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Kempe K, Homco J, Nsa W, Wetherill M, Jelley M, Lesselroth B, Hasenstein T, Nelson PR. Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions. J Vasc Surg 2024; 80:515-526. [PMID: 38604318 DOI: 10.1016/j.jvs.2024.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. METHODS We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. RESULTS Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category. CONCLUSIONS Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.
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Affiliation(s)
- Kelly Kempe
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK.
| | - Juell Homco
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Wato Nsa
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Marianna Wetherill
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Tulsa, OK
| | - Martina Jelley
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medicine, Tulsa, OK
| | - Blake Lesselroth
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Todd Hasenstein
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK
| | - Peter R Nelson
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK
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AlMajali AS, Richards T, Yusuf SW, Telgenkamp B. Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations. Front Endocrinol (Lausanne) 2024; 15:1304436. [PMID: 38836223 PMCID: PMC11148210 DOI: 10.3389/fendo.2024.1304436] [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: 09/29/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients. Methods We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts. Results The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001). Conclusion Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.
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Affiliation(s)
- Ali S AlMajali
- Department of Acute Internal Medicine at the Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Thomas Richards
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Syed Waquar Yusuf
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Bjorn Telgenkamp
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
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Soonarane YK, Pollard G, Knack B, Hope M, Clark D, Naidu S, Anuradha S, Puri G. Inequity of healthcare access for patients with diabetic foot disease: a retrospective study in south-east Queensland. BMJ Open 2024; 14:e074155. [PMID: 38238174 PMCID: PMC11148679 DOI: 10.1136/bmjopen-2023-074155] [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] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Logan local government area (LGA) in Queensland has the highest diabetes prevalence (6.5%) within Metro South Health (MSH). The study aimed to determine the burden of, and equity of access to secondary healthcare, for diabetic foot disease (DFD) for Logan residents to better inform healthcare services planning. DESIGN A retrospective analysis of hospital admissions data between January 2018 and December 2021. SETTING, PARTICIPANTS All episodes of care for DFD provided by MSH hospitals to patients with a residential address in the three LGAs serving the region were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was number of episodes of care for DFD by LGA of residence and hospital of presentation. Secondary outcomes were DFD-related hospital occupied bed days and number of lower extremity amputations. RESULTS Among residents in the MSH region, almost half of all episodes of care (47%) and bed days (48%) for DFD were for patients residing in Logan LGA. 40% of episodes of care, 57% of bed days and 73% of lower extremity amputations for DFD for these patients occurred outside of Logan LGA. These findings led to the planning of an integrated model of care for DFD at Logan hospital to improve and make care available locally. CONCLUSIONS Our study suggests that Logan residents with DFD had poor access to care despite the highest burden. Analysing epidemiology of care for DFD with an equity lens and highlighting gaps in service delivery is paramount to addressing the inequity paradigm.
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Affiliation(s)
- Yudish Kumar Soonarane
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Gayle Pollard
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Brent Knack
- Healthcare Improvement Unit, Clinical Excellence Queensland, Herston, Queensland, Australia
| | - Matthew Hope
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Darren Clark
- Division of Internal Medicine, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Sanjeev Naidu
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Satyamurthy Anuradha
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gaurav Puri
- Healthcare Improvement Unit, Clinical Excellence Queensland, Herston, Queensland, Australia
- Logan Endocrine and Diabetes Services (LEADS), Logan Hospital, Metro South Health, Meadowbrook, Queensland, Australia
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Govindasamy K, Darlong J, Watson SI, Gill P. Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta-analysis. J Foot Ankle Res 2023; 16:77. [PMID: 37953361 PMCID: PMC10641946 DOI: 10.1186/s13047-023-00674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy. METHODS Databases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its "risk factors" associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726. RESULTS Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 g of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed. CONCLUSIONS The prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 g of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.
