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Diacogiorgis D, Perrin BM, Kingsley MIC. Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit. Aust J Rural Health 2024. [PMID: 39044431 DOI: 10.1111/ajr.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service. DESIGN Three-year retrospective medical record audit. SETTING Large regional health service with catchment area of >250 000 people in regional Australia. PARTICIPANTS People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC). MAIN OUTCOME MEASURES Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale. RESULTS Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases. CONCLUSIONS Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.
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Affiliation(s)
- Dimitri Diacogiorgis
- Department of Podiatry and Allied Health Assistants, Ballarat Health Services, Grampians Health, Ballarat, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Byron Matthew Perrin
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Michael Ian Charles Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
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Weatherall T, Avsar P, Nugent L, Moore Z, McDermott JH, Sreenan S, Wilson H, McEvoy NL, Derwin R, Chadwick P, Patton D. The impact of machine learning on the prediction of diabetic foot ulcers - A systematic review. J Tissue Viability 2024:S0965-206X(24)00109-8. [PMID: 39019690 DOI: 10.1016/j.jtv.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Globally, diabetes mellitus poses a significant health challenge as well as the associated complications of diabetes, such as diabetic foot ulcers (DFUs). The early detection of DFUs is important in the healing process and machine learning may be able to help inform clinical staff during the treatment process. METHODS A PRISMA-informed search of the literature was completed via the Cochrane Library and MEDLINE (OVID), EMBASE, CINAHL Plus and Scopus databases for reports published in English and in the last ten years. The primary outcome of interest was the impact of machine learning on the prediction of DFUs. The secondary outcome was the statistical performance measures reported. Data were extracted using a predesigned data extraction tool. Quality appraisal was undertaken using the evidence-based librarianship critical appraisal tool. RESULTS A total of 18 reports met the inclusion criteria. Nine reports proposed models to identify two classes, either healthy skin or a DFU. Nine reports proposed models to predict the progress of DFUs, for example, classing infection versus non-infection, or using wound characteristics to predict healing. A variety of machine learning techniques were proposed. Where reported, sensitivity = 74.53-98 %, accuracy = 64.6-99.32 %, precision = 62.9-99 %, and the F-measure = 52.05-99.0 %. CONCLUSIONS A variety of machine learning models were suggested to successfully classify DFUs from healthy skin, or to inform the prediction of DFUs. The proposed machine learning models may have the potential to inform the clinical practice of managing DFUs and may help to improve outcomes for individuals with DFUs. Future research may benefit from the development of a standard device and algorithm that detects, diagnoses and predicts the progress of DFUs.
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Affiliation(s)
- Teagan Weatherall
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Pinar Avsar
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Linda Nugent
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia.
| | - Zena Moore
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia; Lida Institute, Shanghai, China; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Southport, Queensland, Australia.
| | - John H McDermott
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Seamus Sreenan
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Hannah Wilson
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Natalie L McEvoy
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Rosemarie Derwin
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Paul Chadwick
- Birmingham City University, Birmingham, UK; Spectral MD, London, UK.
| | - Declan Patton
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
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Tehan PE, Donnelly H, Martin E, Peterson B, Hawke F. Experiences and impact of a rural Australian high-risk foot service: A multiple-methods study. Aust J Rural Health 2024; 32:286-298. [PMID: 38337146 DOI: 10.1111/ajr.13087] [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: 06/15/2023] [Revised: 12/15/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE Most podiatry-led high-risk foot services (HRFS) in Australia are located in metropolitan areas or large regional centres. In rural areas, where there are limited specialist services, individuals with diabetes-related foot ulceration are more likely to undergo amputation. This study aimed to explore clinicians' perceptions of a recently implemented HRFS in rural New South Wales, Australia, and compare trends of amputation and hospitalisation prior to and post-implementation of the service. SETTING Rural HRFS in Tamworth, New South Wales, Australia. PARTICIPANTS Health professionals working within the HRFS were recruited to participate. DESIGN This was a multiple-methods study. For the qualitative arm, semi-structured interviews were conducted, which were analysed using a reflexive thematic approach. The quantitative arm of the study utilised a retrospective analytic design which applied an interrupted time series to compare amputation and hospitalisation trends pre- and post-implementation of the HRFS utilising diagnostic and procedural ICD codes. RESULTS The qualitative arm of the study derived three themes: (1) navigating the divide, (2) rural community and rural challenges and (3) professional identity. Results of the interrupted time series indicate that there was a downward trend in major amputations following implementation of the HRFS; however, this was not statistically significant. CONCLUSION Clinicians were aware of the inequity in DFD outcomes between rural and metropolitan areas and were committed to improving outcomes, particularly with respect to First Nations peoples. Future research will explore service use and amputation rates in the longer term to further evaluate this specialised multidisciplinary care in a rural community.
