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Yazdanpanah L, Shahbazian H, Hesam S, Ahmadi B, Zamani AM. Two-year incidence and risk factors of diabetic foot ulcer: second phase report of Ahvaz diabetic foot cohort (ADFC) study. BMC Endocr Disord 2024; 24:46. [PMID: 38622562 PMCID: PMC11017491 DOI: 10.1186/s12902-024-01572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
AIM/INTRODUCTION This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). MATERIALS AND METHODS The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. RESULTS We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. CONCLUSION Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity.
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Affiliation(s)
- Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Ahmadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Mohammad Zamani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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McDermott KM, Bose S, Keegan A, Hicks CW. Disparities in limb preservation and associated socioeconomic burden among patients with diabetes and/or peripheral artery disease in the United States. Semin Vasc Surg 2023; 36:39-48. [PMID: 36958896 PMCID: PMC10039285 DOI: 10.1053/j.semvascsurg.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Racial, ethnic, socioeconomic, and geographic disparities in limb preservation and nontraumatic lower extremity amputation (LEA) are consistently demonstrated in populations with diabetes and peripheral artery disease (PAD). Higher rates of major LEA in disadvantaged groups are associated with increased health care utilization and higher costs of care. Functional decline that often follows major LEA confers substantial risk of disability and premature mortality, and the burden of these outcomes is more prevalent in racial and ethnic minority groups, people with low socioeconomic status, and people in geographic regions where limited resources or distance from specialty care are barriers to access. We present a narrative review of the existing literature on estimated costs of diabetic foot disease and PAD, inequalities in care that contribute to excess costs, and disparities in outcomes that lead to a disproportionate burden of diabetes- and PAD-related LEA on systematically disadvantaged populations.
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Affiliation(s)
- Katherine M McDermott
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287
| | - Sanuja Bose
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287
| | - Alana Keegan
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287; Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287.
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Tabanjeh SF, Al-Malki T, Kharabsheh RA, Mahmood D. A case series of autologous platelet-rich plasma injection in treating chronic ulcers conducted in Saudi Arabia. Int J Health Sci (Qassim) 2023; 17:46-56. [PMID: 36891041 PMCID: PMC9986877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Objective This is a case series study of 14 cases of chronic unhealed ulcers involving patients of 19-85 years, aimed to demonstrate the positive therapeutic outcomes of using autologous platelet rich plasma (PRP) in diabetic foot ulcer (DFU) and other chronic wound healing. Methods This is a formal consecutive clinical case series. Patients with chronic unhealed ulcers were enrolled from the amputation prevention clinic by an interdisciplinary team includes podiatrist, general surgeon, orthopedic, vascular surgeon, and wound care nurses at Kahel Specialized Centre, a specialized center for managing foot and ankle diseases, located in Riyadh, Saudi Arabia. Those patients who presented with chronic wounds and showed no significant wound reduction despite following the standard wound care protocol were included in the study. There were no specific predetermined exclusion criteria when considering patients for treatment with this modality. Results In this case series, majority (80%) of the patients were above 50 years of age, and 10 (66.7%) patients were male and 5 (33.3%) were female. Of all the cases presented to the amputation prevention clinic, majority (73.3%) reported suffering from type 2 diabetes mellitus (DM) and also, one reported type 1 DM [6.7%]). All the cases of DFU received a combination of hydrogel and autologous PRP treatment and were put of suitable offloading devices, except one case received a combination of Cadexomer iodine, hydrogel and PRP treatment. In the present case series involving 3-14 weeks of the treatment duration, only 2-3 doses of autologous PRP provided complete healing and or maximum wound closure. Conclusion Autologous PRP therapy is efficacious in facilitating, enhancing wound healing and aids in complete wound closure. This case series was limited in term of the sample size which is the number patients enrolled for the study, hence, the study finding remain inconclusive to some extent and hence, further study is required with greater number of sample size. The strength of this study is that it is the first study in Saudi Arabia and gulf region, to report the beneficial effect of PRP in chronic unhealed ulcers including diabetic ulcers.
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Affiliation(s)
| | - Talal Al-Malki
- Department of Orthopedics and Trauma, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Rola Al Kharabsheh
- Department of Nursing, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Danish Mahmood
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
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McDermott K, Fang M, Boulton AJ, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care 2023; 46:209-221. [PMID: 36548709 PMCID: PMC9797649 DOI: 10.2337/dci22-0043] [Citation(s) in RCA: 111] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022]
Abstract
Diabetic foot ulcers (DFU) are a major source of preventable morbidity in adults with diabetes. Consequences of foot ulcers include decline in functional status, infection, hospitalization, lower-extremity amputation, and death. The lifetime risk of foot ulcer is 19% to 34%, and this number is rising with increased longevity and medical complexity of people with diabetes. Morbidity following incident ulceration is high, with recurrence rates of 65% at 3-5 years, lifetime lower-extremity amputation incidence of 20%, and 5-year mortality of 50-70%. New data suggest overall amputation incidence has increased by as much as 50% in some regions over the past several years after a long period of decline, especially in young and racial and ethnic minority populations. DFU are a common and highly morbid complication of diabetes. The pathway to ulceration, involving loss of sensation, ischemia, and minor trauma, is well established. Amputation and mortality after DFU represent late-stage complications and are strongly linked to poor diabetes management. Current efforts to improve care of patients with DFU have not resulted in consistently lower amputation rates, with evidence of widening disparities and implications for equity in diabetes care. Prevention and early detection of DFU through guideline-directed multidisciplinary care is critical to decrease the morbidity and disparities associated with DFU. This review describes the epidemiology, presentation, and sequelae of DFU, summarizes current evidence-based recommendations for screening and prevention, and highlights disparities in care and outcomes.
