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Hu L, Liu W, Yin L, Yi X, Zou Y, Sheng X. Analysis of factors influencing the recurrence of diabetic foot ulcers. Skin Res Technol 2024; 30:e13826. [PMID: 38965804 PMCID: PMC11224123 DOI: 10.1111/srt.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The aim of this study is to investigate the factors influencing the recurrence of diabetic foot ulcers (DFU) and provide guidance for reducing the recurrence rate. METHODS A total of 211 patients diagnosed with DFU who were hospitalized and discharged from the hospital from October 2015 to January 2020 were included as the study cohort. Participants were divided into two groups according to whether the foot ulcer recurred during the 2-year follow-up period: a recurrence group (n = 84) and a non-recurrence group (n = 127). The following data were collected and analyzed for the two groups of patients: general information, foot information, laboratory indicators, diabetes comorbidities, and complications. RESULTS (1) The overall recurrence rate of diabetic foot ulcers (DFU) within 2 years was 39.8%, indicating a high recurrence rate. (2) Significant differences were observed between the two patient groups in terms of BMI, HbA1c, TBIL, CRP, financial situation, foot deformity, first ulcer on the sole of the foot, previous amputation history, Wagner grade of the first ulcer, osteomyelitis, DFU duration (>60 days), lower limb vascular reconstruction, peripheral arterial disease (PAD), and diabetic peripheral neuropathy (DPN) (t = 2.455; Z = -1.988, -3.731, -3.618; χ2 = 7.88, 5.004, 3.906, 17.178, 16.237, 5.007, 24.642, 4.782, 29.334, 10.253). No significant differences were found for the other indicators. (3) Logistic regression analysis revealed that TBIL (OR = 0.886, p = 0.036) was a protective factor against ulcer recurrence. In contrast, PAD, previous amputation history, DPN, and the first ulcer on the sole of the foot (OR = 3.987, 6.758, 4.681, 2.405; p < 0.05 or p < 0.01) were identified as risk factors for ulcer recurrence. CONCLUSION Early screening and preventive education targeting high-risk factors such as DPN, PAD and the initial ulcer location on the sole of the foot are essential to mitigate the high long-term recurrence rate of DFU. Furthermore, the protective role of TBIL in preventing ulcer recurrence underscores the importance of monitoring bilirubin levels as part of a comprehensive management strategy for DFU patients.
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Affiliation(s)
- Ling Hu
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
| | - Wenjuan Liu
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
| | - Liqin Yin
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
| | - Xiaoling Yi
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
| | - Yi Zou
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
| | - Xia Sheng
- Department of EndocrinologyThe Third Affiliated Hospital of Nanchang University (The First Hospital of Nanchang)NanchangJiangxiChina
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Xu J, Gao J, Li H, Zhu Z, Liu J, Gao C. The risk factors in diabetic foot ulcers and predictive value of prognosis of wound tissue vascular endothelium growth factor. Sci Rep 2024; 14:14120. [PMID: 38898068 PMCID: PMC11187195 DOI: 10.1038/s41598-024-64009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Diabetic foot ulcer (DFU) is a leading cause of high-level amputation in DM patients, with a low wound healing rate and a high incidence of infection. Vascular endothelial growth factor (VEGF) plays an important role in diabetes mellitus (DM) related complications. This study aims to explore the VEGF expression and its predictive value for prognosis in DFU, in order to provide basis for the prevention of DFU related adverse events. We analyzed 502 patients, with 328 in healing group and 174 in non-healing/recurrent group. The general clinical data and laboratory indicators of patients were compared through Spearman correlation analysis, ROC analysis and logistic regression analysis. Finally, the independent risk factors for adverse prognosis in DFU patients were confirmed. Spearman analysis reveals a positive correlation between the DFU healing rate and ABI, VEGF in wound tissue, and positive rate of VEGF expression, and a negative correlation with DM duration, FPG, HbA1c, TC, Scr, BUN, and serum VEGF. Further logistic regression analysis finds that the DM duration, FPG, HbA1c, ABI, serum VEGF, VEGF in wound tissue, and positive rate of VEGF expression are the independent risk factors for adverse prognosis in DFU (p < 0.05). DM duration, FPG, HbA1c, ABI, serum VEGF, VEGF in wound tissue, and positive rate of VEGF expression are the independent risk factors for prognosis in DFU patients. Patients with these risk factors should be screened in time, which is of great significance to prevent DFU related adverse events and improve outcomes.
