1
|
Fuentevilla-Alvarez G, Soto ME, Robles-Herrera GJ, Vargas-Alarcón G, Sámano R, Meza-Toledo SE, Huesca-Gómez C, Gamboa R. Analysis of Circulating miRNA Expression Profiles in Type 2 Diabetes Patients with Diabetic Foot Complications. Int J Mol Sci 2024; 25:7078. [PMID: 39000190 PMCID: PMC11241130 DOI: 10.3390/ijms25137078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with various complications, including diabetic foot, which can lead to significant morbidity and mortality. Non-healing foot ulcers in diabetic patients are a major risk factor for infections and amputations. Despite conventional treatments, which have limited efficacy, there is a need for more effective therapies. MicroRNAs (miRs) are small non-coding RNAs that play a role in gene expression and have been implicated in diabetic wound healing. miR expression was analyzed through RT-qPCR in 41 diabetic foot Mexican patients and 50 controls. Diabetic foot patients showed significant increases in plasma levels of miR-17-5p (p = 0.001), miR-191-5p (p = 0.001), let-7e-5p (p = 0.001), and miR-33a-5p (p = 0.005) when compared to controls. Elevated levels of miR-17, miR-191, and miR-121 correlated with higher glucose levels in patients with diabetic foot ulcers (r = 0.30, p = 0.004; r = 0.25, p = 0.01; and r = 0.21, p = 0.05, respectively). Levels of miR-17 showed the highest diagnostic potential (AUC 0.903, p = 0.0001). These findings underscore the possible role of these miRs in developing diabetes complications. Our study suggests that high miR-17, miR-191, and miR-121 expression is strongly associated with higher glucose levels and the development of diabetic foot ulcers.
Collapse
Affiliation(s)
- Giovanny Fuentevilla-Alvarez
- Endocrinology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico;
| | - María Elena Soto
- Research Direction, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico; (M.E.S.); (G.V.-A.)
- Cardiovascular Line in American British Cowdary (ABC) Medical Center, Sur 136 No. 116 Col. Las Américas, Mexico City 01120, Mexico
| | - Gustavo Jaziel Robles-Herrera
- Phisiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico; (G.J.R.-H.); (C.H.-G.)
| | - Gilberto Vargas-Alarcón
- Research Direction, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico; (M.E.S.); (G.V.-A.)
| | - Reyna Sámano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Sergio Enrique Meza-Toledo
- Biochemistry Department, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (IPN), Mexico City 11340, Mexico;
| | - Claudia Huesca-Gómez
- Phisiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico; (G.J.R.-H.); (C.H.-G.)
| | - Ricardo Gamboa
- Phisiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Col. Sección XVI, Mexico City 14080, Mexico; (G.J.R.-H.); (C.H.-G.)
| |
Collapse
|
2
|
Yıldırım Ayaz E, Dincer B, Oğuz A. The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022; 21:234-253. [PMID: 35711163 DOI: 10.1177/15347346221109047] [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: 11/15/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: -0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
Collapse
Affiliation(s)
- Elif Yıldırım Ayaz
- University of Health Sciences, 506079Sultan Abdülhamid Han Training and Research Hospital, Internal Medicine Clinic, İstanbul, Turkey
| | - Berna Dincer
- Faculty of Health Sciences, Department of Medical Nursing, Istanbul 226842Medeniyet University, İstanbul, Turkey
| | - Aytekin Oğuz
- 64071Istanbul Medeniyet University Göztepe Prof. Dr Süleyman Yalçın City Hospital, Internal Medicine Clinic, İstanbul, Turkey
| |
Collapse
|
3
|
Chiang N, Wang J, Marie N, Wu A, Ravindra R, Robinson D. Evaluation of Clinical Outcomes Following Minor Amputations in Australia - An Important Consideration for Timing of Revascularisation. Ann Vasc Surg 2021; 76:389-398. [PMID: 33905853 DOI: 10.1016/j.avsg.2021.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/06/2021] [Accepted: 03/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Vascular patients with tissue loss requiring minor amputations could be an early sign of a terminal event. The long-term outcomes and timing of revascularisation for these patients are not well-studied. The aim of this study was to determine the clinical outcomes following minor amputations. Primary outcomes were functional status, limb loss, and mortality. Secondary outcomes compared immediate and delayed revascularisation. METHODS A retrospective analysis of 200 vascular patients who required minor amputations at Austin Hospital, Melbourne was performed over 5 years. Demographics, details of revascularisation, functional status, and clinical outcomes such as recurrent tissue loss, limb loss and death were recorded. RESULTS Of the entire cohort requiring minor amputations, 118 (59%) patients underwent revascularisation. 111 (94%) revascularisation procedures were performed within 90 days of minor amputation. Over all 5-year limb preservation was 89.9%. Patients who required revascularisation were not statistically significantly more at risk for limb loss at 5 years [13.6% vs. 6.6%; P=0.08]. Limb salvage at 1 year was not different between groups revascularized before and after amputation [89.5% vs. 90.9%; P=0.70]. Over all 5-year mortality rate was 50%. In the diabetic subset, those who had revascularisation after minor amputation had a greater 5-year mortality [67.9% vs. 50%; P=0.03]. A scoring system based on risk factors was developed but was not reliable based on the study data. CONCLUSIONS The data from this study suggest that patients with diabetes who undergo revascularisation after minor amputation have worse outcomes than those revascularised prior to minor amputation. A predictive model applied at presentation could help detect high-risk patients but requires further work.