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Affiliation(s)
- Katherine McDermott
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew J.M. Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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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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Local Random Flaps for the Diabetic Foot. Clin Podiatr Med Surg 2022; 39:321-330. [PMID: 35365329 DOI: 10.1016/j.cpm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diabetic foot wounds should be treated in a timely fashion to prevent infection and potential limb loss. When local wound care and traditional off-loading fails, surgeons may consider local random flaps for definitive closure. Wound size, location, and type are characteristics that should be considered for selection of the best flap. This article reviews the application of local random flaps in the treatment of diabetic foot wounds.
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Bundó M, Vlacho B, Llussà J, Puig-Treserra R, Mata-Cases M, Cos X, Jude EB, Franch-Nadal J, Mauricio D. Prevalence and risk factors of diabetic foot disease among the people with type 2 diabetes using real-world practice data from Catalonia during 2018. Front Endocrinol (Lausanne) 2022; 13:1024904. [PMID: 36353236 PMCID: PMC9637660 DOI: 10.3389/fendo.2022.1024904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain). METHODS We undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018. RESULTS During the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72). CONCLUSIONS In this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD.
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Affiliation(s)
- Magdalena Bundó
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center Ronda Prim, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain
| | - Bogdan Vlacho
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Department of Pharmacology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Judit Llussà
- Primary Health Care Centre Sant Roc, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain Catalan Health Institute, Badalona, Spain
| | - Ramon Puig-Treserra
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manel Mata-Cases
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xavier Cos
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center Sant Martí de Provençals, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Innovation Office, Institut Català de la Salut, Barcelona, Spain
| | - Edward B. Jude
- Tameside and Glossop Integrated Care National Health Service (NHS) Foundation Trust, Tameside on Lyne, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - Josep Franch-Nadal
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
| | - Dídac Mauricio
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
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Kirkland-Kyhn H, Generao SA, Teleten O, Young HM. Teaching Wound Care to Family Caregivers: An overview of methods to use to promote wound healing. Home Healthc Now 2022; 40:8-13. [PMID: 34994715 DOI: 10.1097/nhh.0000000000001047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Holly Kirkland-Kyhn
- Holly Kirkland-Kyhn is the director of wound care and Oleg Teleten is a wound care specialist, both in the Patient Care Services Department of the University of California, Davis, Medical Center in Sacramento, where Stephanie Anne Generao is an NP in the vascular clinic. Heather M. Young is dean of the Betty Irene Moore School of Nursing at the University of California, Davis, and associate vice chancellor for nursing at UC Davis Health. Contact author: Holly Kirkland-Kyhn, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Ahmed MU, Tannous WK, Agho KE, Henshaw F, Turner D, Simmons D. Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study. J Foot Ankle Res 2021; 14:65. [PMID: 34915904 PMCID: PMC8680161 DOI: 10.1186/s13047-021-00501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. METHODOLOGY The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. RESULTS The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. CONCLUSION Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.
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Affiliation(s)
- Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Department of Economics, Finance and Property, School of Business, Western Sydney University, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Frances Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- ConvaTec, Building 5, Brandon Business Park, 530 Springvale Rd, Glen Waverley, VIC, 3150, Australia
| | - Deborah Turner
- School of Clinical Sciences, Podiatric Medicine, Kelvin Grove Campus, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - David Simmons
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Каландия ММ, Токмакова АЮ, Галстян ГР. [The role of glycation end products in the development and progression of diabetic neuroarthropathy]. PROBLEMY ENDOKRINOLOGII 2021; 67:4-9. [PMID: 34297497 PMCID: PMC9112848 DOI: 10.14341/probl12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 12/16/2022]
Abstract
Diabetic neuroarthropathy (DNOAP, Charcot's foot) is a serious complication of diabetes mellitus, the genesis of which is not fully understood. In most cases, this pathology is diagnosed late, which leads to the development of severe deformities of the foot, up to the loss of support ability of the limb. There is no single hypothesis for the formation of Charcot's foot, but there are factors predisposing to its development, as well as a few likely provoking events. Excessive formation and accumulation of end products of glycation may play an important role in the pathogenesis of this complication of diabetes. End products of glycation (AGE) are a variety of compounds formed as a result of a non-enzymatic reaction between carbohydrates and free amino groups of proteins, lipids and nucleic acids. There are various factors that lead to the accumulation of AGE in the human body. Allocate endogenous and exogenous factors. The former include certain diseases, such as diabetes mellitus, renal failure, which accelerate glycation processes. Exogenous factors leading to the formation of lipo-oxidation and glyco-oxidation products include tobacco smoke and prolonged heat treatment of food.This review provides information on the role of glycation end products in the development and progression of complications in patients with diabetes mellitus.