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Affiliation(s)
- Peta Ellen Tehan
- Subfaculty of Clinical and Molecular Sciences, Faculty of Medicine, Nursing and Allied Health, Monash University, Clayton, Victoria, Australia
- Podiatry and High Risk Foot Service, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Hailey Donnelly
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Emma Martin
- Podiatry and High Risk Foot Service, Hunter New England Local Health District, Tamworth, New South Wales, Australia
| | - Benjamin Peterson
- Department of Podiatry, School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Fiona Hawke
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Moses JC, Adibi S, Wickramasinghe N, Nguyen L, Angelova M, Islam SMS. Non-invasive blood glucose monitoring technology in diabetes management: review. Mhealth 2023; 10:9. [PMID: 38323150 PMCID: PMC10839510 DOI: 10.21037/mhealth-23-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/07/2023] [Indexed: 02/08/2024] Open
Abstract
Diabetes is one of the leading non-communicable diseases globally, adversely impacting an individual's quality of life and adding a considerable burden to the healthcare systems. The necessity for frequent blood glucose (BG) monitoring and the inconveniences associated with self-monitoring of BG, such as pain and discomfort, has motivated the development of non-invasive BG approaches. However, the current research progress is slow, and only a few BG self-monitoring devices have made considerable progress. Hence, we evaluate the available non-invasive glucose monitoring technologies validated against BG recordings to provide future research direction to design, develop, and deploy self-monitoring of BG with integrated emerging technologies. We searched five databases, Embase, MEDLINE, Proquest, Scopus, and Web of Science, to assess the non-invasive technology's scope in the diabetes management paradigm published from 2000 to 2020. A total of three approaches to non-invasive screening, including saliva, skin, and breath, were identified and discussed. We observed a statistical relationship between BG measurements obtained from non-invasive methods and standard clinical measures. Opportunities exist for future research to advance research progress and facilitate early technology adoption for healthcare practice. The results promise clinical validity; however, formulating regulatory guidelines could foresee the deployment of approved non-invasive BG monitoring technologies in healthcare practice. Further, research prospects are there to design, develop, and deploy integrated diabetes management systems with mobile technologies, data analytics, and the internet of things (IoT) to deliver a personalised monitoring system.
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Affiliation(s)
- Jeban Chandir Moses
- School of Information Technology, Deakin University, Melbourne, VIC, Australia
| | - Sasan Adibi
- School of Information Technology, Deakin University, Melbourne, VIC, Australia
| | - Nilmini Wickramasinghe
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Lemai Nguyen
- Department of Information Systems and Business Analytics, Deakin Business School, Deakin University, Melbourne, VIC, Australia
| | - Maia Angelova
- School of Information Technology, Deakin University, Melbourne, VIC, Australia
- Aston Digital Futures Institute, College of Physical Sciences and Engineering, Aston University, Birmingham, UK
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Perrin BM, Diacogiorgis D, Sullivan C, Gerrard J, Skinner I, Skinner TC, Nawaratne R, Alahakoon D, Kingsley MIC. Habitual Physical Activity of People with or at Risk of Diabetes-Related Foot Complications. SENSORS (BASEL, SWITZERLAND) 2023; 23:5822. [PMID: 37447670 DOI: 10.3390/s23135822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Regular physical activity is an important component of diabetes management. However, there are limited data on the habitual physical activity of people with or at risk of diabetes-related foot complications. The aim of this study was to describe the habitual physical activity of people with or at risk of diabetes-related foot complications in regional Australia. Twenty-three participants with diabetes from regional Australia were recruited with twenty-two participants included in subsequent analyses: no history of ulcer (N = 11) and history of ulcer (N = 11). Each participant wore a triaxial accelerometer (GT3X+; ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist for 14 days. There were no significant differences between groups according to both participant characteristics and physical activity outcomes. Median minutes per day of moderate-to-vigorous physical activity (MVPA) were 9.7 (IQR: 1.6-15.7) while participants recorded an average of 280 ± 78 min of low-intensity physical activity and 689 ± 114 min of sedentary behaviour. The sample accumulated on average 30 min of slow walking and 2 min of fast walking per day, respectively. Overall, participants spent very little time performing MVPA and were largely sedentary. It is important that strategies are put in place for people with or at risk of diabetes-related foot complications in order that they increase their physical activity significantly in accordance with established guidelines.
