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dos Santos VP, de Andrade Barberino MGM, Alves CAS. Microbiological Species and Antibiotic Resistance in Diabetic and Nondiabetic Lower Extremity Wounds: A Comparative Cross-Sectional Study. INT J LOW EXTR WOUND 2024; 23:338-346. [PMID: 34747258 PMCID: PMC11059827 DOI: 10.1177/15347346211053936] [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: 11/17/2022]
Abstract
Severe lower extremity wounds have an increased risk of complications and limb loss. The aim of this study was to evaluate and compare the microbiological profile and antibiotic resistance of wounds in diabetic and nondiabetic patients. A cross-sectional comparative study was carried out at a public hospital including 111 patients with moderate to severe wound infections. Tissue samples were collected during a surgical procedure. One hundred and four patients (94%) had positive cultures and 88 (79%) had a Gram-negative microorganism. Among the 185 cultured microorganisms, 133 (72%) were Gram-negative species. Pseudomonas aeruginosa (23 cases) was the most isolated Gram-negative species, and Enterococcus faecalis (26 cases) was the most prevalent Gram-positive species. Among 185 isolated species, 45 (24%) were extended-spectrum beta-lactamase producers, 23 (12%) were carbapenem-resistant, and 5 (3%) were methicillin-resistant Staphylococcus aureus. Findings revealed that there was no significant difference in the microbiological profile and antibiotic resistance among patients with lower extremity wounds whether they were diabetic or nondiabetic.
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Rosa LDS, Mistro S, Oliveira MG, Kochergin CN, Cortes ML, de Medeiros DS, Soares DA, Louzado JA, Silva KO, Bezerra VM, Amorim WW, Barone M, Passos LC. Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting. Front Pharmacol 2021; 11:588309. [PMID: 33542687 PMCID: PMC7851089 DOI: 10.3389/fphar.2020.588309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20-$10,683.53 and 0.33-0.37 for POC-A1c test group, and $9,288.28-$10,413.99 and 0.08-0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model's result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.
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Affiliation(s)
- Lorena de Sousa Rosa
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Sóstenes Mistro
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Marcio Galvão Oliveira
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Mateus Lopes Cortes
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Danielle Souto de Medeiros
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - José Andrade Louzado
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Kelle Oliveira Silva
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Vanessa Moraes Bezerra
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Welma Wildes Amorim
- Departament of Natural Sciences, State University of Southwest Bahia, Vitória da Conquista, Brazil
| | - Mark Barone
- Intersectoral Forum to Fight NCDs in Brazil, São Paulo, Brazil
| | - Luiz Carlos Passos
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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Souza Júnior EÁ, Camargo RSSD, Baumfeld TS, Baumfeld DS, Macedo BD. Diabetic foot and its serial treatment in high-risk patients: focusing on the individual. ACTA ACUST UNITED AC 2020; 66:1542-1547. [PMID: 33295407 DOI: 10.1590/1806-9282.66.11.1542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.
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Bahia LR, da Rosa MQM, Araujo DV, Correia MG, dos Rosa RDS, Duncan BB, Toscano CM. Economic burden of diabetes in Brazil in 2014. Diabetol Metab Syndr 2019; 11:54. [PMID: 31303899 PMCID: PMC6604164 DOI: 10.1186/s13098-019-0448-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/24/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetes and its complications produce significant clinical, economic and social impact. The knowledge of the costs of diabetes generates subsidies to maintain the financial sustainability of public health and social security systems, guiding research and health care priorities. AIMS The aim of this study was to estimate the economic burden of diabetes in Brazilian adults in 2014, considering the perspectives of the public health care system and the society. METHODS A prevalence-based approach was used to estimate the annual health resource utilization and costs attributable to diabetes and related conditions. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmic procedures, and costs related to end stage renal disease. The costs of hospitalization attributed to diabetes related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency, and then converted to international dollars (2014). RESULTS Based on a national self-reported prevalence of 6.2%, the total cost of diabetes in 2014 was Int$ 15.67 billion, including Int$ 6.89 billion in direct medical costs (44%), Int$ 3.69 billion in non-medical costs (23.6%) and Int$ 5.07 billion in indirect costs (32.4%). Outpatient costs summed Int$ 6.62 billion and the costs of 314,334 hospitalizations attributed to diabetes and related conditions was Int$ 264.9 million. Most hospitalizations were due to cardiovascular diseases (47.9%), followed by diabetes itself (18%), and renal diseases (13.6%). Diet and transportation costs were estimated at Int$ 3.2 billion and Int$ 462.3 million, respectively. CONCLUSIONS Our results showed a substantial economic burden of diabetes in Brazil, and most likely are underrated as they are based on an underestimated prevalence of diabetes. Healthcare policies aiming at diabetes prevention and control are urgently sought.