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Affiliation(s)
- М. М. Каландия
- Национальный медицинский исследовательский центр эндокринологии
| | - А. Ю. Токмакова
- Национальный медицинский исследовательский центр эндокринологии
| | - Г. Р. Галстян
- Национальный медицинский исследовательский центр эндокринологии
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Yammine K, Kheir N, Assi C. A Meta-Analysis of the Outcomes of Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2021; 10:81-90. [PMID: 32870773 DOI: 10.1089/wound.2020.1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Significance: Diabetic foot ulcers (DFUs) are associated with high morbidity, mortality, and health costs. Standard care (SC) associated with nonsurgical offloading is the mainstay treatment for DFUs, but it has high recurrence and infection rates. Metatarsal head resection (MHR) has been proposed as an effective surgical offloading technique for the treatment of plantar neuropathic DFUs, but with no evidence synthesis yet. Recent Advances: Based on PRISMA guidelines, a meta-analysis was conducted to assess the efficacy of MHR. Four electronic databases were searched for. Eleven studies met the inclusion criteria with a total of 477 patients (494 feet and 593 neuropathic forefoot ulcers). The studies included three retrospective comparative studies and eight case series. Critical Issues: Meta-analytical results of comparative studies on recent noninfected DFUs showed MHR having significantly better rates of healing, time to healing, ulcer recurrence, and infection than SC. Failure to heal, recurrence, and infection rates were 4 times higher in the SC group than in the MHR group, and the amputation rate was two times higher in the SC group than in the MHR group. The outcomes of the meta-analysis of case series on chronic and recalcitrant ulcers treated with MHR were similar. Future Directions: Considering the natural history of DFUs treated conservatively and the satisfactory outcomes with a significantly low complication rate of MHR, physicians should consider the use of MHR more often and include this technique in the early management of DFUs. Scope and Significance: DFU impose great public health burden around the globe. Standard of care using in-office debridement and topical agents is the usual mainstay of treatment. However, such conservative care is known to result in high rates of ulcer recurrence and complications. In this systematic review, we quantitatively investigate the outcomes of a surgical off-loading technique, the MHR in the treatment of chronic plantar neuropathic wounds. Translational Relevance: Many biochemical factors are implicated in the complex process of wound healing. In the case of diabetic neuropathic ulcers of the forefoot, additional mechanical factors induced by the presence of diabetic neuropathy lead to high pressure loads of the metatarsal heads on the plantar skin. With time, such chronic loads could favor ulcer formation. Removal of the causal mechanical factor could alleviate the pressure and allow wound healing. Clinical Relevance: Neuropathic plantar ulcers are difficult-to-heal wounds and chronicity is associated to frequent hospitalizations, higher rates of amputation, and mortality. Early removal of the indirect causal agent, the resection of the metatarsal head, after failure of a well-conducted conservative standard of care could be a needed solution for wound healing and consequently a potential for reducing complications and costs.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Nadim Kheir
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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Yammine K, Assi C. Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers: A Meta-Analysis of Comparative Studies. INT J LOW EXTR WOUND 2020; 21:7-17. [PMID: 32525725 DOI: 10.1177/1534734620923425] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The treatment of diabetic foot ulcers (DFUs) is usually based on local debridement, topical agents, and nonsurgical off-loading. When compared with nonsurgical methods, a number of articles reported better results with surgery. The aim of this meta-analysis was to collate quantitative evidence on the outcomes of surgery versus nonsurgical treatment (NST) of DFUs. Databases were searched from inception to September 2019. PRISMA guidelines were followed, and the Joanna Briggs Institute critical appraisal tools were used to appraise studies' quality. Nine studies were included totalizing 436 ulcers (216 treated with surgery and 220 DFUs with NST). The primary outcome was the healing rate. The secondary outcomes were time to heal, recurrence rate, transfer rate, infection rate, and amputation/revision surgery rate. The risk differences (RDs) between the healing rates following surgery and NST for infected and noninfected ulcers were 17% (95% confidence interval [CI] = 0.012-0.328, P = .03) and 19.2% (95% CI = 0.050-0.334, P = .008), respectively, in favor of surgery. The amputation/revision surgery rate was significantly better following surgery for both types of ulcers. Noninfected ulcers demonstrated significantly lesser time to heal, recurrence, and infection rates following surgery. This meta-analysis demonstrated that surgery was superior to NST in treating infected and noninfected neuropathic plantar wounds.
