1
|
Qin X, Yin Y, Liu L, Gao L, Han S, Duan Y, Ren W, Wang J. A retrospective cohort study on enhanced recovery after surgery (ERAS) in patients with diabetic foot ulcer. Sci Rep 2024; 14:18171. [PMID: 39107400 PMCID: PMC11303749 DOI: 10.1038/s41598-024-69150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P < 0.001) and lower hospital costs (CNY 62,165.27 vs. CNY 118,326.84; P < 0.001), as well as a higher patient satisfaction score and Barthel Index score (P < 0.05). Additionally, we found a lower APAIS score, incidence of DVT, and circumference reduction in lower limbs in the ERAS group compared to the non-ERAS group (P < 0.05). In comparison, the wound healing time, nutritional status, and pain levels of participants in both groups showed no significant difference (P > 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures.Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).
Collapse
Affiliation(s)
- Xinyuan Qin
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Yefeng Yin
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Lei Gao
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Siyang Han
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Yijie Duan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Weiyan Ren
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Jiangning Wang
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China.
| |
Collapse
|
2
|
Zhou PB, Sun HT, Bao M. Comparative Analysis of the Efficacy of Spinal Cord Stimulation and Traditional Debridement Care in the Treatment of Ischemic Diabetic Foot Ulcers: A Retrospective Cohort Study. Neurosurgery 2024; 95:313-321. [PMID: 38334381 PMCID: PMC11219160 DOI: 10.1227/neu.0000000000002866] [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: 09/06/2023] [Accepted: 12/26/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal cord stimulation (SCS) is an effective treatment for diabetic peripheral neuropathy. The purpose of this study was to investigate the effectiveness of SCS in the treatment of ischemic diabetic foot ulcers. METHODS In this retrospective study, the SCS group comprised 102 patients with ischemic diabetic foot who were treated with SCS for foot ulcers and nonhealing wounds due to severe lower limb ischemia. The traditional debridement care (TDC) group comprised 104 patients with ischemic diabetic foot who received only TDC. Strict screening criteria were applied. The assignment of patients to either group depended solely on their willingness to be treated with SCS. Secondary end points were transcutaneous partial pressure of oxygen (PtcO 2 ), ankle-brachial index (ABI), and color Doppler of the lower limb arteries in the feet at 6 months and 12 months after treatment. The primary end point was the amputation. RESULTS The dorsal foot PtcO 2 and ABI of the patients in the SCS group were significantly improved at 6 months and 12 months postoperation ( P < .05). The therapeutic efficacy was significantly better than that of the TDC group over the same period of time ( P < .05). The degree of vasodilation of the lower limb arteries (ie, femoral, popliteal, posterior tibial, and dorsalis pedis arteries) on color Doppler was higher in the SCS group than in the TDC group ( P < .05). The odds ratios for total amputation at 6 and 12 months postoperatively in the SCS group were 0.45 (95% CI, 0.19-1.08) and 0.17 (95% CI, 0.08-0.37), respectively, compared with the TDC group. CONCLUSION SCS improved symptoms of lower limb ischemia in ischemic diabetic feet and reduced the rate of toe amputation by increasing PtcO 2 , ABI, and arterial vasodilation in the lower limbs.
