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Adebabay AA, Worede AG, Sume BW, Mihiret GT, Shimelash RA, Goshu BT. Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study. BMC Endocr Disord 2023; 23:265. [PMID: 38037014 PMCID: PMC10687907 DOI: 10.1186/s12902-023-01519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Diabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS Hospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity. RESULT The overall prevalence of foot deformity was 33.4% [95% CI: 28.9-38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity. CONCLUSION The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.
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Affiliation(s)
- Aderajew Agmass Adebabay
- Department of Biomedical science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Amanuel Girma Worede
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bickes Wube Sume
- Department of Biomedical science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Tilaye Mihiret
- Department of Midwifery, Medicine and College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Rahel Asres Shimelash
- Department of pediatric Nursing, Medicine and College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bahiru Tenaw Goshu
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bandarian F, Qorbani M, Nasli-Esfahani E, Sanjari M, Rambod C, Larijani B. Epidemiology of Diabetes Foot Amputation and its Risk Factors in the Middle East Region: A Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022:15347346221109057. [PMID: 35730157 DOI: 10.1177/15347346221109057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. The estimated rate of foot amputation in diabetes patients and those with DFUs in the Middle East region is approximately high, which may indicate low quality of preventive foot care, low socioeconomics and low patients awareness or education in countries with high amputation rate.
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Affiliation(s)
- Fatemeh Bandarian
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular- Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rambod
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
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HEMMATI H, FORGHAN M, ABBASI RANJBAR Z, JAFARYPARVAR Z, RAFIEI E, ANDALIB S. Beyond diabetes mellitus type 2: neuropathy, arterial disease and foot deformity. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gonzalez-Martin C, Pertega-Diaz S, Seoane-Pillado T, Balboa-Barreiro V, Soto-Gonzalez A, Veiga-Seijo R. Structural, Dermal and Ungual Characteristics of the Foot in Patients with Type II Diabetes. ACTA ACUST UNITED AC 2019; 55:medicina55100639. [PMID: 31557980 PMCID: PMC6843386 DOI: 10.3390/medicina55100639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 01/13/2023]
Abstract
Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coruña (CHUAC) (A Coruña-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p < 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment.
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Affiliation(s)
- Cristina Gonzalez-Martin
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Sonia Pertega-Diaz
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Teresa Seoane-Pillado
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Vanesa Balboa-Barreiro
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Alfonso Soto-Gonzalez
- Endocrinology Service of the University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña, 15006 A Coruña, Spain.
| | - Raquel Veiga-Seijo
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
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Moradi Y, Baradaran HR, Djalalinia S, Chinekesh A, Khamseh ME, Dastoorpoor M, Sioofy-Khojine AB, Saed L, Qorbani M. Complications of type 2 diabetes in Iranian population: An updated systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:2300-2312. [PMID: 31235172 DOI: 10.1016/j.dsx.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/22/2019] [Indexed: 01/17/2023]
Abstract
Complications among patients with type 2 diabetes mellitus (T2DM) have increased dramatically through two past decades. Thus, the aim of this updated systematic review and meta-analysis was to estimate the pooled prevalence of T2DM complications in Iranian patients. Using Medical Subject Headings terms, Emtree, and related equal Persian key words, international databases including PubMed, ISI/WOS, Scopus, Iran Medex, SID, Magiran, Irandoc, Medlib, domestic databases were searched from January 1990 till January 2018 reporting prevalence of any complications of type 2 diabetes in Iran. All the keywords were searched electronically by two Boolean operators through the explained search strategy, separately. Relevant additional articles were identified from the lists of the retrieved articles. Random and fixed effect meta-analysis was used to estimate the pooled prevalence of complications in Iranian patients with T2DM. Through searching steps, among 1238 publications retrieved from literature search, finally 45 studies met the inclusion criteria for meta-analysis, with number of 30679 participants. According to random effect, the estimated pooled prevalence of diabetic foot ulcer, cardiovascular disease, retinopathy, neuropathy and nephropathy in Iranian patients with T2DM were 3%(95% CI: 1-5%), 33%(95% CI: 16-49%), 36%(95% CI: 27-45%), 38% (95% CI: 14-63%), and 43% (95% CI: 27-60%), respectively. This updated meta-analysis shows that prevalence of major microvascular complications of T2DM in Iran is high. Our findings provide practical evidence for better planning and clinical decision making.