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Affiliation(s)
- Kaissar Yammine
- The Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.,Department of Orthopedic and Trauma Surgery, Lebanese American University, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Chahine Assi
- The Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.,Department of Orthopedic and Trauma Surgery, Lebanese American University, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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13
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Tong T, Yang C, Tian W, Liu Z, Liu B, Cheng J, Cheng Q, Zhou B. Phenotypes and outcomes in middle-aged patients with diabetic foot ulcers: a retrospective cohort study. J Foot Ankle Res 2020; 13:24. [PMID: 32414389 PMCID: PMC7227070 DOI: 10.1186/s13047-020-00386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/22/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although ageing could increase the risk of delayed healing in diabetic foot ulcers (DFUs) patients, data from middle-aged patients remains greatly limited. The purpose of this study was to explore the clinical phenotypes, outcomes and predictive factors of DFU in middle-aged patients. METHODS A retrospective cohort study conducted with 422 consecutive inpatients with DFUs who visited our hospital between May 2010 and September 2017; participants were recruited and assigned according to age to either the middle-aged group or the elderly group. The Demographics, ulcer characteristics, comorbidities and diabetes complications, laboratory tests, socioeconomic data and final outcomes were collected. Moreover, predictive factors of adverse outcomes in middle-aged DFUs patients were assessed. RESULTS Middle-aged patients were more likely to have worse lifestyle and glucose control, were more likely to have microangiopathy as a complication, and tended to have larger and deeper ulcers; however, these patients also had higher rates of healing and lower rates of mortality and major amputaion than elderly patients. Severe infection,living alone,current smoking cigarettes, and having a high white blood cell count were independent risk factors for adverse outcomes in middle-aged patients. CONCLUSIONS DFUs are relatively common in middle-aged patients with diabetes, and these patients have unique clinical phenotypes and risk profiles. Nonetheless, further investigation is needed to clarify whether intervention targeting these easily recognizable risk factors can improve healing and survival rates in middle-aged DFU patients.
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Affiliation(s)
- Tao Tong
- Department of Endocrinology, Xiangyang No.1 People’s Hospital, Affiliated to Hubei University of Medicine, Xiangyang, 441000 China
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cailian Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenqing Tian
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Liu
- Department of Burns & Plastic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cheng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2020; 20:41. [PMID: 31924173 PMCID: PMC6954527 DOI: 10.1186/s12889-019-8133-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background Diabetes and its complications including foot ulcer constitute a global public health challenge attributing to a significant cause of morbidity and mortality. Foot ulcer is one of the long-term complication of diabetes mellitus which lead to infection and amputation of lower extremities. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the magnitude of foot ulcer in diabetics and factors contributing to it. Methods We identified articles through electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science and Google Scholar. Accordingly, we identified 95 published and one unpublished article. Finally, eleven studies which fullfilled eligibility criteria were included in final systematic review and meta-analysis. Data were extracted using a standardized data extraction checklist and the analyses were conducted using STATA version 14. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. Results The overall magnitude of foot ulcer was 12.98% (95%CI: 7.81–18.15) in diabetic patients in Ethiopia. Sub-group analyses revealed highest prevalence in Addis Ababa (19.31% (95%CI: 2.7. 41.37)). Foot ulcer was significantly associated with rural residence (OR = 2.72, 95%, CI: 1.84–4.01)), presence of callus on the feet ((OR = 12.67, 95%, CI: 6.47–24.79)), a body mass index of ≥24.5 ((OR = 2.68, 95%, CI: 1.58–4.56)), poor self- care practice ((OR = 1.47, 95%CI: 1.25–1.73)), type I diabetes mellitus ((OR = 0.42, 95%, CI: 0.22–0.79)), staying with DM for < 10 years ((OR = 0.23, 95%, CI: 0.11–0.50)), and age < 45 years ((OR = 0.44, 95%, CI: 0.21–0.92)). Conclusion The prevalence of diabetic foot ulcers in Ethiopia is relatively low, although its trend is increasing from time to time. Socio-demographic factors, body weight, and healthcare practice contribute to the development of diabetic foot ulcers. Appropriate interventions towards patient self-care practice, lifestyle modification and follow-up are wanted to prevent diabetic foot ulcers.
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Wang Y, Cao HJ, Wang LQ, Lu CL, Yan YQ, Lu H, Zhang K, Zhang HM, Liu JP. The effects of Chinese herbal medicines for treating diabetic foot ulcers: A systematic review of 49 randomized controlled trials. Complement Ther Med 2019; 44:32-43. [PMID: 31126573 DOI: 10.1016/j.ctim.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the effects and associated risks of Chinese herbal medicine (CHM) for diabetic foot ulcer (DFU). METHODS We systematically searched seven electronic databases for randomized controlled trials (RCTs) about Chinese herbal medicines for treating diabetic foot ulcers. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool. Data was synthesized using review manager (RevMan) 5.3. Meta-analysis was conducted if the data were available. A summary of finding table was generated by The GRADEpro Guideline Development Tool (GDT) online. RESULTS Forty-nine RCTs, all conducted in China, involving 3646 participants were included. Most of the included trials had unclear or high risk of bias. Twenty-six trials could be pooled in five Meta-analyses, the remaining trials could not be pooled due to the obvious clinical heterogeneity. Only low evidence showed CHM therapy may have 42%-60.4% participants healed completely after treatment, approximately twice (RR 1.42-1.76) as much as the healed rates in conventional therapy (or plus hot water foot bath) group. Majority of the included trials reported benefit of CHM group on shortening healing time (4-23 days) and reducing ulcer wound size (at least 2 cm2). No serious adverse events were reported related to the medication in all trials. CONCLUSION Weak evidence showed benefit of CHM as add-on treatment of conventional therapy on increasing number of ulcer heals in patients with DFU. That's about twice the healing rate of the conventional treatment (or plus hot water foot bath) group. With insufficient information, we could not draw confirmative conclusion on safety of CHM administration. These findings need to be tested in further large, rigorous trials.