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Affiliation(s)
- Jing Xu
- Department of Oncology, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Haizhou District, Lianyungang, 222006, China
| | - Jian Gao
- Department of Orthopedics, The Sixth Affiliated Hospital of Xinjiang Medical University, No. 39 Wuxingnan Road, Tian Shan District, Urumqi, 830002, China
| | - Hui Li
- Department of Internal Medicine, Urumqi Maternal and Child Health Care Hospital, No. 3838, Convention and Exhibition Avenue, Midong District, Urumqi, 831400, China
| | - Zhoujun Zhu
- Department of Orthopedics, The Sixth Affiliated Hospital of Xinjiang Medical University, No. 39 Wuxingnan Road, Tian Shan District, Urumqi, 830002, China
| | - Junliang Liu
- Department of Orthopedics, Weihai Stomatological Hospital, No. 268, Tongyi South Road, Huancui District, Weihai, 264299, China
| | - Chong Gao
- Department of Orthopedics, The Second People's Hospital of Lianyungang, No. 41 Hailiandong Road, Haizhou District, Lianyungang, 222006, China.
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Raghav SS, Kumar B, Sethiya NK, Lal DK. Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents. Curr Diabetes Rev 2024; 20:e120623217906. [PMID: 37309771 DOI: 10.2174/1573399820666230612161846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common. OBJECTIVE The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly. METHOD The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system. RESULTS Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments. CONCLUSION The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.
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Affiliation(s)
| | - Bhavna Kumar
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
| | | | - Diwya Kumar Lal
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
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Peng B, Min R. Development of predictive nomograms clinical use to quantify the risk of diabetic foot in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1186992. [PMID: 37388212 PMCID: PMC10304289 DOI: 10.3389/fendo.2023.1186992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The aim of the study was to explore the risk factors for diabetic foot disease in patients with type 2 diabetes mellitus and to establish and verify the nomogram model of DF risk in patients with T2DM. Methods The clinical data of 705 patients with type 2 diabetes who were hospitalized in our hospital from January 2015 to December 2022 were analyzed retrospectively. According to random sampling, the patients were divided into two groups: the training set (DF = 84; simple T2DM = 410) and the verification set (DF = 41; simple T2DM = 170). Univariate and multivariate logistic regression analysis was used to screen the independent risk factors for DF in patients with T2DM in the training set. According to the independent risk factors, the nomogram risk prediction model is established and verified. Results Logistic regression analysis showed age (OR = 1.093, 95% CI 1.062-1.124, P <0.001), smoking history (OR = 3.309, 95% CI 1.849-5.924, P <0.001), glycosylated hemoglobin (OR = 1.328, 95% CI 1.173-1.502, P <0.001), leukocyte (OR = 1.203, 95% CI 1.076-1.345, and LDL-C (OR = 2.002, 95% CI 1.463-2.740), P <0.001) was independent risk factors for T2DM complicated with DF. The area of the nomogram model based on the above indexes under the ROC curve of the training set and the verification set is 0.827 and 0.808, respectively; the correction curve shows that the model has good accuracy; and the DCA results show that when the risk threshold is between 0.10-0.85 (training set) and 0.10-0.75 (verification set), the clinical practical value of the model is higher. Conclusion The nomogram model constructed in this study is of high value in predicting the risk of DF in patients with T2DM and is of reference value for clinicians to identify people at high risk of DF and provide them with early diagnosis and individual prevention.