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Affiliation(s)
- Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Iran.
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahdieh Chinekesh
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohamad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Dastoorpoor
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir-Babak Sioofy-Khojine
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, FI-33520, Tampere, Finland
| | - Lotfolah Saed
- Department of Endocrinology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Younis BB, Shahid A, Arshad R, Khurshid S, Ahmad M, Yousaf H. Frequency of foot ulcers in people with type 2 diabetes, presenting to specialist diabetes clinic at a Tertiary Care Hospital, Lahore, Pakistan. BMC Endocr Disord 2018; 18:53. [PMID: 30081878 PMCID: PMC6090692 DOI: 10.1186/s12902-018-0282-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/27/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Diabetic foot ulceration is a serious limb-threatening complication of diabetes. It is the common cause of hospital admissions and amputations. The objective of the study was to determine the prevalence of diabetic foot ulcers (DFU) and its association with age, gender, duration of diabetes, peripheral neuropathy (PN), peripheral arterial disease (PAD) and HbA1c. METHODS A total of 1940 people (≥ 30 years of age) with type 2 diabetes coming to the Sakina Institute of Diabetes and Endocrine Research (specialist diabetes clinic) at Shalamar Hospital, Lahore, Pakistan, were recruited over a period of 1 year from January 2016 to January 2017. The foot ulcers were identified according to the University of Texas classification. PN was assessed by biothesiometer and PAD by ankle-brachial index (< 0.9). Body weight, height, body mass index (BMI), HbA1c and duration of diabetes were recorded. RESULTS The prevalence of DFU was 7.02%, of which 4.5% of the ulcers were on the planter and 2.6% on the dorsal surface of the foot; 8.5% of the persons had bilateral foot ulcers and 0.4% subjects had Charcot deformity. There was significant association of foot ulcers with age, duration of diabetes, HbA1c, PN and PAD, whereas no association was observed with gender and BMI. PN and PAD were observed in 26.3 and 6.68% of people with diabetes respectively. Neuropathic ulcers and neuro-ischemic ulcers were identified in 74 and 19% of the study population. Logistic regression analysis revealed significant odds ratio for peripheral neuropathy 23.9 (95% confidence interval (5.41-105.6). CONCLUSIONS Peripheral neuropathy is the commonest cause of foot ulcers. An optimum control of blood glucose to prevent neuropathy and regular feet examination of every person with diabetes may go a long way in preventing foot ulceration.
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Affiliation(s)
- Bilal Bin Younis
- Sakina Institute of Diabetes and Endocrine Research, Shalamar Hospital, Lahore, Pakistan
| | - Adeela Shahid
- Physiology Department, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Rozina Arshad
- Sakina Institute of Diabetes and Endocrine Research, Shalamar Hospital, Lahore, Pakistan
| | - Saima Khurshid
- Sakina Institute of Diabetes and Endocrine Research, Shalamar Hospital, Lahore, Pakistan
| | - Muhammad Ahmad
- Sakina Institute of Diabetes and Endocrine Research, Shalamar Hospital, Lahore, Pakistan
| | - Haroon Yousaf
- Sakina Institute of Diabetes and Endocrine Research, Shalamar Hospital, Lahore, Pakistan