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Affiliation(s)
- Ying Wang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hui-Juan Cao
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Li-Qiong Wang
- School of acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Chun-Li Lu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Yu-Qian Yan
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hao Lu
- Department of Endocrinology, Shuguang Hospital affiliated to Shanghai TCM University, Shanghai, 200020, China.
| | - Kang Zhang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hui-Min Zhang
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China; Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
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Rastogi A, Bhansali A, Ramachandran S. Efficacy and Safety of Low-Frequency, Noncontact Airborne Ultrasound Therapy (Glybetac) For Neuropathic Diabetic Foot Ulcers: A Randomized, Double-Blind, Sham-Control Study. INT J LOW EXTR WOUND 2019; 18:81-88. [PMID: 30836809 DOI: 10.1177/1534734619832738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The diabetic foot ulcer (DFU) healing rates remain dismally low. Therefore, many adjunctive therapies have been evaluated including ultrasound therapy. The prior studies with noncontact, low-frequency ultrasound were retrospective, single arm, unblinded, or with historical controls. The aim of the present study was to compare the efficacy of noncontact, low-frequency airborne ultrasound (Glybetac) therapy with sham therapy added to standard treatment in patients with neuropathic, clinically infected, or noninfected DFU (wound size >2 cm2), Wagner grades 2 and 3. Patients received ultrasound or sham therapy for 28 days dosed daily for first 6 days followed by twice a week for next 3 weeks along with standard of care. The primary outcome was percentage of patients with at least >50% decrease in wound area at 4 week of intervention. Fifty-eight patients completed the study protocol. The duration of wound was 15.8 ± 11.2 weeks and 12.1 ± 10.9 weeks and wound area of 11.3 ± 8.2 cm2 and 14.8 ± 13.8 cm2 ( P = .507) in the ultrasound and sham groups, respectively. A >50% reduction in wound area was observed in 97.1% and 73.1% subjects ( P = .042) in ultrasound and sham groups, respectively. Wound contraction was faster in the first 2 weeks with ultrasound therapy, 5.3 cm2, compared with 3.0 cm2 ( P = .025) with sham treatment. Overall, wound area reduction of 69.4 ± 23.2% and 59.6 ± 24.9% ( P = .126) was observed at 4 weeks in the ultrasound and sham groups, respectively. We conclude that the airborne low-frequency ultrasound therapy improves and hastens the healing of chronic neuropathic DFU when combined with standard wound care.
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Affiliation(s)
- Ashu Rastogi
- 1 Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- 1 Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, Cheraghian B, Hesam S. Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study. Int J Endocrinol 2018; 2018:7631659. [PMID: 29736169 PMCID: PMC5875034 DOI: 10.1155/2018/7631659] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/30/2018] [Indexed: 01/30/2023] Open
Abstract
AIM/INTRODUCTION This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). MATERIALS AND METHODS In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. RESULTS Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. CONCLUSION Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.
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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
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Syzygium mundagam bark methanol extract restores skin to normal in diabetic wounded rats. Biomed Pharmacother 2017; 94:781-786. [PMID: 28802230 DOI: 10.1016/j.biopha.2017.07.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022] Open
Abstract
Diabetic wounds have been identified as one of the major complications associated with diabetes. This study features the use of Syzygium mundagam bark methanol (SMBM) extract in the treatment of wounds in Streptozotocin-Nicotinamide induced diabetic rats. The extract ointment base, at 1 and 2% respectively, was applied to the wounded areas on the rats and monitored for 21days. The wound closure, epithelialization period and histopathology of the wounds were evaluated during the study. Both the concentrations of the extract (1% and 2%) healed the wounds even under diabetic conditions induced in rats on day 21 (99.69% and 100% respectively). The 2% SMBM treated animals showed a higher rate of epithelialization of the wound (15±0.49days). The histopathology of the wounded skin on day 10 revealed that the rats treated with SMBM extract could initiate the healing and re-epithelialization. This was evident from the migration of neutrophils and proliferation of fibroblasts. On the 21st day, complete healing of the skin could be observed in the rats treated with 2% extract which was evident from the newly formed epidermis, collagen fibers and fibroblast. The results compared well with those treated with betadine (5%). The results of this study will support the use of this plant extract for diabetic healing over the use of commercially available synthetic drugs.
