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Alhammadi N, Al-Jallal M, AlKaabi HA, Malibari WM, Al Jallal RS, Almarshad AS, Binshalhoub FH, Albalawi AN, Adam TA, Al-Khairat AH. Prevalence and Factors Associated With Tinea Pedis Among Diabetic Patients in Saudi Arabia: A Descriptive Cross-Sectional Study. Cureus 2023; 15:e51210. [PMID: 38288233 PMCID: PMC10823190 DOI: 10.7759/cureus.51210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND It has been estimated that 30% of diabetic people experience dermatological problems. Fungal infections are the most frequent cause of these lesions. While tinea infections in non-diabetic individuals rarely cause symptoms, in diabetes patients, they can create fistulas and entry sites that can result in catastrophic bacterial infections. AIM This research paper aims to evaluate the prevalence and factors associated with tinea pedis among diabetic patients in Saudi Arabia. METHODS The research paper incorporated a cross-sectional study approach with the involvement of a questionnaire-based response aimed at all Saudi inhabitants with diabetes mellitus (DM) who conceded to be part of the study. This research was carried out from March 22, 2023, to May 22, 2023, spanning for three months. The participants who satisfied our requirements provided data using computerized Google Forms for data collection; no nominative information disseminated via social media platforms was visible. The three components of the questionnaire address diabetic information, tinea pedis infections, and foot care. RESULTS A total of 295 people with diabetes case were involved in the study. Among them, 149 (50.5%) were males, and their ages stretched from 16 to above 60 years, with a mean age of 49.5 ± 12.9 years old. A total of 194 (65.8%) of the study patients had type II DM. Of 134 (45.4%) were diagnosed with diabetes for more than 10 years. Exact 152 (52%) of the study diabetic patients were diagnosed with tinea pedis. Only patients' BMI showed a significant association with having tinea pedis as 47 of overweight diabetics were diagnosed with tinea pedis versus 47 of obese patients and only five patients of others who were underweight (p=0.049). CONCLUSION This research concluded that almost 50% of patients with diabetes were suffering from obesity and were earlier diagnosed with tinea pedis and poor glycemic control irrespective of reported good diabetic foot care.
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Affiliation(s)
| | | | | | | | - Rahaf S Al Jallal
- Radiology, Applied Medical Sciences, King Khalid University, Abha, SAU
| | | | - Fahad H Binshalhoub
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Tahani A Adam
- Statistics and Operation Research, Qassim University, Buraydah, SAU
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Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, Heggie R, Smith M, Horne M, Amanna A, Martin A, Gupta S, Gray K, Weller D, Brittenden J, Leese G. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technol Assess 2020; 24:1-198. [PMID: 33236718 PMCID: PMC7768791 DOI: 10.3310/hta24620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. OBJECTIVES Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. DESIGN We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. INTERVENTIONS The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. MAIN OUTCOME MEASURE The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy. DATA SOURCES Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. REVIEW METHODS We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. RESULTS The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. LIMITATIONS The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. CONCLUSIONS There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. FUTURE WORK RECOMMENDATIONS Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. STUDY REGISTRATION This study is registered as PROSPERO CRD42016052324. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fay Crawford
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
- The Sir James Mackenzie Institute for Early Diagnosis, The School of Medicine, University of St Andrews, St Andrews, UK
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Lewsey
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Neil Hawkins
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald Nicolson
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Smith
- Library & Knowledge Service, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | | | - Aparna Amanna
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - Angela Martin
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Saket Gupta
- Diabetes Centre, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Karen Gray
- NHS Fife, R&D Department, Queen Margaret Hospital, Dunfermline, UK
| | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julie Brittenden
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Graham Leese
- Diabetes and Endocrinology, Ninewells Hospital, NHS Tayside, Dundee, UK
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3
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van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3270. [PMID: 31957213 DOI: 10.1002/dmrr.3270] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022]
Abstract
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
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Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS - Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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4
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Crawford F, Nicolson DJ, Amanna AE, Martin A, Gupta S, Leese GP, Heggie R, Chappell FM, McIntosh HH. Preventing foot ulceration in diabetes: systematic review and meta-analyses of RCT data. Diabetologia 2020; 63:49-64. [PMID: 31773194 PMCID: PMC6890632 DOI: 10.1007/s00125-019-05020-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data. METHODS We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses. RESULTS Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions. CONCLUSIONS/INTERPRETATION Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.
