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Legiawati L, Bramono K, Indriatmi W, Yunir E, Pratama AI. Type 2 Diabetes Mellitus with Early Dry Skin Disorder: A Comparison Study Between Primary and Tertiary Care in Indonesia. Curr Diabetes Rev 2022; 18:e060821195350. [PMID: 34365924 DOI: 10.2174/1573399817666210806102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of Type 2 Diabetes Mellitus (T2DM) in Indonesia has continued to increase over the years. Management of T2DM is challenging across clinical settings, including primary and tertiary care. Uncontrolled T2DM puts patients at risk of the development of T2DM complications, especially early-stage dry skin that is neglected by most of the patients. This study aimed to investigate the comparison between the T2DM management profile and dry skin clinical profile of T2DM patients in primary care and tertiary care settings. METHODS The study was conducted as a cross-sectional epidemiological study by comparing T2DM patient profiles in primary and tertiary care. The data collected included sociodemographic, clinical, and laboratory data that were correlated with T2DM and early dry skin related-T2DM. This study included early dry skin within the SRRC score of 3-11 and excluded infection, ulcer, and severe erythema. RESULTS The patients in primary and tertiary care presented poorly controlled T2DM with median HbA1c levels of 7.8% and 7.6%. The patients in primary care also presented with high triglyceride, 179 mg/dl. Furthermore, several significant differences were found in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin). CONCLUSION Significant differences in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin) might be affected by the parameter of T2DM glycemic control (Blood pressure (BP), body mass index (BMI), HbA1c, random blood glucose (RBG), and triglyceride).
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Affiliation(s)
- Lili Legiawati
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl Salemba Raya No. 6, Central Jakarta 10430, Indonesia
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl Salemba Raya No. 6, Central Jakarta 10430, Indonesia
| | - Wresti Indriatmi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl Salemba Raya No. 6, Central Jakarta 10430, Indonesia
| | - Em Yunir
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl Salemba Raya No. 6, Central Jakarta 10430, Indonesia
| | - Aditya Indra Pratama
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl Salemba Raya No. 6, Central Jakarta 10430, Indonesia
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Lira JAC, Nogueira LT, Oliveira BMAD, Soares DDR, Santos AMRD, Araújo TMED. Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care. Rev Esc Enferm USP 2021; 55:e03757. [PMID: 34320142 DOI: 10.1590/s1980-220x2020019503757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze factors associated with diabetic foot risk in patients with diabetes mellitus assisted in Primary Care. METHOD Observational, analytic, and transversal study took place in Teresina, Piauí, with diabetic patients who are assisted in Primary Care. Data collection took place through interviews, foot clinical exams, and medical record analysis. We used the Mann-Whitney, Pearson's Chi-square and multiple logistic regression statistics tests to analyze the data. The association power among categorical variables was measured by Odds Ratio . RESULTS 322 patients participated. Marital status with a partner presented a protection factor (p = 0.007). Risk factors for the development of the diabetic foot are: arterial hypertension (p = 0.045), obesity (p = 0.011), smoking (p = 0.027), not being submitted to follow ups (p = 0.046), inadequate control of capillary blood glucose (p < 0.001), indisposition to the care of the foot (p=0.014), and foot self-exam less frequently (p = 0.040). CONCLUSION Sociodemographic, clinical, and self-care aspects interfere in diabetic foot development, highlighting the necessity of effective follow up tracking and educational interventions for patients with diabetes mellitus in Primary Care.
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Yovera-Aldana M, Velásquez-Rimachi V, Huerta-Rosario A, More-Yupanqui MD, Osores-Flores M, Espinoza R, Gil-Olivares F, Quispe-Nolazco C, Quea-Vélez F, Morán-Mariños C, Pinedo-Torres I, Alva-Diaz C, Pacheco-Barrios K. Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis. PLoS One 2021; 16:e0251642. [PMID: 33984049 PMCID: PMC8118539 DOI: 10.1371/journal.pone.0251642] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC). MATERIALS AND METHODS We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach. RESULTS Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0-55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6-17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty. CONCLUSION The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.
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Affiliation(s)
- Marlon Yovera-Aldana
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Victor Velásquez-Rimachi
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Andrely Huerta-Rosario
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Facultad de Medicina Hipólito Unanue, Universidad Nacional Federico Villarreal, Lima, Perú
| | - M. D. More-Yupanqui
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Servicio de Patología, Departamento de Ayuda Diagnóstico, Hospital Daniel Alcides Carrión, Callao, Perú
| | - Mariela Osores-Flores
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Ricardo Espinoza
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Fradis Gil-Olivares
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Unidad de Guías de Práctica Clínica, AUNA, Lima, Perú
| | | | - Flor Quea-Vélez
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
| | - Christian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú
| | - Isabel Pinedo-Torres
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Servicio de Endocrinología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrín, Callao, Perú
| | - Carlos Alva-Diaz
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Kevin Pacheco-Barrios
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Noronha JAF, Azevedo C, Moura CDC, Gusmão ECR, Cardoso ACLR, Chianca TCM. Altered touch perception and associated risk factors in individuals with diabetes mellitus. Rev Bras Enferm 2020; 73:e20190473. [DOI: 10.1590/0034-7167-2019-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/17/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the prevalence of altered touch perception in the feet of individuals with diabetes mellitus and the associated risk factors. Method: Cross-sectional study with 224 individuals with diabetes mellitus conducted in an endocrinology clinic at a public hospital in Campina Grande, Paraíba. The evaluation used touch sensitivity and perception, and a descriptive and multivariate analysis with Poisson regression was performed. Results: We found the prevalence of altered touch perception to be 53.1%. The risk factors that had a significant and joint impact on its occurrence were: female gender; previous ulcer; diabetes mellitus type 2; burning sensation, cracks, fissures, calluses, and Charcot foot. Conclusions: This study found a high prevalence of altered perception of touch, and this should support the planning of actions aimed at preventing the problem. The study showed the relevance of the phenomenon as a nursing diagnosis that could be included in NANDA-International.