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Anichini R, Policardo L, Lombardo FL, Salutini E, Tedeschi A, Viti S, Francia P, Brocco E, Maggini M, Seghieri G, De Bellis A. Hospitalization for Charcot neuroarthropathy in diabetes: A population study in Italy. Diabetes Res Clin Pract 2017; 129:25-31. [PMID: 28500867 DOI: 10.1016/j.diabres.2017.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/28/2017] [Indexed: 01/29/2023]
Abstract
AIMS To provide data on hospitalization and incidence rates of Charcot neuroarthropathy (CN) and its relation to lower limbs' amputations/revascularizations in population with diabetes of Italy as well as of one of its regions (Tuscany). METHODS Hospitalizations with CN diagnosis (codes ICD-9-CM: 7130, 7135, 7138) have been recorded in people with diabetes over years 2003-2013 in Italy and 2008-2015 in Tuscany. Amputations, peripheral vascular disease, revascularizations and infections were likewise evaluated. RESULTS Between 2003 and 2013 CN hospitalizations were very infrequent in Italy ranging between 14×100,000 and 11×100,000 patients with diabetes. In Tuscany they declined to a minimum of 7×100,000 patients in 2015, after a previous increase to a maximum of 22×100,000 (p=NS for both). Yearly CN incidence remained constant in Italy, declining in Tuscany to a minimum of 3.4×100,000 diabetic patients in 2015 (p=0.047). CN patients were younger and with longer length of hospital stay than those with non-Charcot diabetic foot (p<0.05 for both). Amputation and infection rates were manifold higher in CN patients than in those with non-Charcot diabetic foot, while the revascularization rate was similar in both. CONCLUSIONS Over last decade, in Italy and Tuscany yearly CN incidence and hospitalization rates concerned only a small percentage of patients, remaining constant over years and declining in Tuscany in the last couple of years. CN was significantly associated to younger age, longer hospital stay and greater risk of amputations and infections while the need of revascularization was similar to that of non-Charcot diabetic foot.
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Affiliation(s)
- Roberto Anichini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | | | - Flavia Lucia Lombardo
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Elisabetta Salutini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Anna Tedeschi
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Secondina Viti
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Enrico Brocco
- Regional Referral Center for the Treatment of Diabetic Foot, Policlinico Abano Terme, Padova, Italy
| | - Marina Maggini
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | | | - Alessandra De Bellis
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
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Shin JY, Roh SG, Lee NH, Yang KM. Influence of Epidemiologic and Patient Behavior–Related Predictors on Amputation Rates in Diabetic Patients. INT J LOW EXTR WOUND 2017; 16:14-22. [DOI: 10.1177/1534734617699318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Amputation of patients with diabetic foot is a major issue worldwide, particularly from a medical and economic standpoint. This meta-analysis aimed to identify significant risk factors of high amputation rate among epidemiologic and patient behavior–related predictors in diabetic patients. A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Seven variables were extracted from the included studies and evaluated based on amputation rate. The Newcastle-Ottawa scale was used to assess the quality of the studies. The search strategy identified 101 publications. After screening, 33 articles were selected for review. Male sex and smoking were identified as significant risk factors of high amputation rate of diabetic foot. Although further investigation of long-term and randomized controlled studies is needed, we identified 2 variables as significant risk factors for high amputation rate in diabetic patients in this meta-analysis.
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Affiliation(s)
- Jin Yong Shin
- Medical School of Chonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si-Gyun Roh
- Medical School of Chonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nae-Ho Lee
- Medical School of Chonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyung-Moo Yang
- Medical School of Chonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Menezes MM, Lopes CT, Nogueira LDS. Impact of educational interventions in reducing diabetic complications: a systematic review. Rev Bras Enferm 2016; 69:773-84. [PMID: 27508485 DOI: 10.1590/0034-7167.2016690422i] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/15/2016] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify in the literature evidence of the effectiveness and efficacy of educational interventions in reducing metabolic and/or vascular complications in adults with diabetes mellitus. METHOD A systematic review performed in LILACS, IBECS, CUMED, CINAHL and Medline databases and in the online library SciELO with studies published from 2004 to 2014. RESULTS Eleven studies were included (5 randomized clinical trials and 6 quasi-experimental). We only identified studies that analyzed vascular complications. CONCLUSION Two clinical trials demonstrated efficacy in reducing cardiovascular complications, of cataract or retinopathy and nephropathy and all the quasi-experimental studies showed effectiveness in reducing feet ulcers, peripheral neuropathy and vasculopathy, and maintenance of kidney function.