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Affiliation(s)
- Bocheng Peng
- Department of Pain, Wuhan Fourth Hospital, Wuhan, China
| | - Rui Min
- Department of Geriatrics, Wuhan Fourth Hospital, Wuhan, China
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Lv J, Li R, Yuan L, Huang FM, Wang Y, He T, Ye ZW. Development and Validation of a Risk Prediction Model for Foot Ulcers in Diabetic Patients. J Diabetes Res 2023; 2023:1199885. [PMID: 36846514 PMCID: PMC9949944 DOI: 10.1155/2023/1199885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The current study analyzed the status and the factors of foot ulcers in diabetic patients and developed a nomogram and web calculator for the risk prediction model of diabetic foot ulcers. METHODS This was a prospective cohort study that used cluster sampling to enroll diabetic patients in the Department of Endocrinology and Metabolism in a tertiary hospital in Chengdu from July 2015 to February 2020. The risk factors for diabetic foot ulcers were obtained by logistic regression analysis. Nomogram and web calculator for the risk prediction model were constructed by R software. RESULTS The incidence of foot ulcers was 12.4% (302/2432). Logistic stepwise regression analysis showed that BMI (OR: 1.059; 95% CI 1.021-1.099), abnormal foot skin color (OR: 1.450; 95% CI 1.011-2.080), foot arterial pulse (OR: 1.488; 95% CI: 1.242-1.778), callus (OR: 2.924; 95%: CI 2.133-4.001), and history of ulcer (OR: 3.648; 95% CI: 2.133-5.191) were risk factors for foot ulcers. The nomogram and web calculator model were developed according to risk predictors. The performance of the model was tested, and the testing data were as follows: AUC (area under curve) of the primary cohort was 0.741 (95% CI: 0.7022-0.7799), and AUC of the validation cohort was 0.787 (95% CI: 0.7342-0.8407); the Brier score of the primary cohort was 0.098, and the Brier score of the validation cohort was 0.087. CONCLUSIONS The incidence of diabetic foot ulcers was high, especially in diabetic patients with a history of foot ulcers. This study presented a nomogram and web calculator that incorporates BMI, abnormal foot skin color, foot arterial pulse, callus, and history of foot ulcers, which can be conveniently used to facilitate the individualized prediction of diabetic foot ulcers.
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Affiliation(s)
- Jing Lv
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Rao Li
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Li Yuan
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Feng-Mei Huang
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Yi Wang
- West China School of Nursing, West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu 610041, China
| | - Ting He
- West China School of Nursing, West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu 610041, China
| | - Zi-Wei Ye
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
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Wang Y, Liu B, Pi Y, Hu L, Yuan Y, Luo J, Tao Y, Li P, Lu S, Song W. Risk factors for diabetic foot ulcers mortality and novel negative pressure combined with platelet-rich plasma therapy in the treatment of diabetic foot ulcers. Front Pharmacol 2022; 13:1051299. [PMID: 36588684 PMCID: PMC9800930 DOI: 10.3389/fphar.2022.1051299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to assess the risk factors for morbidity and mortality of diabetic foot ulcers (DFUs). For the treatment of diabetic foot ulcers, negative pressure wound therapy (NPWT) combined with platelet-rich plasma-fibrin glue (PRP) was also investigated. There were 653 patients in the diabetic foot ulcer group and 510 patients in the diabetic patients without foot ulceration (NFU) group, for a total of 1163 patients in the study samples after individuals without follow-up were excluded. The patients were randomized into two groups: the negative pressure wound therapy group and the negative pressure wound therapy combined with the PRP group. The findings of the univariate analysis revealed the blood indicators for predicting diabetic foot ulcer morbidity risk factors, such as C-reactive protein, albumin, creatinine, alkaline phosphatase, procalcitonin, platelets, 25-hydroxyvitamin D, β-2-microglobulin, monocyte ratio, low-density protein cholesterol (LDL), triglyceride, alanine aminotransferase (ALT), aminotransferase (AST), creatine kinase (CK) and total cholesterol. Using logistic regression analysis revealed only albumin and age to be independent predictors of diabetic foot ulcer mortality. Our study also revealed that, compared to negative pressure wound therapy alone, negative pressure wound therapy combined with PRP accelerated wound healing and reduced the mortality rate. According to the findings of this pilot study, new risk factors for diabetic foot ulcer morbidity and mortality have been found, and negative pressure wound therapy combined with PRP therapy may provide the first information that it is an effective adjunct treatment for diabetic foot ulcers.