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Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. Ann Med 2017; 49:106-116. [PMID: 27585063 DOI: 10.1080/07853890.2016.1231932] [Citation(s) in RCA: 811] [Impact Index Per Article: 115.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot is a severe public health issue, yet rare studies investigated its global epidemiology. Here we performed a systematic review and meta-analysis through searching PubMed, EMBASE, ISI Web of science, and Cochrane database. We found that that global diabetic foot ulcer prevalence was 6.3% (95%CI: 5.4-7.3%), which was higher in males (4.5%, 95%CI: 3.7-5.2%) than in females (3.5%, 95%CI: 2.8-4.2%), and higher in type 2 diabetic patients (6.4%, 95%CI: 4.6-8.1%) than in type 1 diabetics (5.5%, 95%CI: 3.2-7.7%). North America had the highest prevalence (13.0%, 95%CI: 10.0-15.9%), Oceania had the lowest (3.0%, 95% CI: 0.9-5.0%), and the prevalence in Asia, Europe, and Africa were 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), and 7.2% (95%CI: 5.1-9.3%), respectively. Australia has the lowest (1.5%, 95%CI: 0.7-2.4%) and Belgium has the highest prevalence (16.6%, 95%CI: 10.7-22.4%), followed by Canada (14.8%, 95%CI: 9.4-20.1%) and USA (13.0%, 95%CI: 8.3-17.7%). The patients with diabetic foot ulcer were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot ulceration. Our results provide suggestions for policy makers in deciding preventing strategy of diabetic foot ulceration in the future. Key messages Global prevalence of diabetic foot is 6.3% (95%CI: 5.4-7.3%), and the prevalence in North America, Asia, Europe, Africa and Oceania was 13.0% (95%CI: 10.0-15.9%), 5.5% (95%CI: 4.6-6.4%), 5.1% (95%CI: 4.1-6.0%), 7.2% (95%CI: 5.1-9.3%), and 3.0% (95% CI: 0.9-5.0%). Diabetic foot was more prevalent in males than in females, and more prevalent in type 2 diabetic foot patients than in type 1 diabetic foot patients. The patients with diabetic foot were older, had a lower body mass index, longer diabetic duration, and had more hypertension, diabetic retinopathy, and smoking history than patients without diabetic foot.
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Affiliation(s)
- Pengzi Zhang
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Jing Lu
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Yali Jing
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Sunyinyan Tang
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Dalong Zhu
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
| | - Yan Bi
- a Department of Endocrinology , Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School , Nanjing , China
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Hashmi F, Nester C, Wright C, Newton V, Lam S. Characterising the biophysical properties of normal and hyperkeratotic foot skin. J Foot Ankle Res 2015; 8:35. [PMID: 26269720 PMCID: PMC4533794 DOI: 10.1186/s13047-015-0092-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plantar foot skin exhibits unique biophysical properties that are distinct from skin on other areas of the body. This paper characterises, using non-invasive methods, the biophysical properties of foot skin in healthy and pathological states including xerosis, heel fissures, calluses and corns. METHODS Ninety three people participated. Skin hydration, elasticity, collagen and elastin fibre organisation and surface texture was measured from plantar calluses, corns, fissured heel skin and xerotic heel skin. Previously published criteria were applied to classify the severity of each skin lesion and differences in the biophysical properties compared between each classification. RESULTS Calluses, corns, xerotic heel skin and heel fissures had significantly lower levels of hydration; less elasticity and greater surface texture than unaffected skin sites (p < 0.01). Some evidence was found for a positive correlation between hydration and elasticity data (r ≤ 0.65) at hyperkeratotic sites. Significant differences in skin properties (with the exception of texture) were noted between different classifications of skin lesion. CONCLUSIONS This study provides benchmark data for healthy and different severities of pathological foot skin. These data have applications ranging from monitoring the quality of foot skin, to measuring the efficacy of therapeutic interventions.