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Affiliation(s)
- Marcela Machado Menezes
- Universidade de São Paulo, Escola de Enfermagem, Programa de Residência em Enfermagem na Saúde do Adulto e do Idoso. São Paulo-SP, Brasil
| | - Camila Takáo Lopes
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica. São Paulo-SP, Brasil
| | - Lilia de Souza Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. São Paulo-SP, Brasil
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Ramanujam CL, Han D, Zgonis T. Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation: Data Analysis of 116 Patients. Foot Ankle Spec 2016; 9:113-26. [PMID: 26276212 DOI: 10.1177/1938640015599036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The aim of this study was to determine the lower extremity amputation and mortality rates of a group of patients who underwent reconstructive surgery using circular external fixation for treatment of diabetic Charcot neuroarthropathy (CN) of the foot and/or ankle. Existing studies regarding lower extremity amputation or mortality rates for diabetic CN of the foot and/or ankle have been performed on mostly conservatively treated patients. The objective of the statistical analysis in this studied population was to understand the difference in overall amputation and mortality rates between the 2 main groups: one with foot and/or ankle ulceration (group 1), and the other without ulceration or osteomyelitis (group 2, control group). Within group 1, 2 subgroups were established: one with osteomyelitis (group 1A) and the other without osteomyelitis (group 1B). Initially, a retrospective analysis of 150 consecutive surgically reconstructed diabetic foot and ankle cases using circular external fixation from January 2005 through December 2012 was conducted. Those which were not supported with the diagnosis of diabetic CN were excluded and the 2 other charts without proper follow-up duration (6 months) for analysis were removed, resulting in the final sample size of N = 116. There were a total of n = 7 (6.0%) below the knee amputations (group 1A = 1, group 1B = 4, and group 2 = 2) with a total of n = 5 mortalities (4.3%) (group 1A = 2, group 1B = 2, and group 2 = 1). The total amount of time for a lower extremity amputation event (n = 7) since the time of surgical reconstruction was 729.43 ± 519.73 days (range 230-1777 days) while for a mortality event (n = 5), it was 1302.00 ± 765.48 days (range 633-2499 days). LEVELS OF EVIDENCE Prognostic, Level III: Retrospective study.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
| | - David Han
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
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24
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Khamaisi M, Katagiri S, Keenan H, Park K, Maeda Y, Li Q, Qi W, Thomou T, Eschuk D, Tellechea A, Veves A, Huang C, Orgill DP, Wagers A, King GL. PKCδ inhibition normalizes the wound-healing capacity of diabetic human fibroblasts. J Clin Invest 2016; 126:837-53. [PMID: 26808499 DOI: 10.1172/jci82788] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 12/08/2015] [Indexed: 12/21/2022] Open
Abstract
Abnormal fibroblast function underlies poor wound healing in patients with diabetes; however, the mechanisms that impair wound healing are poorly defined. Here, we evaluated fibroblasts from individuals who had type 1 diabetes (T1D) for 50 years or more (Medalists, n = 26) and from age-matched controls (n = 7). Compared with those from controls, Medalist fibroblasts demonstrated a reduced migration response to insulin, lower VEGF expression, and less phosphorylated AKT (p-AKT), but not p-ERK, activation. Medalist fibroblasts were also functionally less effective at wound closure in nude mice. Activation of the δ isoform of protein kinase C (PKCδ) was increased in postmortem fibroblasts from Medalists, fibroblasts from living T1D subjects, biopsies of active wounds of living T1D subjects, and granulation tissues from mice with streptozotocin-induced diabetes. Diabetes-induced PKCD mRNA expression was related to a 2-fold increase in the mRNA half-life. Pharmacologic inhibition and siRNA-mediated knockdown of PKCδ or expression of a dominant-negative isoform restored insulin signaling of p-AKT and VEGF expression in vitro and improved wound healing in vivo. Additionally, increasing PKCδ expression in control fibroblasts produced the same abnormalities as those seen in Medalist fibroblasts. Our results indicate that persistent PKCδ elevation in fibroblasts from diabetic patients inhibits insulin signaling and function to impair wound healing and suggest PKCδ inhibition as a potential therapy to improve wound healing in diabetic patients.
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25
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Rodrigues BT, Vangaveti VN, Malabu UH. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study. J Diabetes Res 2016; 2016:5941957. [PMID: 27446962 PMCID: PMC4942664 DOI: 10.1155/2016/5941957] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/03/2016] [Indexed: 01/26/2023] Open
Abstract
Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98-65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.
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Affiliation(s)
- Beverly T. Rodrigues
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Venkat N. Vangaveti
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Usman H. Malabu
- Department of Diabetes and Endocrinology, The Townsville Hospital and College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
- *Usman H. Malabu:
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26
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McEwen LN, Ylitalo KR, Munson M, Herman WH, Wrobel JS. Foot Complications and Mortality: Results from Translating Research Into Action for Diabetes (TRIAD). J Am Podiatr Med Assoc 2016; 106:7-14. [PMID: 26895355 PMCID: PMC5094452 DOI: 10.7547/14-115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We sought to study the impact of foot complications on 10-year mortality independent of other demographic and biological risk factors in a racially and socioeconomically diverse managed-care population with access to high-quality medical care. METHODS We studied 6,992 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Foot complications were assessed using administrative claims data. The National Death Index was searched for deaths across 10 years of follow-up (2000-2009). RESULTS Charcot's neuro-osteoarthropathy and diabetic foot ulcer with debridement were associated with an increased risk of mortality; however, the associations were not significant in fully adjusted models. Lower-extremity amputation (LEA) was associated with an increased risk of mortality in unadjusted (hazard ratio [HR], 3.21; 95% confidence interval [CI], 2.50-4.12) and fully adjusted (HR, 1.84; 95% CI, 1.28-2.63) models. When we examined the associations between LEA and mortality stratified by sex and race, risk was increased in men (HR, 1.96; 95% CI, 1.25-3.07), Hispanic individuals (HR, 5.17; 95% CI, 1.48-18.01), and white individuals (HR, 2.18; 95% CI, 1.37-3.47). In sensitivity analyses, minor LEA tended to increase the risk of mortality (HR, 1.48; 95% CI, 0.92-2.40), and major LEA was associated with a significantly higher risk of death at 10 years (HR, 1.89; 95% CI, 1.18-3.01). CONCLUSIONS In this managed-care population with access to high-quality medical care, LEA remained a robust independent predictor of mortality. The association was strongest in men and differed by race.