Collapse
Affiliation(s)
- Peng-Bo Zhou
- The First School of Clinical Medical, Lanzhou University, Lanzhou, Gansu, People's Republic of China
- Tianjin Key Laboratory of Neurotrauma Repair, Characteristic Medical Center of People's Armed Police Forces, Tianjin, People's Republic of China
| | - Hong-Tao Sun
- The First School of Clinical Medical, Lanzhou University, Lanzhou, Gansu, People's Republic of China
- Tianjin Key Laboratory of Neurotrauma Repair, Characteristic Medical Center of People's Armed Police Forces, Tianjin, People's Republic of China
| | - Min Bao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| |
Collapse
|
3
|
Sucrose Octasulfate-Impregnated Dressings for Adults With Difficult-to-Heal Noninfected Diabetic Foot Ulcers and Difficult-to-Heal Noninfected Venous Leg Ulcers: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2024; 24:1-101. [PMID: 39070301 PMCID: PMC11271442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Diabetic foot ulcers and venous leg ulcers may not always heal in a timely manner despite proper wound care. Treatments that improve the healing rate of these ulcers would improve clinical outcomes for patients and may result in downstream cost savings for the health care system. We conducted a health technology assessment of sucrose octasulfate-impregnated dressings for adults with difficult-to-heal noninfected diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding sucrose octasulfate-impregnated dressings, and patient preferences and values. Methods We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and analyzed the budget impact of publicly funding sucrose octasulfate-impregnated dressings for adults with difficult-to-heal noninfected diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers in Ontario. We did not conduct a primary economic evaluation because there is existing evidence to approximate the cost-effectiveness of sucrose octasulfate-impregnated dressings in Ontario. We leveraged 4 previous health technology assessments to explore the perspectives and experiences of patients with diabetic foot ulcers and venous leg ulcers, as well as the perspectives and experiences of their care partners. Results We included 3 randomized controlled trials and 2 subsequent publications of these randomized controlled trials in the clinical evidence review. Compared with dressings that do not contain sucrose octasulfate, sucrose octasulfate-impregnated dressings result in faster wound closure in patients with difficult-to-heal noninfected neuroischemic diabetic foot ulcers (GRADE: Moderate) and reduce ulcer size and improve health-related quality of life in the domains of pain/discomfort and anxiety/depression for patients with difficult-to-heal noninfected venous leg ulcers (GRADE: Moderate). The use of sucrose octasulfate-impregnated dressings with noninfected wounds is considered safe (GRADE: Moderate).The economic evidence showed that, compared with dressings that do not contain sucrose octasulfate, sucrose octasulfate-impregnated dressings are highly likely to be cost-effective for both difficult-to-heal noninfected diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers and would lead to cost savings due to faster and increased complete wound healing. The annual budget impact of publicly funding sucrose octasulfate-impregnated dressings in Ontario over the next 5 years would range from cost savings of $0.93 million in year 1 to $0.62 million in year 5 for adults with difficult-to-heal noninfected diabetic foot ulcers, and cost savings of $0.8 million in year 1 to $0.53 million in year 5 for adults with difficult-to-heal noninfected venous leg ulcers. Overall, we estimate that publicly funding sucrose octasulfate-impregnated dressings in Ontario for adults with difficult-to-heal noninfected diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers would lead to total cost savings of $3.91 million and $3.38 million, respectively, over the next 5 years.Patients with diabetic foot ulcers and venous leg ulcers discussed the effects of living with these wounds, as well as their treatment journey. They spoke about the burden of their condition and its negative impact on their daily lives, including mobility, employment, social activities, and mental health. Patients also spoke about the variety of treatment options available and the financial barriers to accessing these treatments. Conclusions Sucrose octasulfate-impregnated dressings are safe and improve the healing of difficult-to-heal noninfected neuroischemic diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers compared with dressings that do not contain sucrose octasulfate. We estimate that publicly funding sucrose octasulfate-impregnated dressings in Ontario would result in cost savings for both difficult-to-heal noninfected diabetic foot ulcers and difficult-to-heal noninfected venous leg ulcers. Evidence from patient engagement suggests that people with diabetic foot ulcers or venous leg ulcers face negative impacts on their quality of life, especially related to mobility. Patients spoke about their challenges, including long and difficult care journeys, as well as trying different treatment options to heal their ulcers and avoid amputation. It is not clear if the participants had direct experience with sucrose octasulfate-impregnated dressings, so we could not draw specific conclusions about these dressings from the preferences and values evidence.
Collapse
|
4
|
Shi H, Yuan X, Fan W, Yang X, Liu G. Stem Cell Therapy for Diabetic Foot: An Umbrella Review of Systematic Reviews and Meta-Analyses. Adv Wound Care (New Rochelle) 2024; 13:201-216. [PMID: 38149885 DOI: 10.1089/wound.2023.0136] [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] [Indexed: 12/28/2023] Open
Abstract
Objective: This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of stem cell therapy for diabetic foot (DF). Approach: We conducted a comprehensive search in four databases for SRs/MAs that included randomized controlled trials (RCTs) on stem cell therapy for DF. Two separate researchers independently evaluated the methodological quality and evidence quality of the SRs/MAs that were included in the study. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Egger's test and sensitivity analysis are used to examine the reliability of the results. Results: This umbrella review includes eight SRs/MAs, and their methodological quality and evidence quality were all deemed unsatisfactory. Out of the 8 SRs/MAs, 26 RCTs were included, with a total corrected covered area of 21.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that DF patients can benefit from stem cell therapy, as indicated by effectiveness in measures, including healing rate, amputation rate, ankle-brachial index, transcutaneous oxygen pressure, ulcer size reduction, complete healing time, pain-free walking distance, rest pain score, and new angiogenesis rate. Innovation: This study conducted a comprehensive evaluation and reanalysis of the current evidence regarding the effectiveness and safety of stem cell therapy for DF, which is the first of its kind. Conclusion: Based on the existing evidence, stem cell therapy is effective and safe for patients with DF.
