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Simonsen MB, Christiansen SL, Pedersen MK, Røikjer J, Croosu SS, Leutscher PDC, Ejskjaer N. Health literacy and cognitive function in people with diabetic foot ulcer with focus on knowledge, attitude, and practice in relation to foot self-care. SAGE Open Med 2024; 12:20503121241258841. [PMID: 38855003 PMCID: PMC11159546 DOI: 10.1177/20503121241258841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Preventative foot self-care is vital for avoiding diabetic foot ulcer episodes and lowering the risk of amputations. Yet, it demands high levels of health literacy and cognitive function. Objective To investigate health literacy and cognitive function in persons presenting with a diabetic foot ulcer. Methods Participants with type 2 diabetes were recruited from the tertiary foot clinic at Steno Diabetes Center North Denmark. The European Health Literacy Survey Questionnaire and Addenbrooke's Cognitive Examination were applied. A semi-structured interview guide was developed to evaluate foot self-care knowledge, attitude, and practice. The qualitative data were analyzed with a deductive approach based on a qualitative thematic analysis model. Subsequently, an integrated analysis of the quantitative and qualitative results was conducted. Results The participants (n = 12) had a mean age of 62.6 ± 8.4 years, and 11 were males. The mean diabetes duration was 15.9 ± 8.9 years. Eight participants had a recurrent diabetic foot ulcer. The health literacy level was sufficient in nine participants, and cognitive function was normal in five participants. Three different profiles related to foot self-care (proactive, active, or passive, respectively) were constructed by the final integrated analysis: a proactive profile refers to taking preventative action in concordance with knowledge and attitude, an active profile to taking action in response to a situation, but challenged by conflicting levels of knowledge and attitude, and a passive profile to not taking action. Conclusion The study suggests that people presenting with a diabetic foot ulcer have different foot self-care profiles based on person-specific health literacy, cognitive function, and knowledge, attitude, and practice element characteristics, highlighting the need for individualized education and intervention strategy instead of a one-size-fits-all approach.
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Affiliation(s)
- Morten Bilde Simonsen
- North Denmark Regional Hospital, Center for Clinical Research, Hjorring, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | | | - Mona Kyndi Pedersen
- North Denmark Regional Hospital, Center for Clinical Research, Hjorring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Suganthiya Santhiapillai Croosu
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Derek Christian Leutscher
- North Denmark Regional Hospital, Center for Clinical Research, Hjorring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Jeffcoate W, Boyko EJ, Game F, Cowled P, Senneville E, Fitridge R. Causes, prevention, and management of diabetes-related foot ulcers. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00110-4. [PMID: 38824929 DOI: 10.1016/s2213-8587(24)00110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/04/2024]
Abstract
In this Review, we aim to complement the 2023 update of the guidelines of the International Working Group on the Diabetic Foot. We highlight the complexity of the pathological processes that underlie diabetes-related foot ulceration (DFU) and draw attention to the potential implications for clinical management and outcome. Variation observed in the incidence and outcome of DFUs in different communities might result from differences in study populations and the accessibility of care. Comparing differences in incidence, management, and outcome of DFUs in different communities is an essential component of the quality of disease care. Additionally, these comparisons can also highlight the relationship between DFU incidence, management, and outcome and the structure of local clinical services and the availability of staff with the necessary skills. The clinical outcome is, however, also dependent on the availability of multidisciplinary care and the ability of people with DFUs to gain access to that care.
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Affiliation(s)
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Eric Senneville
- Discipline of Infectious Diseases, The University of Lille, Gustave Dron Hospital, Tourcoing, France
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia; Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Duarte EG, Lopes CF, Gaio DRF, Mariúba JVDO, Cerqueira LDO, Manhanelli MAB, Navarro TP, Castro AA, de Araujo WJB, Pedrosa H, Galli J, de Luccia N, de Paula C, Reis F, Bohatch MS, de Oliveira TF, da Silva AFV, de Oliveira JCP, Joviliano EÉ. Brazilian Society of Angiology and Vascular Surgery 2023 guidelines on the diabetic foot. J Vasc Bras 2024; 23:e20230087. [PMID: 38803655 PMCID: PMC11129855 DOI: 10.1590/1677-5449.202300872] [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] [Received: 05/22/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024] Open
Abstract
The diabetic foot interacts with anatomical, vascular, and neurological factors that challenge clinical practice. This study aimed to compile the primary scientific evidence based on a review of the main guidelines, in addition to articles published on the Embase, Lilacs, and PubMed platforms. The European Society of Cardiology system was used to develop recommendation classes and levels of evidence. The themes were divided into six chapters (Chapter 1 - Prevention of foot ulcers in people with diabetes; Chapter 2 - Pressure relief from foot ulcers in people with diabetes; Chapter 3 -Classifications of diabetic foot ulcers; Chapter 4 - Foot and peripheral artery disease; Chapter 5 - Infection and the diabetic foot; Chapter 6 - Charcot's neuroarthropathy). This version of the Diabetic Foot Guidelines presents essential recommendations for the prevention, diagnosis, treatment, and follow-up of patients with diabetic foot, offering an objective guide for medical practice.