Collapse
Affiliation(s)
- Nathaniel Chiang
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Judy Wang
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia.
| | - Natalie Marie
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Angela Wu
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Raevin Ravindra
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| | - Domenic Robinson
- Department of Vascular Surgery, Austin Health, Melbourne Victoria Australia
| |
Collapse
|
4
|
Zhang Y, van Netten JJ, Baba M, Cheng Q, Pacella R, McPhail SM, Cramb S, Lazzarini PA. Diabetes-related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations. J Foot Ankle Res 2021; 14:8. [PMID: 33468226 PMCID: PMC7816323 DOI: 10.1186/s13047-021-00447-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations. Methods We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators. Results Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0–58.8%, of DFD from 1.2–1.5%, and the incidence of diabetes-related amputation ranged from 5.2–7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2–36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3–43.3%, DFD from 7.0–15.1% and amputation during hospitalisation from 1.4–5.8%. Conclusions Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00447-x.
Collapse
Affiliation(s)
- Yuqi Zhang
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Jaap J van Netten
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mendel Baba
- Podiatry Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Qinglu Cheng
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Peter A Lazzarini
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia. .,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
| |
Collapse
|
5
|
Linton C, Searle A, Hawke F, Tehan PE, Chuter V. Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit. J Foot Ankle Res 2021; 14:6. [PMID: 33435997 PMCID: PMC7805117 DOI: 10.1186/s13047-020-00445-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13). Conclusion This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.
Collapse
Affiliation(s)
- Clare Linton
- BE130 Health Precinct, Brush Road, Ourimbah, NSW, 2258, Australia. .,Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia. .,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, NSW, Australia.
| | - Angela Searle
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Fiona Hawke
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Peta Ellen Tehan
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Vivienne Chuter
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| |
Collapse
|
6
|
Clinical outcome and determinants of amputation in a large cohort of Iranian patients with diabetic foot ulcers. Foot (Edinb) 2020; 45:101688. [PMID: 33011496 DOI: 10.1016/j.foot.2020.101688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Determining the predictive factors of diabetes foot ulcer (DFU) development and lower extremity amputations (LEA) in patients with diabetes mellitus (DM) is of great importance to compose risk stratification models. The aim of this study is to investigate the outcome and predictors of LEA in patients with DFU in large sample of Iranian patients. METHODS This prospective cohort study was conducted during a 2-year period from 2014 to 2016, in Shiraz, southern Iran. All the patients with type 1 and 2 DM and DFU were included in the cohort and were followed for 2 years at least. They were visited in the clinic on a monthly basis and development of new DFU and LEA were recorded. The two-year free-DFU survival and predictors of the DFU development and LEA were recorded. Multivariate regression models were used to determine the factors. RESULTS A total number of 432 patients with mean age of 56.8 ± 13.3 years were included. The two-year DFU-free survival rate was 0.826. The two-year DFU-free survival was associated with male gender (p = 0.005), foot deformity (p = 0.002), history of prior DFU (p < 0.001), cigarette smoking (p = 0.032), nephropathy (p = 0.005), retinopathy (p = 0.007), ischemic heart disease (p = 0.043), and neuropathy (p < 0.001). CONCLUSION Development of new DFU is associated with higher age, longer duration of disease, and type I diabetes. LEA was associated with increased white blood cell (WBC), Creatinine and ulcer history for major amputation and ulcer history, fasting blood sugar (FBS), infection, revascularization history, and foot deformity, for minor amputation.
Collapse
|
7
|
Treatment of Diabetic Foot with Autologous Stem Cells: A Meta-Analysis of Randomized Studies. Stem Cells Int 2020; 2020:6748530. [PMID: 32724314 PMCID: PMC7381994 DOI: 10.1155/2020/6748530] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/16/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background This meta-analysis was to evaluate the efficacy of autologous stem cell administration for the treatment of diabetic foot. Methods The electronic databases included PubMed, EMBASE, BIOSIS, Cochrane central, and Google Scholar internet, last updated on May 30, 2019. Evaluated outcomes included the rate of wound healing and amputation. Dichotomous outcomes were described as risk ratios (RR) with 95% confidence intervals (CIs). Statistical analysis was performed with RevMan 5.0 software and STATA 10.0 software. Results Eight randomized controlled trial (RCT) studies were included in this study. The meta-analysis showed a lower amputation (RR 0.25, 95% CI 0.11 to 0.54, I2 = 0) and a higher wound healing rate (RR 2.05, 95% CI 1.67 to 2.51, I2 = 4) in the cell therapy group compared with control. Conclusion This meta-analysis supports the effective role of stem cell therapy in promoting wound healing and decreasing rate of amputation in diabetic foot. In the future, more high quality and well-designed studies are need.