Collapse
Affiliation(s)
- Hongshuo Shi
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Yuan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weijing Fan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Yang
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guobin Liu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
5
|
Haghdoost A, Mobayen M, Baghi I, Haghani‐Dogahe Z, Zarei R, Pirooz A, Balou HA, Feizkhah A. Potassium permanganate in treatment of diabetic foot ulcer: A randomized clinical trial. Health Sci Rep 2024; 7:e2073. [PMID: 38650725 PMCID: PMC11033332 DOI: 10.1002/hsr2.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/03/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Diabetic foot ulcers (DFU) are a severe complication in diabetes patients, often resulting in significant morbidity and mortality due to non-healing. This study investigated the effectiveness of 5% topical potassium permanganate on these ulcers. Methods A clinical trial was conducted on 23 patients with Wagner grade I and II DFU. Patients in the control group received standard treatment, while those in the intervention group also received 5% potassium permanganate topically. Data were recorded at 0, 7, 14, and 21 days for analysis. Results Among 23 patients studied, 7 (30.4%) were male and 16 (43.7%) female, with an average age of 59 ± 4 years. Both groups showed a statistically significant decrease in wound size and infection over time (p < 0.001). The intervention group, however, had a more substantial reduction in wound size and infection rate (p < 0.05). Conclusion Potassium permanganate, when applied topically, is both well-tolerated and effective in enhancing wound healing and reducing infection in DFU, suggesting its potential as a complementary treatment.
Collapse
Affiliation(s)
- Afrooz Haghdoost
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Iraj Baghi
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Zahra Haghani‐Dogahe
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Reza Zarei
- Department of Statistics, Faculty of Mathematical SciencesUniversity of GuilanRashtIran
| | - Amir Pirooz
- Clinical Research Development Unit of Poursina HospitalGuilan University of Medical SciencesRashtIran
| | - Heydar Ali Balou
- School of Medicine, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| |
Collapse
|
6
|
Shi HS, Yuan X, Wu FF, Li XY, Fan WJ, Yang X, Hu XM, Liu GB. Research progress and challenges in stem cell therapy for diabetic foot: Bibliometric analysis and perspectives. World J Stem Cells 2024; 16:33-53. [PMID: 38292441 PMCID: PMC10824042 DOI: 10.4252/wjsc.v16.i1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Stem cell therapy has shown great potential for treating diabetic foot (DF). AIM To conduct a bibliometric analysis of studies on the use of stem cell therapy for DF over the past two decades, with the aim of depicting the current global research landscape, identifying the most influential research hotspots, and providing insights for future research directions. METHODS We searched the Web of Science Core Collection database for all relevant studies on the use of stem cell therapy in DF. Bibliometric analysis was carried out using CiteSpace, VOSviewer, and R (4.3.1) to identify the most notable studies. RESULTS A search was conducted to identify publications related to the use of stem cells for DF treatment. A total of 542 articles published from 2000 to 2023 were identified. The United States had published the most papers on this subject. In this field, Iran's Shahid Beheshti University Medical Sciences demonstrated the highest productivity. Furthermore, Dr. Bayat from the same university has been an outstanding researcher in this field. Stem Cell Research & Therapy is the journal with the highest number of publications in this field. The main keywords were "diabetic foot ulcers," "wound healing," and "angiogenesis." CONCLUSION This study systematically illustrated the advances in the use of stem cell therapy to treat DF over the past 23 years. Current research findings suggested that the hotspots in this field include stem cell dressings, exosomes, wound healing, and adipose-derived stem cells. Future research should also focus on the clinical translation of stem cell therapies for DF.
Collapse
Affiliation(s)
- Hong-Shuo Shi
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Xin Yuan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Fang-Fang Wu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Xiao-Yu Li
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Wei-Jing Fan
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Xiao Yang
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Xiao-Ming Hu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China
| | - Guo-Bin Liu
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 250021, China.
| |
Collapse
|
7
|
Frescos N, Stopher L, Jansen S, Kaminski MR. The financial burden of diabetes-related foot disease in Australia: a systematic review. J Foot Ankle Res 2023; 16:92. [PMID: 38151723 PMCID: PMC10751954 DOI: 10.1186/s13047-023-00688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. METHODS Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. RESULTS Three economic evaluations were included in the review. One study was rated as 'poor', one as 'very good' and one as 'excellent' when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. CONCLUSION There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. TRIAL REGISTRATION PROSPERO Registration No. CRD42022290910.