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Affiliation(s)
- Yanling Wang
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Bang Liu
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Yinzhen Pi
- The First Hospital of Changsha, Changsha, China
| | - Li Hu
- The First Hospital of Changsha, Changsha, China
| | - Yeling Yuan
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiao Luo
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Yixiao Tao
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Ping Li
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Shan Lu
- Changsha Maternal and Child Health Hospital Affiliated to Hunan Normal University, Changsha, China
| | - Wei Song
- National & Local Joint Engineering Research Center of High-Throughput Drug Screening Technology, College of Health Science and Engineering, Hubei University, Wuhan, China,*Correspondence: Wei Song,
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Guo Q, Ying G, Jing O, Zhang Y, Liu Y, Deng M, Long S. Influencing factors for the recurrence of diabetic foot ulcers: A meta‐analysis. Int Wound J 2022; 20:1762-1775. [PMID: 36385501 PMCID: PMC10088840 DOI: 10.1111/iwj.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to systematically review and identify the related influencing factors for the recurrence of diabetic foot ulcers (DFUs)in diabetic patients. We searched PUBMED, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang and VIP databases to identify eligible studies published before March 31, 2022 to collect case-control studies or cohort studies on the related influencing factors for the recurrence of DFUs. Two reviewers independently screened the literature, and extracted data. Also, they assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale. A meta-analysis was performed using RevMan5.4.1 software. 20 studies were included; 4238 patients were enrolled, in which 1567 were in the DFU recurrence group and 2671 were in the non-recurrent DFU group. Risk factors for the recurrence of DFUs included diabetic peripheral neuropathy (odds ratio [OR] = 4.05, 95% CI, 2.50-6.58, P < 0.00001), peripheral vascular disease (OR = 3.94, 95% CI, 2.65-5.84, P < 0.00001), poor blood glucose control (OR = 3.27, 95% confidence interval [CI], 2.79-3.84, P < 0.00001), plantar ulcer (OR = 3.66, 95% CI, 2.06-6.50, P < 0.00001), osteomyelitis (OR = 7.17, 95% CI, 2.29-22.47, P = 0.0007), smoking (OR = 1.98, 95% CI, 1.65-2.38, P < 0.00001), history of amputation (OR = 11.96, 95%CI, 4.60-31.14, P < 00001), multidrug-resistant bacterial infection (OR = 3.61, 95%CI, 3.13-4.17, P < 0.00001), callus (OR = 5.70, 95%CI, 1.36-23.89, P = 0.02), previous diabetic foot ulcer (OR = 4.10, 95% CI, 2.58-6.50, P < 0.00001), duration of previous diabetic foot ulcer >60d (OR = 1.02, 95% CI, 1.00-1.03, P = 0.004), history of vascular intervention (OR = 3.20, 95% CI, 2.13-4.81, P < 0.00001) and Wagner grade III/IV (OR = 4.40, 95% CI, 2.21-8.78, P < 0.0001). However, no significant differences were found in age, duration of diabetes, body mass index, total cholesterol or foot deformity. Recurrence of diabetic foot ulcers is affected by a variety of factors. Thus, we should focus on high-risk groups and take targeted interventions as soon as possible to reduce the recurrence rate of DFUs, because of the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.
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Affiliation(s)
- Qingjiao Guo
- School of Nursing Guizhou Medical University Guiyang China
| | - Gu Ying
- Central sterile supply department Affiliated Hospital of Guizhou Medical University Guiyang China
| | - Ouyang Jing
- Central sterile supply department Affiliated Hospital of Guizhou Medical University Guiyang China
| | - Yizhi Zhang
- School of Nursing Guizhou Medical University Guiyang China
| | - Yang Liu
- School of Nursing Lanzhou University Lanzhou China
| | - Meijie Deng
- Department of burn and plastic surgery Affiliated Hospital of Guizhou Medical University Guiyang China
| | - Shirong Long
- Department of burn and plastic surgery Affiliated Hospital of Guizhou Medical University Guiyang China
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