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Affiliation(s)
- Luciana Ribeiro Bahia
- Internal Medicine Department, Institute for Health Technology Assessment, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77-Vila Isabel, Rio de Janeiro, RJ 20551-030 Brazil
| | - Michelle Quarti Machado da Rosa
- Internal Medicine Department, Institute for Health Technology Assessment, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77-Vila Isabel, Rio de Janeiro, RJ 20551-030 Brazil
| | - Denizar Vianna Araujo
- Internal Medicine Department, Institute for Health Technology Assessment, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77-Vila Isabel, Rio de Janeiro, RJ 20551-030 Brazil
| | - Marcelo Goulart Correia
- Biostatistics and Bioinformatics Department, National Institute of Cardiology, Rio de Janeiro, Brazil
| | | | - Bruce Bartholow Duncan
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristiana Maria Toscano
- Collective Health Department, Institute for Health Technology Assessment, Federal University of Goiânia, Goiânia, Brazil
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Santos KPBD, Luz SCTD, Mochizuki L, d'Orsi E. Burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, 2008-2013. CAD SAUDE PUBLICA 2018; 34:e00013116. [PMID: 29412312 DOI: 10.1590/0102-311x00013116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/25/2017] [Indexed: 11/22/2022] Open
Abstract
The objective was to estimate the burden of disease from lower limb amputations attributable to diabetes mellitus in Santa Catarina State, Brazil, from 2008 to 2013. A descriptive epidemiological study was performed by calculating disability-adjusted life years (DALY). Burden of disease was high, more than 8,000 DALY in men and women. Disability accounted for 93% of DALY and mortality for 7.5%. The burden in men was 5,580.6 DALY, almost double that in women (2,894.8), and the share of the years lost due to disability (YLD) component in men pushed this rate to 67.6% of total DALY. Men live longer following amputation, so they lose more years of healthy life (65.8%), while mortality is higher in women (61%). DALY rates were not distributed homogeneously across the state. The intensification of evaluation, planning, and development of cost-effective strategies for prevention and health education for diabetic foot should be oriented according to higher male vulnerability.
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Affiliation(s)
| | | | | | - Eleonora d'Orsi
- Universidade Federal de Santa Catarina, Florianópolis, Brasil
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Toscano CM, Sugita TH, Rosa MQM, Pedrosa HC, Rosa RDS, Bahia LR. Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010089. [PMID: 29316689 PMCID: PMC5800188 DOI: 10.3390/ijerph15010089] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 12/30/2022]
Abstract
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
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Affiliation(s)
- Cristiana M Toscano
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Tatiana H Sugita
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Michelle Q M Rosa
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | | | - Roger Dos S Rosa
- Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Luciana R Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
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Costa RHR, Cardoso NA, Procópio RJ, Navarro TP, Dardik A, de Loiola Cisneros L. Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia. Diabetes Metab Syndr 2017; 11 Suppl 2:S583-S587. [PMID: 28465149 DOI: 10.1016/j.dsx.2017.04.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Foot ulcer is also a clinical marker for limb amputation and for death in diabetic patients. The purpose of this study was to determine amputation and mortality rates and its associated factors in patients with diabetic foot ulcerations in a tertiary hospital in Brazil. METHODS Retrospective medical records from 654 diabetic foot patients were reviewed. The risk factors were determined using the conditional logistic regression model analysis. RESULTS The mean patient age was 63.1 years (SD 12.20). Peripheral arterial disease was present in 160 patients (24.5%). Major amputations were performed in 135 (21%). The in-hospital mortality rate was 12% and the mortality rate of the amputees was 22.2%. The lowest hemoglobin level, the median value was 9.50g/dL, (4.0-17.0). Anemia was detected in 89.6% of patients submitted to amputation and in 82,1% of those who died. Hemoglobin <11g/dL was the most significant risk factor for major amputation (odds ratio 5.57, p<0.0001). The presence of peripheral arterial disease and old age were also a risk for major amputation (odds ratio 1.84, p=0.007 and 1.02, p=0.028, respectively). Factors associated with increased risk for death were hemoglobin <11g/dL (odds ratio 4.04, p<0.001), major amputation (1.79, p=0.03) and old age (1.05, p<0,001). CONCLUSIONS Diabetic foot ulcer is associated with high amputation and mortality rates. Old age, peripheral arterial disease and low hemoglobin level are risk factor for major amputation. Old age, major amputation and low hemoglobin level are risk factors for death.