Collapse
Affiliation(s)
- Nicoletta Frescos
- Austin Health, Melbourne, VIC, Australia.
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - Lucy Stopher
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Shirley Jansen
- Sir Charles Gairdner Hospital, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Department of Podiatry, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied healthcare, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Sussman G. An update on wound management. Aust Prescr 2023; 46:29-35. [PMID: 38053564 PMCID: PMC10664094 DOI: 10.18773/austprescr.2023.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Wound management involves an understanding of the aetiology and pathophysiology of a wound, the healing process and how best to manage both. Acute wounds can occur suddenly, such as burns and skin tears. Chronic wounds fail to progress through the normal stages of healing and can include ulcers, pressure injuries and infected wounds. Dressings and bandages provide the optimal environment for the healing of all wound types. It is important for healthcare practitioners to understand the key differences in their properties, uses and precautions. Selecting the ideal dressing or bandage can minimise the healing duration, reduce the bioburden, and improve a patient's quality of life.
Collapse
Affiliation(s)
- Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University
| |
Collapse
|
10
|
Nube VL, Alison JA, Twigg SM. Diabetic foot ulcers: weekly versus second-weekly conservative sharp wound debridement. J Wound Care 2023; 32:383-390. [PMID: 37300856 DOI: 10.12968/jowc.2023.32.6.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diabetic foot ulcers (DFU) are a serious and costly long-term complication of diabetes, and are one of the most prevalent hard-to-heal (chronic) wound types. Conservative sharp wound debridement (CSWD) is a mainstay of care. It is performed regularly until healing is achieved (when there is adequate blood flow for healing) to support endogenous healing and improve the efficacy of advanced healing therapies. CSWD is supported by evidence-based treatment guidelines, despite a lack of prospective studies. The first prospective randomised study to compare different frequencies of CSWD-the Diabetes Debridement Study (DDS)-showed no difference in healing outcomes at 12 weeks between those ulcers debrided weekly and those debrided every second week. A DFU may require more or less frequent debridement according to individual wound characteristics; however, the new data from DDS can inform clinical decisions and service provision. The implications of weekly versus second-weekly debridement are discussed.
Collapse
Affiliation(s)
- Vanessa L Nube
- Royal Prince Alfred Hospital Department of Podiatry, Sydney Local Health District, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jennifer A Alison
- Sydney Local Health District Professorial Unit, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney
| | - Stephen M Twigg
- Sydney Medical School (Central), Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
11
|
Matijević T, Talapko J, Meštrović T, Matijević M, Erić S, Erić I, Škrlec I. Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes. World J Clin Cases 2023; 11:1669-1683. [PMID: 36970006 PMCID: PMC10037285 DOI: 10.12998/wjcc.v11.i8.1669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.
Collapse
Affiliation(s)
- Tatjana Matijević
- Department of Dermatology and Venereology, University Hospital Center Osijek, Osijek 31000, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation and the Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States
| | - Marijan Matijević
- Department of Surgery, National Memorial Hospital Vukovar, Vukovar 32000, Croatia
| | - Suzana Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Radiotherapy and Oncology, Clinical Hospital Center Osijek, Osijek 31000, Croatia
| | - Ivan Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Surgery, Osijek University Hospital Centre, Osijek 31000, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| |
Collapse
|
12
|
Pappachan JM, Cassidy B, Fernandez CJ, Chandrabalan V, Yap MH. The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future. World J Diabetes 2022; 13:1131-1139. [PMID: 36578875 PMCID: PMC9791570 DOI: 10.4239/wjd.v13.i12.1131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/01/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Foot ulcers are common complications of diabetes mellitus and substantially increase the morbidity and mortality due to this disease. Wound care by regular monitoring of the progress of healing with clinical review of the ulcers, dressing changes, appropriate antibiotic therapy for infection and proper offloading of the ulcer are the cornerstones of the management of foot ulcers. Assessing the progress of foot ulcers can be a challenge for the clinician and patient due to logistic issues such as regular attendance in the clinic. Foot clinics are often busy and because of manpower issues, ulcer reviews can be delayed with detrimental effects on the healing as a result of a lack of appropriate and timely changes in management. Wound photographs have been historically useful to assess the progress of diabetic foot ulcers over the past few decades. Mobile phones with digital cameras have recently revolutionized the capture of foot ulcer images. Patients can send ulcer photographs to diabetes care professionals electronically for remote monitoring, largely avoiding the logistics of patient transport to clinics with a reduction on clinic pressures. Artificial intelligence-based technologies have been developed in recent years to improve this remote monitoring of diabetic foot ulcers with the use of mobile apps. This is expected to make a huge impact on diabetic foot ulcer care with further research and development of more accurate and scientific technologies in future. This clinical update review aims to compile evidence on this hot topic to empower clinicians with the latest developments in the field.