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Affiliation(s)
- Karthikeyan Govindasamy
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Research Domain, The Leprosy Mission Trust India, New Delhi, India.
| | - Joydeepa Darlong
- Research Domain, The Leprosy Mission Trust India, New Delhi, India
| | - Samuel I Watson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Paramjit Gill
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Hessain D, Andersen A, Fredslund EK. Inequalities in healthcare utilisation among adults with type 2 diabetes. Diabetes Res Clin Pract 2023; 205:110982. [PMID: 37890705 DOI: 10.1016/j.diabres.2023.110982] [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: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately. RESULTS The majority (59.7 %) had attended the ophthalmologist at least once in the preceding year, whereas 46.5 % and 34.2 % had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p < 0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p < 0.001). CONCLUSIONS This study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.
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Affiliation(s)
- Dunia Hessain
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Eskild Klausen Fredslund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
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González-Colaço Harmand M, Tejera Concepción A, Farráis Expósito FJ, Domínguez González J, Ramallo-Fariña Y. Pilot Study on the Relationship between Malnutrition and Grip Strength with Prognosis in Diabetic Foot. Nutrients 2023; 15:3710. [PMID: 37686742 PMCID: PMC10490286 DOI: 10.3390/nu15173710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Sarcopenia and malnutrition have been associated in the elderly population with a poor prognosis in wound healing and with other adverse events, such as institutionalization or functional impairment. However, it is not known how these factors influence the prognosis of diabetic foot in the elderly. To answer this question, a prospective observational study of 45 patients over 65 years of age admitted with diagnoses of diabetic foot in a tertiary hospital has been conducted. All patients were assessed at admission and at 3 months after returning home to determine quality of life, pain, mobility and healing, overall hospital stay in relation to the presence of malnutrition (measured by BMI, CIPA scale and analytical parameters at admission of serum proteins and albumin), and sarcopenia measured by grip force, among other geriatric syndromes. The results found a relationship between altered sarcopenia and more pain and poorer quality of life, and altered BMI was related to a lower cure rate and worse mobility at follow-up. This study seems to indicate that, in the elderly population with diabetic foot, malnutrition and sarcopenia should be managed at the same time as the treatment of the diabetic foot itself.
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Affiliation(s)
- Magali González-Colaço Harmand
- Department of Internal Medicine-Geriatric Medicine, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Spain
| | - Alicia Tejera Concepción
- Department of Internal Medicine-Geriatric Medicine, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Internal Medicine Department, Universidad de la Laguna, 38200 La Laguna, Spain
| | | | | | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), 35019 Las Palmas de Gran Canaria, Spain;
- Network for Research on Chronicity Primary Care and Health Promotion, 28029 Madrid, Spain
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Alahakoon C, Singh TP, Galappaththy C, Charles J, Fernando M, Lazzarini P, Moxon JV, Golledge J. Risk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:221-228. [PMID: 37196911 DOI: 10.1016/j.ejvs.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Diabetes related foot disease (DFD) is a common reason for admission to hospital, but the predictive factors for repeat admission are poorly defined. The primary aim of this study was to identify rates and predictive factors for DFD related hospital re-admission. METHODS Patients admitted to hospital for treatment of DFD at a single regional centre were recruited prospectively between January 2020 and December 2020. Participants were followed for 12 months to evaluate the primary outcome of hospital re-admission. The relationship between predictive factors and re-admission were examined using non-parametric statistical tests and Cox proportional hazard analyses. RESULTS The median age of the 190 participants was 64.9 (standard deviation 13.3) years and 68.4% were male. Forty-one participants (21.6%) identified themselves as Aboriginal or Torres Strait Islander people. One hundred participants (52.6%) were re-admitted to hospital at least once over 12 months. The commonest reason for re-admission was for treatment of foot infection (84.0% of first re-admission). Absent pedal pulses (unadjusted hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26 - 2.85), loss of protective sensation (LOPS) (unadjusted HR 1.98; 95% CI 1.08 - 3.62), and male sex (unadjusted HR 1.62; 95% CI 1.03 - 2.54) increased the risk of re-admission. After risk adjustment, only absence of pedal pulses (HR 1.92, 95% CI 1.27 - 2.91) and LOPS (HR 2.02, 95% CI 1.09 - 3.74) significantly increased the risk of re-admission. CONCLUSION Over 50% of patients admitted to hospital for treatment of DFD are re-admitted within one year. Patients with absent pedal pulses and those with LOPS are twice as likely to be re-admitted.