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Affiliation(s)
| | - Natália Anício Cardoso
- Post-Graduate Program for Surgery and Ophthalmology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ricardo Jayme Procópio
- Endovascular Unit of University Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Túlio Pinho Navarro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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de Sousa RG, Batista KDNM. Laser therapy in wound healing associated with diabetes mellitus - Review. An Bras Dermatol 2016; 91:489-93. [PMID: 27579745 PMCID: PMC4999108 DOI: 10.1590/abd1806-4841.20163778] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/12/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the most effective parameter in healing wounds related to diabetes mellitus, as well as the most widely used type of laser. METHODOLOGY consisted of bibliographic searching the databases Bireme, SciELO, PubMed/Medline and Lilacs by using the keywords related to the topic. Were selected from these keywords, papers discussing the use of laser on wounds associated with diabetes, published in the period 2005-2014, in Portuguese or English. RESULTS After analyzing the research, 12 studies consistent with the theme were selected. CONCLUSION Based on this review, the studies that showed more satisfactory results in healing diabetic wounds were those who applied energy densities in the range of 3-5 J/cm2, power densities equal to or below 0.2 W/cm2 and continuous emission. The He-Ne laser with a wavelength of 632.8 nm was used more often.
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Oliveira AFD, Oliveira Filho HD. Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections. J Vasc Bras 2014. [DOI: 10.1590/1677-5449.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction:Diabetic foot infections are a difficult problem to solve, often requiring hospitalization and exposing patients to the risk of amputations. Identification of the most prevalent pathogens is useful for administration of antibiotic therapy, and can reduce mutilations.Objective:To identify the microbiological profile and resistance to antimicrobial drugs in a series of patients with infected diabetic feet.Material and methods:an epidemiological, retrospective and descriptive study based on analysis of medical records from diabetic patients with plantar lesions who underwent surgical treatment over a 24-month period at a public hospital. Data were collected on age, sex, length of hospital stay, cultures from lesions, antibiotic therapy administered, bacterial resistance and surgeries conducted, with statistical analysis of means and standard deviations.Results:There were 66 admissions of diabetic patients, the majority elderly people (77%). Hospital stays ranged from 2 to 29 days, with a mean of 12.42. There were 91 surgical procedures, resulting in some kind of amputation in 65% of cases. The most common bacterial group was enterobacteria (47%), followed by staphylococci (27%). Three patients (4.5%) had multi-resistant organisms. Resistance to clindamycin was the most common at 39 admissions (59%), followed by resistance to cephalexin, seen in 24 admissions (36%).Conclusions:Diabetic foot infections were most often caused by germs found in the community, in particular the enterococci. Bacterial resistance was very widespread and was most commonly associated with drugs for oral administration, in particular clindamycin and cephalexin.
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The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration. Wien Klin Wochenschr 2014; 127:45-50. [PMID: 25398288 DOI: 10.1007/s00508-014-0630-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabetic patients with acute foot ulceration. METHODS A total of 55 type 2 diabetic patients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner's classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA1C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded. RESULTS WBC and CRP were significantly higher in lower-extremity amputation (LEA) group (p = 0.001 and p = 0.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values < 0.001). Glycemic control parameters (i.e., HbA1C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (r = - 0.512, p < 0.001) with length of stay. WBC, ESR, CRP, Wagner grade, and severity of infection showed positive correlation with length of stay (r = 0.493, p < 0.001; r = 0.271, p = 0.045; r = 0.299, p = 0.027; r = 0.434, p = 0.001; and r = 0.464, p < 0.001, respectively). CONCLUSIONS Baseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabetic patients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.
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Oliveira AFD, De Marchi ACB, Leguisamo CP, Baldo GV, Wawginiak TA. Estimativa do custo de tratar o pé diabético, como prevenir e economizar recursos. CIENCIA & SAUDE COLETIVA 2014; 19:1663-71. [DOI: 10.1590/1413-81232014196.09912013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho estimamos o custo do tratamento hospitalar do pé diabético e discutimos a literatura referente à profilaxia destas lesões. Para isto revisamos os prontuários dos pacien tes submetidos a tratamento cirúrgico num período de 16 meses em um hospital público e revisamos os métodos de prevenção do pé diabético. Foram 44 internações com duração média de 11,93 dias (± 6,34), 61 procedimentos cirúrgicos, com amputações em 65% dos casos. Encontramos um custo médio de R$ 4.367,05 (± 9.249,01) e um custo total de R$ 192.150,40 para estes tratamentos hospitalares. O tratamento do pé diabético teve um alto custo e exigiu amputações na maioria dos casos. A revisão da literatura evidenciou diversos modelos possíveis de serem adotados para atuar na profilaxia de lesões associadas ao pé diabético, os quais podem evitar amputações e economizar recursos.