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Affiliation(s)
- Fay Crawford
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK.
- School of Medicine, University of St Andrews, Fife, UK.
| | | | - Aparna E Amanna
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | - Angela Martin
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | - Saket Gupta
- NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | | | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA) Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Francesca M Chappell
- The Centre for Clinical Brain Sciences (CCBS) Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
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5
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Nijenhuis-Rosien L, Kleefstra N, van Dijk PR, Wolfhagen MJHM, Groenier KH, Bilo HJG, Landman GWD. Laser therapy for onychomycosis in patients with diabetes at risk for foot ulcers: a randomized, quadruple-blind, sham-controlled trial (LASER-1). J Eur Acad Dermatol Venereol 2019; 33:2143-2150. [PMID: 30920059 DOI: 10.1111/jdv.15601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with diabetes mellitus are at high risk for onychomycosis, which is related to the development of foot ulcers. OBJECTIVE The aim of this study was to evaluate the safety and efficacy of the treatment of onychomycosis with local laser therapy. METHODS In a single-centre, randomized (1:1), quadruple-blind, sham-controlled trial, patients and microbiological confirmation with diabetes mellitus, at risk for developing diabetic foot ulcers (Sims classification score 1, 2) and a clinical suspicion on onychomycosis, were randomized to either four sessions neodymium-doped yttrium aluminium garnet (Nd-YAG) 1064 nm laser or sham treatment. The primary outcome was clinical and microbiological cure of onychomycosis after 1-year follow-up. RESULTS From March 2015 to July 2016, 64 patients were randomized; 63 could be analysed. Trichophyton rubrum was the most detected pathogen. There was no difference in the primary outcome between laser and sham treatment. With the exception of a subungual haematoma in the fifth toenail occurring 2 weeks after laser treatment, the results suggested that treatment with Nd-YAG 1064 nm laser is safe. CONCLUSION At this moment, there is no evidence of any effect of laser treatment for onychomycosis in patients with diabetes at increased risk for foot ulcers, at least not within 1 year after treatment.
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Affiliation(s)
- L Nijenhuis-Rosien
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Innofeet, Zwolle, The Netherlands
| | - N Kleefstra
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.,University of Groningen, Groningen, The Netherlands.,Medical Research Group Langerhans, Ommen, The Netherlands
| | - P R van Dijk
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - M J H M Wolfhagen
- Laboratory of Medical Microbiology and Infectious Diseases, Isala, Zwolle, The Netherlands
| | | | - H J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.,University of Groningen, Groningen, The Netherlands
| | - G W D Landman
- Medical Research Group Langerhans, Ommen, The Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
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6
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Affiliation(s)
- David G Armstrong
- From the Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson (D.G.A.); Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (D.G.A., A.J.M.B.); and the Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, and Amsterdam Movement Sciences - both in Amsterdam (S.A.B.)
| | - Andrew J M Boulton
- From the Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson (D.G.A.); Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (D.G.A., A.J.M.B.); and the Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, and Amsterdam Movement Sciences - both in Amsterdam (S.A.B.)
| | - Sicco A Bus
- From the Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson (D.G.A.); Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (D.G.A., A.J.M.B.); and the Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, and Amsterdam Movement Sciences - both in Amsterdam (S.A.B.)