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Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Charith Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - James Charles
- First Peoples Health Unit, Griffith University, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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Shen JM, Chen J, Feng L, Feng C. A scientometrics analysis and visualisation of diabetic foot research from 1955 to 2022. Int Wound J 2023; 20:1072-1087. [PMID: 36164753 PMCID: PMC10031233 DOI: 10.1111/iwj.13964] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Diabetic foot (DF) has become a serious health problem in modern society, and it has been a hotspot of research for a long time. However, little scientometric analysis has been carried out on DF. In the present study, we analysed 8633 literature reports on DF in the Web of Science Core Collection from database inception until April 23, 2022. VOSviewer (Centre for Science and Technology Studies at Leiden University, Leiden, the Netherlands) and CiteSpace (College of Computing and Informatics, Drexel University, Philadelphia, United States) were employed to address high-impact countries and institutions, journals, references, research hotspots, and key research fields in DF research. Our analysis findings indicated that publications on DF have increased markedly since 2016 and were primarily published in the United States of America. The recent studies focus on the amniotic membrane, foot ulcers, osteomyelitis, and diabetic wound healing. The five keyword clusters, which included DF ulcer and wound healing therapies, management and guidelines, neuropathy and plantar pressure, amputation and ischemia, and DF infection and osteomyelitis, are helpful for enhancing prevention, standardising treatment, avoiding complications, and improving prognosis. These findings indicated a method for future therapies and research in DF.
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Affiliation(s)
- Jin-Ming Shen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jie Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Lei Feng
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Chun Feng
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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A clinicopathological study on management of diabetic foot ulcer in tertiary care centre. Foot (Edinb) 2023; 54:101971. [PMID: 36773396 DOI: 10.1016/j.foot.2023.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Diabetes is a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. India being the Diabetes Capital of the World has a Prevalence of 65.1 million suffering from DM of the Entire Indian Population being 1.33 billion of Worlds 6 billion people. This states that almost half of the Indian Population will sometime in their life be detected with Diabetes Almost 15-20 % of the population suffering from Diabetes are seen to have Diabetic Foot Ulcer at least once in their lifetime. It is also been noted that 10-15 % of patients suffering from Diabetic Foot Ulcer require Expert Management or Multi Disciplinary Approach. Diabetic foot ulcers have many pathogenic mechanisms, These risk factors are as follows: gender (male), duration of diabetes longer than 10 years, advanced age of patients, high Body Mass Index and other co-morbidities such as retinopathy, diabetic peripheral neuropathy, peripheral vascular disease, high glycated haemoglobin level (HbA1C), foot deformity, high plantar pressure, infections and inappropriate foot selfcare habits. Rough estimates are at about 1,00,000 lower limbs are amputated in India every year, of which at least seventy-five percent are neuropathic feet with secondary infections and are potentially preventable. AIMS AND OBJECTIVES
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SELVİ ÖZTORUN H, GÖZÜKARA B, BAHŞİ R, TURGUT T, MUT SÜRMELİ D, COŞARDERELİOĞLU Ç, ATMIŞ V, VARLI M, ARAS S. A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1133659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Diabetes mellitus (DM) tends to increase with aging. Nearly half of the patients with DM develop neuropathy (DPN). Despite its high burden and morbidity, the conditions that DPN may be associated with have not been adequately studied in older adults. We aimed to identify sleep duration and comprehensive geriatric assessment components that may be associated with DPN.
Material and Method: This is a cross-sectional retrospective study. DPN diagnosed with a medical history, neurologic examination, and electromyography (EMG). 125 diabetic older patients were included. All comprehensive geriatric assessment tests and questions about sleep quality and time were performed. We divided the patients into two groups those without neuropathy and with neuropathy and compared them.