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Affiliation(s)
- Farina Hashmi
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Manchester, UK
| | - Christopher Nester
- Foot and Ankle Research Programme, Centre for Health Sciences Research, School of Health Sciences, University of Salford, Manchester, UK
| | - Ciaran Wright
- School of Health Sciences, Centre for Health Sciences Research, University of Salford, Manchester, UK
| | - Veronica Newton
- School of Health Sciences, University of Salford, Manchester, UK
| | - Sharon Lam
- Reckitt Benckiser, Dansom Lane, Hull, UK
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Hadadi A, Omdeh Ghiasi H, Hajiabdolbaghi M, Zandekarimi M, Hamidian R. Diabetic foot: infections and outcomes in Iranian admitted patients. Jundishapur J Microbiol 2014; 7:e11680. [PMID: 25368803 PMCID: PMC4216583 DOI: 10.5812/jjm.11680] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/30/2013] [Accepted: 02/11/2014] [Indexed: 12/19/2022] Open
Abstract
Background: Diabetes mellitus (along with its complications) has become a global problem. Diabetic foot infection, among the most common complications, is responsible for 40 to 50% of foot amputations. Antibiotic-resistant microorganisms, however, have compromised empiric therapy in the infected patients. Objectives: The current study aimed to determine the most common microorganisms involved in diabetic foot infection in order to minimize the failure of antibiotic therapy and the risk of developing complications. Patients and Methods: All patients with diabetic foot infection admitted to the infectious diseases, surgery and endocrinology wards of two teaching hospitals from 2007 to 2010 (n = 196) were recruited. In this retrospective study, demographic characteristics, type of lesions, history of hospitalization/antibiotic therapy, isolated microorganisms, clinical complications, administered treatment (medical or surgical) and outcome were recorded. Results: Patients’ mean age was 60.84 (± 10.30) years. Totally, 113 (57.65%) of the patients were male and 83 (42.35%) were female. According to Wagner’s grading, deep ulcers with/without osteomyelitis accounted for the majority of lesions. A single microorganism was isolated (most common: Escherichia coli, Staphylococcus aureus and Klebsiella spp.) from 81 of the patients (80.20%); while for the remaining polymicrobial infection was reported. Isolated pathogens showed no significant correlation with duration of diabetes, type of the lesions (P = 0.13) and history of hospitalization (P = 0.61). The majority of patients (n = 118, 60.20%) were treated surgically; however 11 patients expired due to sepsis. Amputation (most common at toes and below the knee) was performed for 89 patients (45.40%). The response rate to medical treatment was 31.6% for single-pathogen and 10% for polymicrobial infection (with a 30% mortality rate). Conclusions: Physicians are recommended to take microbiological cultures before starting empirical therapy recommended to cover Gram-negative microorganisms in order to lower the risk of antibiotic resistance.
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Affiliation(s)
- Azar Hadadi
- Department of Internal Medicine, Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Azar Hadadi, Department of Internal Medicine, Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Sina Hospital, Imam Khomeini St. Hasan Abad Square, Tehran, IR Iran. Tel/Fax: +98-2166348555, E-mail:
| | | | - Mahboubeh Hajiabdolbaghi
- Department of Infectious Diseases, Iranian Research Center for HIV and AIDS, Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Reza Hamidian
- Research Development Center, Sina hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, Woo K, Boeni T, Ayello EA, Kirsner RS. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014; 70:1.e1-18; quiz 19-20. [PMID: 24355275 DOI: 10.1016/j.jaad.2013.06.055] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.
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Affiliation(s)
- Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada.
| | - R Gary Sibbald
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Department of Medicine (Dermatology) and Public Health, University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - Dieter Mayer
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | | | - Mariam Botros
- Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - David G Armstrong
- Department of Surgery, the University of Arizona College of Medicine/SALSA, Tucson, Arizona
| | - Kevin Woo
- Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Thomas Boeni
- Department of Prosthetics and Orthotics, University of Zurich, Zurich, Switzerland
| | | | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MCR. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 2013; 44:119-24. [PMID: 23124278 DOI: 10.1007/s12020-012-9829-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/23/2012] [Indexed: 12/20/2022]
Abstract
Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81-6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01-20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
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Affiliation(s)
- Arnaldo Moura Neto
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Abstract
People with diabetes mellitus will develop lower-limb complications, such as neuropathy, peripheral vascular disease, foot ulcers, and lower-leg amputations. Resources to control elevated hemoglobin A1c and blood pressure, along with the standardized approach using the 60-second tool (2012), can detect the high-risk diabetic foot and help prevent complications.