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7
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Isei T, Abe M, Nakanishi T, Matsuo K, Yamasaki O, Asano Y, Ishii T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ohtsuka M, Ogawa F, Kadono T, Kodera M, Kawakami T, Kawaguchi M, Kukino R, Kono T, Sakai K, Takahara M, Tanioka M, Nakamura Y, Hashimoto A, Hasegawa M, Hayashi M, Fujimoto M, Fujiwara H, Maekawa T, Madokoro N, Yoshino Y, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene. J Dermatol 2016; 43:591-619. [DOI: 10.1111/1346-8138.13285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Taiki Isei
- Department of Dermatology; Kansai Medical University; Osaka Japan
| | - Masatoshi Abe
- Department of Dermatology; Gunma University Graduate School of Medicine; Gunma Japan
| | - Takeshi Nakanishi
- Department of Dermatology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Koma Matsuo
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Yoshihide Asano
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Takayuki Ishii
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Takaaki Ito
- Department of Dermatology; Hyogo College of Medicine; Hyogo Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Shinichi Imafuku
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka Japan
| | - Ryokichi Irisawa
- Department of Dermatology; Tokyo Medical University; Tokyo Japan
| | - Masaki Ohtsuka
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Mikio Ohtsuka
- Department of Dermatology; Fukushima Medical University; Fukushima Japan
| | - Fumihide Ogawa
- Department of Dermatology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takafumi Kadono
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Masanari Kodera
- Department of Dermatology; Japan Community Health Care Organization Chukyo Hospital; Aichi Japan
| | - Tamihiro Kawakami
- Department of Dermatology; St. Marianna University School of Medicine; Kanagawa Japan
| | - Masakazu Kawaguchi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Ryuichi Kukino
- Department of Dermatology; NTT Medical Center; Tokyo Japan
| | - Takeshi Kono
- Department of Dermatology; Nippon Medical School; Tokyo Japan
| | - Keisuke Sakai
- Intensive Care Unit; Kumamoto University Hospital; Kumamoto Japan
| | - Masakazu Takahara
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Miki Tanioka
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Akira Hashimoto
- Department of Dermatology; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Minoru Hasegawa
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Masahiro Hayashi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Hiroshi Fujiwara
- Department of Dermatology; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - Takeo Maekawa
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Naoki Madokoro
- Department of Dermatology; Mazda Hospital; Hiroshima Japan
| | - Yuichiro Yoshino
- Department of Dermatology; Japanese Red Cross Kumamoto Hospital; Kumamoto Japan
| | | | - Takao Tachibana
- Department of Dermatology; Osaka Red Cross Hospital; Osaka Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
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8
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van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 Suppl 1:84-98. [PMID: 26340966 DOI: 10.1002/dmrr.2701] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. METHODS The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. RESULTS From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. CONCLUSION The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.
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Affiliation(s)
- J J van Netten
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - P E Price
- Vice Chancellors' Office, Cardiff University, Cardiff, Wales, UK
| | - L A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Centre, Dallas, TX, USA
| | - M Monteiro-Soares
- CIDES/CINTESIS - Health Information and Decision Sciences Department (U753-FCT), Oporto Faculty of Medicine, Oporto, Portugal
| | - A Rasmussen
- Steno Diabetes Centre A/S, Gentofte, Denmark
| | - Y Jubiz
- Diabetic Foot Unit, Colombian Diabetes Association, Bogotá, Colombia
| | - S A Bus
- Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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9
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Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJG, Landman GWD. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015; 16:108. [PMID: 25872590 PMCID: PMC4381488 DOI: 10.1186/s13063-015-0622-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background In a sham-controlled double-blind trial, we aim to establish the efficacy and safety of the local application of laser therapy in patients with diabetes, onychomycosis and risk factors for diabetes-related foot complications. Onychomycosis leads to thickened and distorted nails, which in turn lead to increased local pressure. The combination of onychomycosis and neuropathy or peripheral arterial disease (PAD) increases the risk of developing diabetes-related foot complications. Usual care for high-risk patients with diabetes and onychomycosis is completely symptomatic with frequent shaving and clipping of the nails. No effective curative local therapies exist, and systemic agents are often withheld due to concerns for side effects and interactions. Methods/Design The primary aim is to evaluate the efficacy of four sessions of Nd:YAG 1064 nM laser application on the one-year clinical and microbiological cure rate in a randomized, double-blind, sham-controlled design with blinded outcome assessment. Mandatory inclusion criteria are diagnosis of diabetes, risk factors for developing foot ulcers defined as a modified Simm’s classification score 1 or 2 and either neuropathy or PAD. A total of 64 patients are randomized to intervention or sham treatment performed by a podiatrist. Discussion This study will be the first double-blind study that investigates the effects of local laser therapy on onychomycosis, specifically performed in patients with diabetes with additional risk factors for foot complications. Trial registration Clinical trials.gov as NCT01996995, first received 22 November 2013.