Results: The median age of 125 patients was 72 (min-max; 64-94). 58.8% of them were women. The percentage of married people and living with their spouse and slept for 6 hours or more had a lower percentage in the DPN group. Polypharmacy and the percentage of heart failure were significantly higher in the DPN group. Lawton-Brody score, which shows instrumental daily living activities (IADL) and geriatric depression score (GDS) was higher in the DPN group. In logistic regression, we found that depression scores were higher and sleep duration was shorter in the DPN group (respectively, odd ratio:265 p:.012; odd ratio:.1.917 p:.045)
Conclusions: DPN in older adults may affect the functionality and be associated with fewer sleep hours and depression. Not only blood glucose regulation but also other factors such as sleep duration and depressed mood may be associated with DPN in older adults.
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Affiliation(s)
- Hande SELVİ ÖZTORUN
- Republic of Turkey Ministry of Health Ankara City Training and Research Hospital Department of Geriatrics
| | - Bilge GÖZÜKARA
- Ankara University, Faculty of Medicine, Department of Internal Medicine
| | - Remzi BAHŞİ
- Ankara University, Faculty of Medicine, Ibn-i Sina Hospital, Department of Geriatrics
| | - Tuğba TURGUT
- Republic of Turkey Ministry of Health ,Antalya Training and Research Hospital, Department of Geriatrics, Antalya, Turkey
| | - Deniz MUT SÜRMELİ
- Ankara University, Faculty of Medicine, Ibn-i Sina Hospital, Department of Geriatrics
| | | | - Volkan ATMIŞ
- Ankara University, Faculty of Medicine, Ibn-i Sina Hospital, Department of Geriatrics
| | - Murat VARLI
- Ankara University, Faculty of Medicine, Ibn-i Sina Hospital, Department of Geriatrics
| | - Sevgi ARAS
- Ankara University, Faculty of Medicine, Ibn-i Sina Hospital, Department of Geriatrics
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Cuddapah GV, Vallivedu Chennakesavulu P, Pentapurthy P, Vallakati M, Kongara A, Reddivari P, Singareddy S, Chandupatla KP, Swamy M. Complications in Diabetes Mellitus: Social Determinants and Trends. Cureus 2022; 14:e24415. [PMID: 35619856 PMCID: PMC9126423 DOI: 10.7759/cureus.24415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Conditions that impact an individual's health are referred to as social determinants of health. Through a retrospective study (January 2017-February 2022) and statistical analysis, researchers looked at the relationship between social demands and type 2 diabetes mellitus (T2DM) diagnosis. All social demands, with the exception of childcare, were more typically documented in patients with T2DM. Prescription expense, conveyance, and health literacy were the domains with the greatest relationships. These results might help health systems and social service providers develop collaborations to help in certain areas.
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Ahmed MU, Tannous WK, Agho KE, Henshaw F, Turner D, Simmons D. The burden of diabetes-related foot disease among older adults in Australia. Int Wound J 2022; 19:1758-1768. [PMID: 35247036 PMCID: PMC9615279 DOI: 10.1111/iwj.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022] Open
Abstract
Diabetes‐related foot disease (DFD) is imposing an enormous burden on the health system and society due to the rapid growth of diabetes worldwide. Given the paucity of robust data on the disease burden of DFD in Australia, this study aimed to estimate the burden of disease due to DFD. The burden of DFD was estimated using the disability‐adjusted life‐years (DALY) approach. Data of 27 931 individuals aged 45 years and older with diabetes residing in New South Wales (NSW) from the 45 and Up Study survey were used in this study by linking it with the emergency department, hospital admissions and the deaths' registry data. The disease burden of DFD was estimated as 8915 DALY in NSW and 27 164 DALY in Australia in 2011. The burden was prominent among males and people aged 65 years and older. Most of the DALY (87%) was attributed to years of life lost or the fatal burden due to diabetes‐related lower limb amputation (DRLEA). The total monetary values of DALY of DFD for NSW and Australia were estimated at approximately AUD 2 billion and AUD 6 billion annually, respectively. Preventative and curative priorities should be given to DRLEA to reduce this burden and target males, especially those aged 65 years and older.
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Affiliation(s)
- Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.,School of Business, Western Sydney University, Parramatta, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia.,African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, South Africa
| | - Frances Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia.,ConvaTec, Glen Waverley, Victoria, Australia
| | - Deborah Turner
- School of Clinical Sciences, Podiatric Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, New South Wales, Australia
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