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Affiliation(s)
- Eliud Garcia Duarte
- Hospital Estadual de Urgência e Emergência do Estado do Espírito Santo – HEUE, Departamento de Cirurgia Vascular, Vitória, ES, Brasil.
| | - Cicero Fidelis Lopes
- Universidade Federal da Bahia – UFBA, Departamento de Cirurgia Vascular, Salvador, BA, Brasil.
| | | | | | | | | | - Tulio Pinho Navarro
- Universidade Federal de Minas Gerais – UFMG, Faculdade de Medicina, Belo Horizonte, MG, Brasil.
| | - Aldemar Araújo Castro
- Universidade Estadual de Ciências da Saúde de Alagoas – UNCISAL, Departamento de Cirurgia Vascular, Maceió, AL, Brasil.
| | - Walter Jr. Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Universidade Federal do Paraná – UFPR, Hospital das Clínicas – HC, Curitiba, PR, Brasil.
| | - Hermelinda Pedrosa
- Hospital Regional de Taguatinga – HRT, Departamento de Cirurgia Vascular, Brasília, DF, Brasil.
| | - Júnio Galli
- Universidade Federal do Paraná – UFPR, Hospital das Clínicas – HC, Curitiba, PR, Brasil.
| | - Nelson de Luccia
- Universidade de São Paulo – USP, Faculdade de Medicina, Hospital das Clínicas – HC, São Paulo, SP, Brasil.
| | - Clayton de Paula
- Rede D’or São Luiz, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Fernando Reis
- Faculdade de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
| | - Milton Sérgio Bohatch
- Faculdade de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
| | | | | | - Júlio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia Vascular, Rio de Janeiro, RJ, Brasil.
| | - Edwaldo Édner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Departamento de Cirurgia Vascular, Ribeirão Preto, SP, Brasil.
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Andrikopoulou E, Chatzistergos P, Chockalingam N. Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e54852. [PMID: 38656782 PMCID: PMC11079765 DOI: 10.2196/54852] [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: 11/24/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. OBJECTIVE This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. METHODS This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. RESULTS The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. CONCLUSIONS This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54852.
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Affiliation(s)
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
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Naemi R, Chockalingam N, Lutale JK, Abbas ZG. What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration? J Diabetes Investig 2024. [PMID: 38571302 DOI: 10.1111/jdi.14193] [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: 10/11/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS/INTRODUCTION This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications. MATERIALS AND METHODS A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two-step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics. RESULTS Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly-decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1. CONCLUSIONS Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5-fold risk of future foot ulceration compared to the other.