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Affiliation(s)
- Laura N. McEwen
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Kelly R. Ylitalo
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI,Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Michael Munson
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - William H. Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI,Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - James S. Wrobel
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
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27
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Müller N, Heller T, Freitag MH, Gerste B, Haupt CM, Wolf G, Müller UA. Healthcare utilization of people with type 2 diabetes in Germany: an analysis based on health insurance data. Diabet Med 2015; 32:951-7. [PMID: 25781644 DOI: 10.1111/dme.12747] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 12/21/2022]
Abstract
AIMS This population-based study assesses the healthcare utilization of people with Type 2 diabetes by analysing routine data from Allgemeine Orts-Krankenkasse (AOK), the largest statutory health insurance provider in Germany. METHODS Anonymized billing data from all AOK-insured persons with at least one day of insurance during the evaluation year 2010 were analysed. Treatment and cost data from all areas of inpatient and outpatient care were available, as was information regarding patient age and sex. International Classification of Diseases (ICD-10) diagnosis and Anatomical Therapeutic Chemical (ATC) classification were used to identify 2.7 million insured persons with diabetes. RESULTS The age- and sex-standardized prevalence of Type 2 diabetes was 9.8%. Of those patients identified, 33.9% had at least one diabetes-related complication and 83.0% had a diagnosis of hypertension. Almost two-thirds (63.1%) received antihyperglycaemic medication. Metformin and sulfonylurea were prescribed most often; medications without proof of benefit in endpoint studies were prescribed much less frequently. People without diabetes were admitted to hospital only half as often as those with Type 2 diabetes. The projected total expenditure in Germany for all people with Type 2 diabetes amounted to approximately €33.3 billion in 2010. CONCLUSIONS This study shows an increase in both the prevalence of diabetes and treatment costs. The majority of people with Type 2 diabetes were aged 70 years or older. One third of this group has diabetes-related complications. Antihyperglycaemic medications without proof of benefit in endpoint studies were prescribed much less frequently than drugs with proof of benefit.
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Affiliation(s)
- N Müller
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Heller
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - M H Freitag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - B Gerste
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - C M Haupt
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), Berlin, Germany
| | - G Wolf
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
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Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes 2015; 6:37-53. [PMID: 25685277 PMCID: PMC4317316 DOI: 10.4239/wjd.v6.i1.37] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/22/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.
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Alzahrani HA, Wang D, Alzahrani AH, Hu FB. Incidence of diabetic foot disorders in patients with diabetes in Jeddah, Saudi Arabia. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0272-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Munson ME, Wrobel JS, Holmes CM, Hanauer DA. Data mining for identifying novel associations and temporal relationships with Charcot foot. J Diabetes Res 2014; 2014:214353. [PMID: 24868558 PMCID: PMC4020407 DOI: 10.1155/2014/214353] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION. Charcot foot is a rare and devastating complication of diabetes. While some risk factors are known, debate continues regarding etiology. Elucidating other associated disorders and their temporal occurrence could lead to a better understanding of its pathogenesis. We applied a large data mining approach to Charcot foot for elucidating novel associations. METHODS. We conducted an association analysis using ICD-9 diagnosis codes for every patient in our health system (n = 1.6 million with 41.2 million time-stamped ICD-9 codes). For the current analysis, we focused on the 388 patients with Charcot foot (ICD-9 713.5). RESULTS. We found 710 associations, 676 (95.2%) of which had a P value for the association less than 1.0 × 10⁻⁵ and 603 (84.9%) of which had an odds ratio > 5.0. There were 111 (15.6%) associations with a significant temporal relationship (P < 1.0 × 10⁻³). The three novel associations with the strongest temporal component were cardiac dysrhythmia, pulmonary eosinophilia, and volume depletion disorder. CONCLUSION. We identified novel associations with Charcot foot in the context of pathogenesis models that include neurotrophic, neurovascular, and microtraumatic factors mediated through inflammatory cytokines. Future work should focus on confirmatory analyses. These novel areas of investigation could lead to prevention or earlier diagnosis.
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Affiliation(s)
- Michael E. Munson
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
- *Michael E. Munson:
| | - James S. Wrobel
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
| | - Crystal M. Holmes
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Suite 1300, Ann Arbor, MI 48106, USA
| | - David A. Hanauer
- Department of Pediatrics, University of Michigan Medical School, 5312 CC, SPC 5940, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
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