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Affiliation(s)
- Byron M Perrin
- La Trobe Rural Health School, La Trobe University, Bendigo 3552, Australia
- Holsworth Research Initiative, La Trobe University, Bendigo 3550, Australia
| | | | - Courtney Sullivan
- La Trobe Rural Health School, La Trobe University, Bendigo 3552, Australia
- Holsworth Research Initiative, La Trobe University, Bendigo 3550, Australia
| | - James Gerrard
- Central Australian Aboriginal Congress, Mparntwe (Alice Springs) 0870, Australia
| | - Isabelle Skinner
- La Trobe Rural Health School, La Trobe University, Bendigo 3552, Australia
| | - Timothy C Skinner
- School of Psychology and Public Health, La Trobe University, Bendigo 3552, Australia
| | - Rashmika Nawaratne
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora 3086, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora 3086, Australia
| | - Michael I C Kingsley
- La Trobe Rural Health School, La Trobe University, Bendigo 3552, Australia
- Holsworth Research Initiative, La Trobe University, Bendigo 3550, Australia
- Department of Exercise Sciences, University of Auckland, Auckland 1023, New Zealand
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Amazon Amandaba-Prevalence, Risk Factors and Self-Care Perception Associated with Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11040518. [PMID: 36833052 PMCID: PMC9956822 DOI: 10.3390/healthcare11040518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common complications of type 2 diabetes mellitus. There is a gradual loss of protective sensation in the skin and the function of the foot joints, increasing the risk of injury as the disease progresses. The objective of this study was to verify whether socioeconomic factors, health risk factors, and self-care are associated with DPN. METHODS Observational cross-sectional with 228 individuals of ≥30 years in Family Health Strategies in a city in the eastern Amazon, in northern Brazil, using questionnaires containing socioeconomic information, clinical and laboratory parameters, the Summary of Diabetes Self-Care Activities Questionnaire, and the Michigan Neuropathy Screening Instrument. RESULTS The prevalence of DPN was 66.6%. The presence of neuropathy is associated with male gender, dyslipidemia, and increased microalbuminuria. Logistic regression analysis revealed male subjects' increased BMI and altered HDL levels were associated with DPN. CONCLUSIONS In men with altered BMI, and dysregulation in biochemical parameters, neuropathy is more prevalent.