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Chu YJ, Li XW, Wang PH, Xu J, Sun HJ, Ding M, Jiao J, Ji XY, Feng SH. Clinical outcomes of toe amputation in patients with type 2 diabetes in Tianjin, China. Int Wound J 2014; 13:175-81. [PMID: 24629051 DOI: 10.1111/iwj.12249] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 12/11/2022] Open
Abstract
The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes. This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non-healing) and was followed for a 5-year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated. The rate of wound healing was 82·4%. The rate of follow-up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living. Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long-term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.
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Affiliation(s)
- Yue-Jie Chu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xi-Wen Li
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Peng-Hua Wang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jun Xu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Hao-Jie Sun
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Min Ding
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jiao Jiao
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xiao-Yan Ji
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shu-hong Feng
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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Santos VPD, Alves CAS, Fidelis C, Araújo Filho JSD. Análise das arteriografias de diabéticos e não diabéticos com isquemia crítica da perna. Rev Assoc Med Bras (1992) 2013. [DOI: 10.1590/s0104-42302013000600008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RESUMO OBJETIVO: Comparar características angiográficas de pacientes diabéticos e não diabéticos com isquemia crítica. MÉTODOS: Foram incluídos 161 membros inferiores de pacientes com isquemia crítica infrainguinal. Avaliaram-se as características clínicas e arteriográficas (número e presença de opacificação das artérias da perna) dos dois grupos de pacientes. A análise estatística foi realizada pelo EPI-INFO RESULTADOS: A maioria dos pacientes era categoria 5da Classificação de Rutherford e apresentava doença do território fêmoro-poplíteo. Opacificação da artéria fibular foi encontrada em 72% dos não diabéticos e em 67% dos diabéticos (p = 0,25), sendo esta a artéria mais presente em ambos os grupos. Os diabéticos apresentaram menor índice de opacificação da artéria tibial posterior na análise univariada (29% vs. 47%; p = 0,008). Na regressão logística, apenas o sexo feminino se mostrou significante para a ausência da artéria tibial posterior (OR = 2,6; p = 0,01) CONCLUSÃO: A artéria fibular foi a mais encontrada nas angiografias de diabéticos e não diabéticos com isquemia crítica. Diabéticos e não diabéticos não diferiram em relação ao padrão angiográfico da perna.
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Santos VPD, Alves CAS, Fidelis C, Araújo Filho JSD. Arteriographic findings in diabetic and non-diabetic with critical limb ischemia. Rev Assoc Med Bras (1992) 2013; 59:557-62. [PMID: 24211015 DOI: 10.1016/j.ramb.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To compare angiographic findings of diabetic and non-diabetic patients with critical limb ischemia. METHODS We included 161 patients with infrainguinal critical limb ischemia (CLI). We evaluated the clinical and arteriographic (number and presence of opacification of leg arteries) of the two groups of patients. Statistical analysis was performed using EPI-INFO. RESULTS Most patients were category 5 of Rutherford's Classification and had femoropopliteal disease. Seventy-two percent of non-diabetic and 67% of diabetic had opacification of the fibular artery (p = 0.25), this is the most present artery in both groups. Diabetic patients had less opacification of the posterior tibial artery in the univariate analysis (29% vs. 47%, p = 0.008). But only female sex showed a significant risk for the absence of the posterior tibial artery in logistic regression (OR = 2.6; p = 0.01). CONCLUSION The peroneal artery was the most frequently artery in angiograms of diabetic and non-diabetic patients with CLI. Diabetic and non-diabetic patients did not differ in angiographic findings of the leg.
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Affiliation(s)
- Vanessa Prado dos Santos
- Instituto de Humanidades Artes e Ciências Professor Milton Santos, Universidade Federal da Bahia, Salvador, BA, Brasil.