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Oe M, Sanada H, Nagase T, Minematsu T, Ohashi Y, Kadono T, Ueki K, Kadowaki T. Factors associated with deep foot fissures in diabetic patients: A cross-sectional observational study. Int J Nurs Stud 2012; 49:739-46. [DOI: 10.1016/j.ijnurstu.2012.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 12/25/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
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Kosachunhanun N, Tongprasert S, Rerkasem K. Diabetic foot problems in tertiary care diabetic clinic in Thailand. INT J LOW EXTR WOUND 2012; 11:124-7. [PMID: 22553278 DOI: 10.1177/1534734612446967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Foot problems in patients with diabetes cause substantial morbidity and may lead to lower extremity amputations. These risks may be reduced by appropriate screening and intervention measures. Effective screening assigns the patient to a risk category and dictates both the type and frequency of appropriate foot interventions. Less than half of diabetic patients in tertiary care hospital in Thailand received annual foot examination and there are limited data available on the nature of foot problems in such setting. This study reported a cross-sectional data of 438 diabetic patients attend tertiary diabetic clinic in the university hospital in Northern Thailand. Neuropathy manifestations as skin dryness, limitation of joint mobility and insensate to monofilament was the most common manifestation of diabetic foot problems in this setting. Most patients were not protected by proper footwear. More effort is needed to educate diabetic patients about foot care and improve their choice and selection of footwear.
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Sanjari M, Safari S, Shokoohi M, Safizade H, Rashidinezhad H, Mashrouteh M, Alavi A. A cross-sectional study in Kerman, Iran, on the effect of diabetic foot ulcer on health-related quality of life. INT J LOW EXTR WOUND 2012; 10:200-6. [PMID: 22184751 DOI: 10.1177/1534734611428728] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes the impact of diabetic foot ulcers (DFUs) on health-related quality of life (HRQoL) using a generic instrument including 8 domains. Data were obtained from 54 patients with DFU who were compared with 78 patients who had diabetes without foot ulcer. HRQoL was measured using the Iranian version of Medical Outcome Study-Short Form (SF-36). The fasting plasma glucose, creatinine, glycosylated hemoglobin (HbA1c), and urine microalbumin as well as ankle-brachial pressure index (ABI) were measured for all participants in the 2 groups. In all, 51.9% of patients with DFU had ABI scores of <0.9 compared with only 11.8% of the control group (P < .001). No differences were found in any of the treatment characteristics (oral/insulin therapy) between the 2 groups (case/control). HRQoL evaluated by the SF-36 questionnaire, in particular in the areas of physical function, is lower in patients with diabetes with foot ulcers compared with patients with diabetes without foot ulcers (41.04 ± 22.69 vs 56.67 ± 25.57; P < .01). After adjusting by sex, 2 domains of physical functioning and bodily pain as well as the total HRQoL score in patients with DFU were lower than in patients with diabetes (P < .001). This study showed that physical functioning and bodily pain along with total score of HRQoL were important aspects that were lower in patients with DFU than in patients with diabetes. Gender was considered as a confounding factor, which was omitted in multivariate analysis.
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Affiliation(s)
- Mojgan Sanjari
- Physiology Research center, Kerman University of Medical Sciences, Kerman, Iran
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Vatankhah N, Noudeh YJ, Khamseh ME, Baradaran HR. Screening people with type 2 diabetes at risk for foot ulceration in Iran. Diabetes Technol Ther 2010; 12:731-6. [PMID: 20707739 DOI: 10.1089/dia.2010.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Foot screening is one of the most effective means of preventing foot complications in diabetes. Therefore the aim of this study was to perform a screening program for people with type 2 diabetes at risk of foot complications. METHODS Physical examinations consisting of vascular, neurological, musculoskeletal, and dermatologic examinations were performed. We used a Semmes-Weinstein monofilament and a 128-Hz tuning fork to test peripheral neuropathy. The study population was categorized based on Scottish Intercollegiate Guidelines into three groups of low, medium, and high risk for diabetes foot disease. RESULTS Of a total of 148 people with type 2 diabetes, 4.7% had an active foot ulcer, and 41.9% were classed as low risk, 40.6% as medium risk, and 12.8% as high risk. CONCLUSIONS Considering the potential of developing risk of foot disease in people with diabetes, it is recommended that foot screening should be performed by primary care practitioners and specialists to detect foot disease in an early stage. Foot screening program for people with diabetes should also be taken into account by health policy makers in national guidelines.
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Affiliation(s)
- Nasibeh Vatankhah
- Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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