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Drovandi A, Seng L, Crowley B, Fernando ME, Golledge J. Health Professionals' Opinions About Secondary Prevention of Diabetes-Related Foot Disease. INT J LOW EXTR WOUND 2022:15347346221099798. [PMID: 35578540 DOI: 10.1177/15347346221099798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study explored health professionals' perceptions of current issues and opportunities for the secondary prevention of diabetes-related foot disease (DFD), and potential strategies for improving DFD care. From May to October 2020, relevant Australian health professionals completed an online survey which used ordinal scales, ranking questions, and open text fields to assess perceptions about the importance of aspects of secondary prevention for DFD and elements for a prevention program. Quantitative data were summarised and compared between professions using non-parametric tests, and qualitative data was analysed using conceptual content analysis to identify emerging themes. Perceptions from 116 health professionals with experience in managing patients with DFD were obtained, including 69 podiatrists, 21 vascular surgeons, 16 general practitioners, and ten nurses. Access and adherence to appropriate offloading footwear was perceived as a key element for effective DFD care, and believed to be affected by social and economic factors, such as the cost of footwear, as well as patient-related factors, such as motivation to wear footwear and adhere to other medical therapies. In addition to a lack of patient motivation and financial limitations, health professionals also believed patients lacked an understanding of the likelihood and severity of DFD recurrence. Several elements of care were perceived as missing from practice, including psychological support and ways to improve footwear adherence, with health professionals identifying several strategies for the design and implementation of an effective secondary prevention program. Prospective trials evaluating secondary prevention programs are required to determine the most effective means for preventing DFD recurrence.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Abstract
Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM). Patients with DFU have increased mortality and morbidity as well as decreased quality of life (QoL). The present scoping review aims to study the social issues of diabetic foot. Following PRISMA guidelines, the review was conducted in two databases (Scopus and Pubmed) with the use of the following keywords: “social aspects and diabetic foot”, “social characteristics and diabetic foot”, “social issues and diabetic foot”, “demographic profiles and diabetic foot”, “social determinants and diabetic foot”, “social capital and diabetic foot”, “social characteristics and gender and diabetic foot”, “social profiles and diabetic foot”, “social relationships and diabetic foot” and “social risk and diabetic foot”, from July to August 2021. Predetermined exclusion and inclusion criteria were selected. Forty-five studies (quantitative and qualitative) were eligible for inclusion in this review. Gender problems, socioeconomic status, social capital, and medical problems were the most important negative variables for diabetic foot. All the included variables reveal that the social impact of diabetic foot is the most important factor for management and prevention, in terms of aggravation and more, of the diabetic foot.
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Disparities in Advanced Peripheral Arterial Disease Presentation by Socioeconomic Status. World J Surg 2022; 46:1500-1507. [PMID: 35303132 PMCID: PMC9054861 DOI: 10.1007/s00268-022-06513-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/24/2022]
Abstract
Background Diabetes and peripheral arterial disease (PAD) often synergistically lead to foot ulceration, infection, and gangrene, which may require lower limb amputation. Worldwide there are disparities in the rates of advanced presentation of PAD for vulnerable populations. This study examined rates of advanced presentations of PAD for unemployed patients, those residing in low Index of Economic Resources (IER) areas, and those in rural areas of Australia. Methods A retrospective study was conducted at a regional tertiary care centre (2008–2018). To capture advanced presentations of PAD, the proportion of operative patients presenting with complications (gangrene/ulcers), the proportion of surgeries that are amputations, and the rate of emergency to elective surgeries were examined. Multivariable logistic regression adjusting for year, age, sex, Charlson Comorbidity Index, and sociodemographic variables was performed. Results In the period examined, 1115 patients underwent a surgical procedure for PAD. Forty-nine per cent of patients had diabetes. Following multivariable testing, the rates of those requiring amputations were higher for unemployed (OR 1.99(1.05–3.79), p = 0.036) and rural patients (OR 1.83(1.21–2.76), p = 0.004). The rate of presentation with complications was higher for unemployed (OR 7.2(2.13–24.3), p = 0.001), disadvantaged IER (OR 1.91(1.2–3.04), p = 0.007), and rural patients (OR 1.73(1.13–2.65), p = 0.012). The rate of emergency to elective surgery was higher for unemployed (OR 2.32(1.18–4.54), p = 0.015) and rural patients (OR 1.92(1.29–2.86), p = 0.001). Conclusions This study found disparities in metrics capturing delayed presentations of PAD: higher rates of presentations with complications, higher amputation rates, and increased rates of emergency to elective surgery, for patients of low socioeconomic status and those residing in rural areas. This suggests barriers to appropriate, effective, and timely care exists for these patients.
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The Effect of Structured Exercise Compared with Education on Neuropathic Signs and Symptoms in People at Risk of Neuropathic Diabetic Foot Ulcers: A Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2021; 58:medicina58010059. [PMID: 35056367 PMCID: PMC8777697 DOI: 10.3390/medicina58010059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/30/2023]
Abstract
Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.