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Affiliation(s)
- Leonie Nijenhuis-Rosien
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Innofeet Voetencentrum Nijenhuis Podiatry, Simon Stevinweg 13, 8013 NA, Zwolle, the Netherlands.
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Langerhans Medical Research Group, Postbus 21, 4254 ZG, Sleeuwijk, the Netherlands.
| | - Maurice J Wolfhagen
- Department of Medical Microbiology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
| | - Klaas H Groenier
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Henk J G Bilo
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Gijs W D Landman
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, the Netherlands.
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Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev 2012; 28:574-600. [PMID: 22730196 DOI: 10.1002/dmrr.2319] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Improving ability to predict and prevent diabetic foot ulceration is imperative because of the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value. We performed a search in PubMed for studies published through April 2011 that analysed the association between independent variables and DFU. Articles were selected by two investigators-independently and blind to each other. Divergences were solved by a third investigator. A total of 71 studies were included that evaluated the association between diabetic foot ulceration and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, BMI, HbA(1c) and neuropathy. Diabetic foot ulceration prevalence varied greatly among studies. The majority of the identified variables were assessed by only two or fewer studies. Diabetic neuropathy, peripheral vascular disease, foot deformity and previous diabetic foot ulceration or lower extremity amputation - which are the most common variables included in risk stratification systems - were consistently associated with diabetic foot ulceration development. Existing diabetic foot ulceration risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired because of deficiencies noted, including a great lack of standardization in outcome definition and variable selection and measurement.
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Affiliation(s)
- M Monteiro-Soares
- Endocrinology, Diabetes and Metabolism Department-Diabetic Foot Team, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Portugal.
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11
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Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res 2011; 4:26. [PMID: 22136082 PMCID: PMC3248359 DOI: 10.1186/1757-1146-4-26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/04/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Effective treatment of tinea pedis and onychomycosis is crucial for patients with diabetes as these infections may lead to foot ulcers and secondary bacterial infections resulting in eventual lower limb amputation. Although numerous studies have assessed the effectiveness of antifungal drug and treatment regimens, most exclude patients with diabetes and examine otherwise healthy individuals. While these studies are useful, results cannot necessarily be extrapolated to patients with diabetes. The purpose of this study was to therefore identify the best evidence-based treatment interventions for tinea pedis or onychomycosis in people with diabetes. METHODS The question for this systemic review was: 'what evidence is there for the safety and/or efficacy of all treatment interventions for adults with tinea pedis and/or onychomycosis in people with diabetes'? A systematic literature search of four electronic databases (Scopus, EbscoHost, Ovid, Web of Science) was undertaken (6/1/11). The primary outcome measure for safety was self-reported adverse events likely to be drug-related, while the primary outcome measures assessed for 'efficacy' were mycological, clinical and complete cure. RESULTS The systematic review identified six studies that examined the safety and/or efficacy of treatment interventions for onychomycosis in people with diabetes. No studies were identified that examined treatment for tinea pedis. Of the studies identified, two were randomised controlled trials (RCTs) and four were case series. Based on the best available evidence identified, it can be suggested that oral terbinafine is as safe and effective as oral itraconazole therapy for the treatment of onychomycosis in people with diabetes. However, efficacy results were found to be poor. CONCLUSIONS This review indicates that there is good evidence (Level II) to suggest oral terbinafine is as safe and effective as itraconazole therapy for the treatment of onychomycosis in people with diabetes. Further research is needed to establish the evidence for other treatment modalities and treatment for tinea pedis for people with diabetes. Future efforts are needed to improve the efficacy of treatment intervention.
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Affiliation(s)
- Lisa Matricciani
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Kerwin Talbot
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Sara Jones
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
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