of New England, Armidale, NSW, 2351, Australia
| | - N A Smart
- School of Science and Technology, The University of New England, Armidale, NSW, 2351, Australia.
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Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study. Cardiovasc Diabetol 2016; 15:129. [PMID: 27590190 PMCID: PMC5010714 DOI: 10.1186/s12933-016-0446-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of major PAD, and its different presentations, on the 10-year risk of death, major macrovascular events, and major clinical microvascular events in these patients. Methods Participants in the action in diabetes and vascular disease: PreterAx and DiamicroN modified-release controlled evaluation (ADVANCE) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 (in-trial), 5.4 (post-trial), and 9.9 (overall) years. Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularization by angioplasty or surgery. Results Among 11,140 participants, 516 (4.6 %) had major PAD at baseline: 300 (2.7 %) had lower-extremity ulceration or amputation alone, 190 (1.7 %) had peripheral revascularization alone, and 26 (0.2 %) had both presentations. All-cause mortality, major macrovascular events, and major clinical microvascular events occurred in 2265 (20.3 %), 2166 (19.4 %), and 807 (7.2 %) participants, respectively. Compared to those without PAD, patients with major PAD had increased rates of all-cause mortality (HR 1.35, 95 % CI 1.15–1.60, p = 0.0004), and major macrovascular events (1.47 [1.23–1.75], p < 0.0001), after multiple adjustments for region of origin, cardiovascular risk factors and treatments, peripheral neuropathy markers, and randomized treatments. We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events [1.31 (0.96–1.78), p = 0.09]. These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularization. Furthermore, the risk of retinal photocoagulation or blindness, but not renal events, increased in patients with lower-extremity ulceration or amputation [1.53 (1.01–2.30), p = 0.04]. Conclusions Lower-extremity ulceration or amputation, and peripheral revascularization both increased the risks of death and cardiovascular events, but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes. Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes (ClinicalTrials.gov number, NCT00949286). Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0446-x) contains supplementary material, which is available to authorized users.
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Kinnear EM, d'Emden MC, Reed L. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open 2016; 6:e010811. [PMID: 27324710 PMCID: PMC4916592 DOI: 10.1136/bmjopen-2015-010811] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. METHODS Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. RESULTS Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). CONCLUSIONS This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Ng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, Queensland, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Michael C d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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