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Ahmed MU, Tannous WK, Agho KE, Henshaw F, Turner D, Simmons D. Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study. J Foot Ankle Res 2021; 14:65. [PMID: 34915904 PMCID: PMC8680161 DOI: 10.1186/s13047-021-00501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. METHODOLOGY The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. RESULTS The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. CONCLUSION Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.
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Affiliation(s)
- Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Department of Economics, Finance and Property, School of Business, Western Sydney University, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Frances Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- ConvaTec, Building 5, Brandon Business Park, 530 Springvale Rd, Glen Waverley, VIC, 3150, Australia
| | - Deborah Turner
- School of Clinical Sciences, Podiatric Medicine, Kelvin Grove Campus, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - David Simmons
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Moodley RM, D'Almeida SS, Lameko V, Ghimire S. Novel Relationship Between Hemoglobin A1c Levels and Foot Ulcer Development Among Patients With Type 2 Diabetes Mellitus Admitted at Tupua Tamasese Meaole Hospital. Cureus 2021; 13:e20054. [PMID: 34993030 PMCID: PMC8720040 DOI: 10.7759/cureus.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
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Prevalence and Burden of Diabetes-Related Foot Disease in New South Wales, Australia: Evidence from the 45 and Up Study Survey Data Linked with Health Services Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111528. [PMID: 34770043 PMCID: PMC8582678 DOI: 10.3390/ijerph182111528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/13/2023]
Abstract
Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services' administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (<AUD 20,000), or were without private health insurance. Interventional messages to reduce all forms of DFD should target those who are from high-risk groups.
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Diacogiorgis D, Perrin BM, Kingsley MIC. Factors impacting the evidence-based assessment, diagnosis and management of Acute Charcot Neuroarthropathy: a systematic review. J Foot Ankle Res 2021; 14:26. [PMID: 33827640 PMCID: PMC8025319 DOI: 10.1186/s13047-021-00469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute Charcot Neuroarthropathy (CN) is a destructive condition that is characterised by acute fractures, dislocations and joint destruction in the weight-bearing foot. The acute phase is often misdiagnosed and can rapidly lead to devastating health outcomes. Early diagnosis and management of CN is imperative to attenuate progression of this condition. Consequently, timely evidence-based assessment, diagnosis and management of acute CN is imperative. OBJECTIVE To identify the factors that impact the delivery of evidence-based care in assessment, diagnosis and management of people with acute CN. METHOD Systematic searches were conducted in four databases to identify studies in English that included factors that impact the delivery of evidence-based care in the assessment, diagnosis and management of people with acute CN. Articles and consensus/guideline documents were assessed for inclusion by the researchers and disagreements were resolved through consensus. Additionally backward citation searching was used to source other potentially relevant documents. Information relevant to the research question was extracted and thematic analyses were performed using qualitative synthesis. RESULTS Thirty-two articles and four additional consensus/guideline documents were included for data extraction and analyses. Information related to the research question was of expert opinion using the National Health and Medical Research Council (NHMRC) Levels of Evidence guidelines. Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental. Delay to diagnosis is particularly influenced by the patient's knowledge of when to seek help, practitioner knowledge in knowing how to recognise and refer for appropriate immediate care, confusion in imaging and offloading and geographical and local health service resources to appropriately manage the condition. CONCLUSION Individual and health professional awareness and geographical barriers are key challenges to the effective delivery of evidence-based assessment, diagnosis and management of people with acute CN. Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate.
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Affiliation(s)
- D Diacogiorgis
- Department of Podiatry and Allied Health Assistants, Ballarat Health Services, Ballarat, Australia
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
| | - B M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia.
- Holsworth Research Initiative, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia.
| | - M I C Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
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Kim TI, Mena C, Sumpio BE. The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia. Int J Angiol 2020; 29:149-155. [PMID: 32904807 DOI: 10.1055/s-0040-1710075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease associated with high rates of limb loss. The primary goal of treatment in CLTI is limb salvage via revascularization. Multidisciplinary teams provide improved care for those with CLTI and lead to improved limb salvage rates. Not all patients are candidates for revascularization, and a subset will require major amputation. This article highlights the role of amputations in the management of CLTI, and describes the patients who should be offered primary amputation.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Carlos Mena
- Cardiology Section, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Bauer E Sumpio
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Cardiology Section, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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