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Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MCR. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 2013; 44:119-24. [PMID: 23124278 DOI: 10.1007/s12020-012-9829-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/23/2012] [Indexed: 12/20/2022]
Abstract
Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81-6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01-20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
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Affiliation(s)
- Arnaldo Moura Neto
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Gehling Bertoldi E, Marcolino MS, Rohde LEP, Luiz Ribeiro A, Polanczyk CA. Cost-Effectiveness of Routine Screening for Cardiac Toxicity in Patients Treated with Imatinib in Brazil. Value Health Reg Issues 2012; 1:180-183. [DOI: 10.1016/j.vhri.2012.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nita ME, Eliaschewitz FG, Ribeiro E, Asano E, Barbosa E, Takemoto M, Donato B, Rached R, Rahal E. Custo-efetividade e impacto orçamentário da saxagliptina como terapia adicional à metformina para o tratamento do diabetes mellitus tipo 2 no sistema de saúde suplementar do Brasil. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000300008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70198-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Marinho MGDS, Cesse EÂP, Bezerra AFB, Sousa IMCD, Fontbonne A, Carvalho EFD. [Analysis of health care costs of patients with diabetes mellitus and hypertension in a public health reference unit in Recife--Brazil]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2011; 55:406-11. [PMID: 22011857 DOI: 10.1590/s0004-27302011000600007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 08/07/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze health care costs of patients with diabetes mellitus and hypertension, and to estimate the cost of medium complexity outpatient procedures, compared with the standard reimbursement values used in Brazil. MATERIALS AND METHODS We analyzed direct health costs in a public health reference unit in Recife/PE, in 2007. Costs were determined and allocated using the techniques of absorption costing and apportionment. RESULTS Direct costs and the amount reimbursed by the SUS totaled R$ 4,855,291.82 and R$ 2.118.893,56, respectively. The greatest groups of expenditure were medications, with R$ 1,762,424.42 (36.3%), outsourced services, with R$ 996,637.82 (20.5%); and personnel, with R$ 978,096.10 (20.1%). All procedures had higher estimated costs than what is reimbursed by the SUS. CONCLUSIONS Drugs were associated with the highest health care costs, a considerable difference was observed between estimated costs and the amount reimbursed by the SUS.
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Affiliation(s)
- Michelly Geórgia da Silva Marinho
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Rua Mário Campelo 201/406, Recife, PE, Brazil.
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Marcelo D, Beatriz PM, Jussara R, Fabiana B. Tissue therapy with autologous dermal and epidermal culture cells for diabetic foot ulcers. Cell Tissue Bank 2011; 13:241-9. [DOI: 10.1007/s10561-011-9249-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 03/09/2011] [Indexed: 11/28/2022]
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Rezende KF, Ferraz MB, Malerbi DA, Melo NH, Nunes MP, Pedrosa HC, Chacra AR. Predicted annual costs for inpatients with diabetes and foot ulcers in a developing country-a simulation of the current situation in Brazil. Diabet Med 2010; 27:109-12. [PMID: 20121897 DOI: 10.1111/j.1464-5491.2009.02871.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS The objective of this cost-of-illness analysis was to quantify the annual costs associated with hospital admission for people with diabetes and foot ulcers in Brazil. METHODS A hypothetical cohort was simulated using a decision tree model. Prevalence and incidence rates and clinical outcomes were estimated from published studies and applied to the general Brazilian population over 30 years. Costs were quoted in Brazilian real (BRL) and converted to US dollars ($US) at the 2008 currency exchange rate ($US1 = BRL 1.64). In the sensitivity analysis, we reduced and increased rates to assess the robustness of the cost estimates. RESULTS In this hypothetical cohort there are 6.48 million (95% confidence interval 4.47-7.12) Brazilians citizens with Type 2 diabetes. Each year, approximately 323,000 (89,500-484,500) of these people develop foot ulcers and almost 97,200 (17,900-169,600) require hospital admission as a result. Each year, almost 46,300 (8500-80,900) limb amputations and 12,400 (2300-21,700) deaths occur as a result of diabetic foot disease in Brazil. The annual cost associated with these hospital admissions is estimated to be almost $US264m ($US51m-461m). The estimated cost for patients with amputation is nearly $US128m ($US24.5m-222.3m). CONCLUSIONS Our model shows that the social and economic impact of diabetic foot disease in Brazil is high. Government decision makers should reflect on the current situation and provide organized foot care throughout the whole country.
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Affiliation(s)
- K F Rezende
- Sergipe Federal University, Aracaju, Brazil.
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Virgini-Magalhães CE, Bouskela E. [Vascular disease and diabetic foot - between the academic knowledge and clinical reality]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2008; 52:1073-1075. [PMID: 19082294 DOI: 10.1590/s0004-27302008000700002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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