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Lechner A, Akdeniz M, Tomova-Simitchieva T, Bobbert T, Moga A, Lachmann N, Blume-Peytavi U, Kottner J. Comparing skin characteristics and molecular markers of xerotic foot skin between diabetic and non-diabetic subjects: An exploratory study. J Tissue Viability 2019; 28:200-209. [PMID: 31575473 DOI: 10.1016/j.jtv.2019.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Xerosis cutis of the feet is one of the most common skin conditions among type 2 diabetics. Whether skin dryness among diabetic patients is different from 'general' skin dryness is unclear. The overall aim was to compare the structure, function and molecular markers of dry and cracked foot skin between diabetics and non-diabetics. METHODS The foot skin of 40 diabetics and 20 non-diabetics was evaluated. A clinical assessment of skin dryness was performed and transepidermal water loss, stratum corneum hydration, skin surface pH, epidermal thickness, skin roughness, elasticity and structural stiffness were measured. Ceramides, natural moisturizing factors, histamines, proteins and molecular markers of oxidative stress were analyzed based on a non-invasive sampling method for collection of surface biomarkers. RESULTS The mean number of superficial fissures in the diabetic group was nearly three times higher than in the non-diabetic group (11.0 (SD 6.2) vs. 3.9 (SD 4.2)). The skin stiffness was higher in the diabetic group and the values of almost all molecular markers showed considerably higher values compared to non-diabetics. Malondialdehyde and glutathione were lower in the diabetic sample. CONCLUSIONS The high number of superficial fissures may be based on an increased stiffness of dry diabetic foot skin combined with different concentrations of molecular markers in the stratum corneum compared to dry foot skin of non-diabetics.
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Affiliation(s)
- Anna Lechner
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Merve Akdeniz
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Tsenka Tomova-Simitchieva
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Thomas Bobbert
- Charité-Universitätsmedizin Berlin, Department of Diabetology and Endocrinology, Berlin, Germany.
| | | | | | - Ulrike Blume-Peytavi
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Berlin, Germany.
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Khan MIH, Azhar U, Zubair F, Khan ZA. Can we link foot ulcer with risk factors in diabetics? A study in a tertiary care hospital. Pak J Med Sci 2018; 34:1375-1380. [PMID: 30559788 PMCID: PMC6290204 DOI: 10.12669/pjms.346.16199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/10/2018] [Accepted: 10/23/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Although many studies worldwide explained the risk factors for developing Diabetic Foot Ulceration (DFU), little has been done to assess medical factors in DFU formation and link them in patients of Pakistan. This study aimed to link the DFU with different risk factors. METHODS This descriptive cross-sectional retrospective study was conducted in Diabetes Endocrine and Metabolic Centre / Post Graduate Medical Institute / Lahore General Hospital. Data of all patients presenting between July 2017 to June 2018 were analyzed for risk factors. Analysis was done on SPSS version 21. RESULTS Total of 3301 patient were seen during this period, out of which 2052 patient data was picked up as it was complete in respect to the information needed. Middle age, Male gender, Type 2 diabetes, and Hypertension, were insignificantly co-related. High waist circumference, Comorbidity like Neuropathy, Dyslipidemia, Greater body mass index, Poor compliance with Medication and type of medication used (combination of oral and injectable) were found statistically significant predictor for DFU. However retinopathy was not found to be a risk factor of DFU. This result was statistically significant. CONCLUSION Factors like obesity, waist circumference, combination of oral along with injectable therapies, neuropathy, dyslipidemia, retinopathy and poor compliance with medication were statistically significant and can be strongly linked with diabetic foot ulcer. Middle age, Male gender, Type 2 diabetes, and Hypertension were insignificantly co-related. However, further studies are needed in larger population to support these findings.
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Affiliation(s)
- Muhammad Imran Hassan Khan
- Dr. M. Imran Hasan Khan, MBBS (Pb) MRCP (UK), FCPS (MED), MRCPS (Glas), FRCP (Edin) FRCP (Glas) FRCP (LONDON) Department of Medicine, Ameer-ud-Din Medical College/ PGMI, Lahore General Hospital, Lahore, Pakistan
| | - Usama Azhar
- Usama Azhar, (Final Year MBBS) Department of Medicine, Ameer-ud-Din Medical College/ PGMI, Lahore General Hospital, Lahore, Pakistan
| | - Fizza Zubair
- Fizza Zubair, (Final Year MBBS) Department of Medicine, Ameer-ud-Din Medical College/ PGMI, Lahore General Hospital, Lahore, Pakistan
| | - Zohaib Abbas Khan
- Zohaib Abbas Khan, Director technical (Add), Drug Testing Laboratory, Punjab, Rawalpindi
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