Collapse
|
8
|
Qin X, Wang J. [Clinical study of local injection of autologous platelet-rich plasma in treatment of diabetic foot ulcer]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1547-1551. [PMID: 31823556 PMCID: PMC8355805 DOI: 10.7507/1002-1892.201905124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/07/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the effectiveness of local injection of autologous platelet-rich plasma (PRP) in treatment of diabetic foot ulcer. METHODS Between October 2017 and October 2018, 90 diabetic foot ulcer patients who met the selection criteria were randomly divided into 3 groups: PRP injection group (group A, PRP was injected and hydrogel dressing covered the wounds), PRP covered group (group B, PRP gel and hydrogel dressing covered the wounds), and the control group (group C, hydrogel dressing covered the wounds), 30 cases in each group. There was no significant difference in gender, age, injured side, disease duration, preoperative glycosylated hemoglobin, wound size, and Wagner grading between groups (P>0.05). The frequency of treatments and hospitalization day in all groups and the total amount of PRP application in groups A and B were recorded. The wound healing condition was recorded during the treatment, and the wound healing rate was calculated at 3 months after the first debridement. RESULTS The frequency of treatments in groups A, B, and C were (10.2±0.8), (11.4±0.6), (12.5±0.5) times, respectively. The total amount of PRP application of groups A and B were (306±24) and (342±18) mL, respectively. There was no significant difference in the frequency of treatments and the total amount of PRP application between groups (P>0.05). The hospitalization days of groups A, B, and C were (40.5±1.8), (62.1±2.3), and (88.6±1.4) days, respectively, showing significant differences between groups (P<0.05). In the course of treatment, the necrosis and exudation of the wounds gradually reduced, the areas of wounds gradually reduced; and the above conditions of group A were significantly better than groups B and C, and group B was better than group C. At 3 months after the first debridement, the wound healing rates of groups A, B, and C were 93.2%±0.8%, 52.1%±1.1%, and 21.3%±1.3%, respectively, with significant differences between groups (P<0.05). CONCLUSION PRP can effectively promote the repair of diabetic foot ulcer. The effectiveness of local injection of PRP is superior to the local coverage.
Collapse
Affiliation(s)
- Xinyuan Qin
- Department of Orthopaedic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, P.R.China
| | - Jiangning Wang
- Department of Orthopaedic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038,
| |
Collapse
|
9
|
Lazzarini PA, van Netten JJ, Fitridge RA, Griffiths I, Kinnear EM, Malone M, Perrin BM, Prentice J, Wraight PR. Pathway to ending avoidable diabetes-related amputations in Australia. Med J Aust 2019; 209:288-290. [PMID: 30257626 DOI: 10.5694/mja17.01198] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/09/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Ian Griffiths
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD
| | | | | | - Byron M Perrin
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC
| | - Jenny Prentice
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD
| | | |
Collapse
|
10
|
Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, Cheraghian B, Latifi SM. Prevalence and related risk factors of diabetic foot ulcer in Ahvaz, south west of Iran. Diabetes Metab Syndr 2018; 12:519-524. [PMID: 29602761 DOI: 10.1016/j.dsx.2018.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to evaluate the prevalence of diabetic foot ulcer and its related risk factors. MATERIALS AND METHODS In this descriptive cross-sectional study, 605 patients with diabetes were evaluated in July 2014. A checklist was used to obtain demographic data, diabetes related data, past medical history, and physical examination data. RESULTS The prevalence of diabetic foot ulcer was 6.4% (95% CI: 4.64-8.73). Seventeen cases of them were female (4.9%). In univariate analysis, the following variables had statistically significant relationship with DFU prevalence: diabetes duration, educational level, 10 g monofilament sensation, Ankle Brachial Index (ABI) and Body Mass Index (BMI). Patients' age, glycemic control and smoking did not show any significant relationship with DFU. After logistic regression analysis, the patients with decreased 10 g monofilament sensation had DFU more than patients with normal sensation (OR = 8.84, 95% CI: 3.5-22.3). Abnormal ABI increased the odds of DFU (OR = 5.6, 95% CI: 1.3-24.18). The DFU prevalence in patients with diabetes duration of 11-20 years, was more than patients with ≤5 years (OR = 3.8, 95% CI: 1.33-10.8).The odds of DFU development in educated patients compared with illiterate patients was 0.27(95% CI: 0.12-0.57). BMI had a significant relationship with DFU prevalence. The odds in overweight patients was 0.259(95% CI: 0.108-0.623) and in obese patients was 0.263 (95% CI: 0.1-0.687). CONCLUSION The prevalence of DFU was 6.4% in this study. Final associated risk factors of DFU were decreased 10 g monofilament sensation, abnormal ABI, diabetes duration, educational level and BMI.
Collapse
Affiliation(s)
- Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Iraj Nazari
- Department of Vascular Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Reza Arti
- Department of Orthopedic, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Ahmadi
- Infectious Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mahmoud Latifi
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
11
|
Abstract
Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073.
Collapse
Affiliation(s)
- Önder İ. Kılıçoğlu
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Şamil Aktaş
- Department of Underwater and Hyperbaric Medicine, İstanbul University, Istanbul Faculty of Medicine, Turkey
| |
Collapse
|