Collapse
Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
| | - Bill Cassidy
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
| | | | - Vishnu Chandrabalan
- Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Moi Hoon Yap
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
| |
Collapse
|
13
|
Bastami F, Mardani M, Rezapour P. Development and psychometric analysis of a new tool to assess food literacy in diabetic patients. BMC Nutr 2022; 8:134. [PMCID: PMC9666971 DOI: 10.1186/s40795-022-00626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
One of the factors affecting self-care in diabetic patients is food literacy, which helps said patients in following a healthy diet. Thus, it is crucial to analyze food literacy in diabetic patients through suitable and reliable instruments.
Objective
The current study aimed to design a questionnaire for food literacy assessment in diabetic patients and analyze its psychometric features.
Method
The present study was a cross-sectional descriptive analysis carried out in 2021. Firstly, the concepts of food literacy in diabetic patients were identified and the questionnaire was deigned based on them. Secondly, its face and content validities and its reliability were analyzed. Finally, the construct validity was analyzed by exploratory factor analysis. The study was carried out on 300 diabetic participants chosen at random via stratified cluster sampling from Health service centers. The exploratory factor analysis was carried out by extracting the main factors and using varimax rotation with eigenvalue values more than 1.
Results
A five-pronged structure accounted for 52.745% of food literacy variance. This included the ability to read food facts, practical ability to group foods, the ability to identify the caloric content of different foods, the ability to understand the effect of food on health, and the ability to prepare a healthy meal. Items with an impact score below 1.5 were discarded. Additionally, items with CVR scores below 0.62 and CVI scores below 0.79 were deleted too. The Kaiser-Meyer-Okin measurement was 0.836 (p < 0.001). Alpha Cronbach Scale dimension was 0.610–0.951.
Conclusion
The results of this study showed that the exploratory dimensions of the current study were consistent with health literacy measurements, such as functional, interactive, and critical food literacy. This scale has acceptable reliability and validity. Health professionals can use this scale to analyze and improve food literacy in diabetic patients. This is a new instrument and thus far no questionnaire has been made to evaluate food literacy in diabetic patients.
Collapse
|
14
|
Da Porto A, Miranda C, Brosolo G, Zanette G, Michelli A, Ros RD. Nutritional supplementation on wound healing in diabetic foot: What is known and what is new? World J Diabetes 2022; 13:940-948. [PMID: 36437863 PMCID: PMC9693742 DOI: 10.4239/wjd.v13.i11.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/13/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Non-healing diabetic foot ulcers (DFU) are the most notable and striking complications of diabetes mellitus. More than 25% of nonhealing DFU can ultimately lead to amputation of the lower extremity within 6-18 mo after the first manifestation of the wound. Although wound healing is complex, nutritional status is crucial in soft tissue repair. Malnutrition is highly prevalent and overlooked in patients with diabetes and chronic wounds. Moreover, to date, we do not have clear recommendations or evidence about the use of nutritional supplements for improving wound healing in patients with DFU. In this article the authors briefly analyzed the current evidence on the use of nutritional supplements of proteins or amino acids, fatty acids, probiotics, vitamins, and trace elements in the wound healing process in patients with DFU.
Collapse
Affiliation(s)
- Andrea Da Porto
- Department on Internal Medicine, University of Udine, Udine 33100, Italy
| | - Cesare Miranda
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism Diseases Azienda Sanitaria Friuli Occidentale, Pordenone 33170, Italy
| | - Gabriele Brosolo
- Department on Internal Medicine, University of Udine, Udine 33100, Italy
| | - Giorgio Zanette
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism Diseases Azienda Sanitaria Friuli Occidentale, Pordenone 33170, Italy
| | - Andrea Michelli
- Department of Internal Medicine , SC Diabete e Centro Trattamento Piede Diabetico, Monfalcone 34074, Gorizia, Italy
| | - Roberto Da Ros
- Department of Internal Medicine , SC Diabete e Centro Trattamento Piede Diabetico, Monfalcone 34074, Gorizia, Italy
| |
Collapse
|
15
|
Sun Y, Zhao J, Zhang L, Li Z, Lei S. Effectiveness and safety of stem cell therapy for diabetic foot: a meta-analysis update. Stem Cell Res Ther 2022; 13:416. [PMID: 35964145 PMCID: PMC9375292 DOI: 10.1186/s13287-022-03110-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetic foot (DF) is one of the most common and serious complications of diabetes mellitus (DM), which brings great psychological and economic pressure to patients. This study aimed to evaluate the efficacy of stem cells in the treatment of diabetic foot. METHODS All relevant studies in Cochrane, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, and WanFang databases were systematically searched for meta-analysis. The outcomes consisted of ulcer or wound healing rate, amputation rate, new vessels, ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), pain-free walking distance, and rest pain score. Dichotomous outcomes were described as risk ratios (RR) with 95% confidence intervals (CIs), while continuous data were presented as standardized mean differences (SMDs) with 95% CIs. Statistical analysis was performed with RevMan 5.3 software. RESULTS A total of 14 studies with 683 participants were included in the meta-analysis. Meta-analysis showed that stem cell therapy was more effective than conventional therapy in terms of ulcer or wound healing rate [OR = 8.20 (5.33, 12.62)], improvement in lower extremity ischemia(new vessels) [OR = 16.48 (2.88, 94.18)], ABI [MD = 0.13 (0.04, 0.08)], TcO2[MD = 4.23 (1.82, 6.65)], pain-free walking distance [MD = 220.79 (82.10, 359.48)], and rest pain score [MD = - 1.94 (- 2.50, - 1.39)], while the amputation rate was significantly decreased [OR = 0.19 (0.10, 0.36)]. CONCLUSIONS The meta-analysis of the current studies has shown that stem cells are significantly more effective than traditional methods in the treatment of diabetic foot and can improve the quality of life of patients after treatment. Future studies should conduct large-scale, randomized, double-blind, placebo-controlled, multicenter trials with high-quality long-term follow-up to demonstrate the most effective cell types and therapeutic parameters for the treatment of diabetic foot.
Collapse
Affiliation(s)
- Yuming Sun
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Jinhong Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lifang Zhang
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Zhexuan Li
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
| | - Shaorong Lei
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
| |
Collapse
|
16
|
Commons RJ, Charles J, Cheney J, Lynar SA, Malone M, Raby E. Australian guideline on management of diabetes-related foot infection: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:47. [PMID: 35676695 PMCID: PMC9178854 DOI: 10.1186/s13047-022-00545-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes-related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up-to-date evidence-based guidelines to ensure optimal management of patients with diabetes-related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence-based guideline for people with a diabetes-related foot infection. METHODS Following Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation. RESULTS Of 36 original diabetes-related foot infection IWGDF sub-recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub-recommendations' intended population. One sub-recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence-based sub-recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes-related foot infection in Australia. Additionally, we incorporated these sub-recommendations into two clinical pathways to assist Australian health professionals to implement these evidence-based sub-recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ . CONCLUSIONS A new national guideline for the diagnosis and management of people with diabetes-related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence-based framework to ensure best management of individuals with diabetes-related foot infections across Australia and highlight considerations for implementation and monitoring.
Collapse
Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Internal Medical Services, Ballarat Health Services, Ballarat, Australia.
| | - James Charles
- First Peoples Health Unit, Faculty of Health Griffith University, Gold Coast, Australia
| | | | - Sarah A Lynar
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Infectious Diseases Unit, Royal Darwin Hospital, Darwin, Australia
| | - Matthew Malone
- South West Sydney Limb Preservation and Wound Research, South Western Sydney LHD, Liverpool, Sydney, Australia
- Infectious Diseases and Microbiology, School of Medicine Western Sydney University, Campbelltown Campus, Sydney, Australia
| | - Edward Raby
- Infectious Diseases Department, Royal Perth Hospital, Perth, Australia
- Department of Microbiology, Fiona Stanley Hospital Network, PathWest Laboratory Medicine, Murdoch, Australia
| |
Collapse
|