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Affiliation(s)
- Roozbeh Naemi
- School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK
- School of Health and Society, University of Salford, Manchester, UK
| | | | - Janet K Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali G Abbas
- School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Abbas Medical Centre, Dar es Salaam, Tanzania
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van Netten JJ, Sacco ICN, Lavery L, Monteiro-Soares M, Paton J, Rasmussen A, Raspovic A, Bus SA. Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3649. [PMID: 37132203 DOI: 10.1002/dmrr.3649] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most interventions to prevent foot ulcers in people with diabetes do not seek to reverse the foot abnormalities that led to the ulcer. Foot-ankle exercise programs target these clinical and biomechanical factors, such as protective sensation and mechanical stress. Multiple RCTs exist investigating the effectiveness of such programs, but these have never been summarised in a systematic review and meta-analysis. METHODS We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on foot-ankle exercise programs for people with diabetes at risk of foot ulceration. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed the risk of bias of controlled studies and extracted data. Meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was performed when >2 RCTs were available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. RESULTS We included a total of 29 studies, of which 16 were RCTs. A foot-ankle exercise programme of 8-12 weeks duration for people at risk of foot ulceration results in: (a) no increase or decrease risk of foot ulceration or pre-ulcerative lesion (Risk Ratio (RR): 0.56 (95% CI: 0.20-1.57)); (b) no increase or decrease risk of adverse events (RR: 1.04 (95% CI: 0.65-1.67)); (c) not increase or decrease barefoot peak plantar pressure during walking (Mean Difference (MD): -6.28 kPa (95% CI: -69.90-57.34)); (d) no increase or decrease health-related quality of life (no meta-analysis possible). Likely results in increases in ankle joint and first metatarsalphalangeal joint range of motion (MD: 1.49° (95% CI: -0.28-3.26)) may result in improvements in neuropathy signs and symptoms (MD: -1.42 (95% CI: -2.95-0.12)), may result in a small increase in daily steps in some people (MD: 131 steps (95% CI: -492-754)), and may not increase or decrease foot and ankle muscle strength and function (no meta-analysis was possible). CONCLUSIONS In people at risk of foot ulceration, a foot-ankle exercise programme of 8-12 weeks duration may not prevent or cause diabetes-related foot ulceration. However, such a programme likely improves the ankle joint and first metatarsalphalangeal joint range of motion and neuropathy signs and symptoms. Further research is needed to strengthen the evidence base, and should also focus on the effects of specific components of foot-ankle exercise programs.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lawrence Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health-Lisbon, Lisbon, Portugal
- MEDCIDS-Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@ CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal
| | - Joanne Paton
- School of Health Professions, University of Plymouth, Plymouth, UK
| | | | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
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Bus SA, Sacco ICN, Monteiro-Soares M, Raspovic A, Paton J, Rasmussen A, Lavery LA, van Netten JJ. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40:e3651. [PMID: 37302121 DOI: 10.1002/dmrr.3651] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Abstract
AIMS This is the 2023 International Working Group on the Diabetic Foot guideline on the prevention of foot ulcers in persons with diabetes, which updates the 2019 guideline. This guideline is targeted at clinicians and other healthcare professionals. MATERIALS AND METHODS We followed the Grading of Recommendations, Assessment, Development and Evaluations methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature including, where appropriate, meta-analyses, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where (sufficient) evidence was not available, and a weighing of the desirable and undesirable effects of an intervention, as well as patient preferences, costs, equity, feasibility and applicability. RESULTS We recommend screening a person with diabetes at very low risk of foot ulceration annually for the loss of protective sensation and peripheral artery disease, and screening persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate persons at-risk about appropriate foot self-care, educate not to walk without suitable foot protection, and treat any pre-ulcerative lesion on the foot. Educate moderate-to-high risk people with diabetes to wear properly fitting, accommodative, therapeutic footwear, and consider coaching them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking, to help prevent plantar foot ulcer recurrence. Consider advising people at low-to-moderate risk to undertake a, preferably supervised, foot-ankle exercise programme to reduce ulcer risk factors, and consider communicating that a total increase in weight-bearing activity of 1000 steps/day is likely safe with regards to risk of ulceration. In people with non-rigid hammertoe with pre-ulcerative lesion, consider flexor tendon tenotomy. We suggest not to use a nerve decompression procedure to help prevent foot ulcers. Provide integrated foot care for moderate-to-high-risk people with diabetes to help prevent (recurrence of) ulceration. CONCLUSIONS These recommendations should help healthcare professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days and reduce the patient and healthcare burden of diabetes-related foot disease.
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Affiliation(s)
- Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation & Development, Amsterdam, The Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne Paton
- School of Health Professions, University of Plymouth, Plymouth, UK
| | | | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation & Development, Amsterdam, The Netherlands
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van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Paton J, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3652. [PMID: 37243880 DOI: 10.1002/dmrr.3652] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
AIMS Prevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual 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 and meta-analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof. MATERIALS AND METHODS We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. RESULTS From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non-controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31-0.84) and pressure-optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26-1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37-1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24-1.17), flexor tenotomy (1 RCT, 7 non-controlled studies, no meta-analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58-1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration. CONCLUSIONS Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure-optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high-quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low-to-moderate risk of ulceration.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, 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, USA
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine, Oporto University, Porto, Portugal
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
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Mohammed SA, Crawford F, Cezard GI, Papathomas M. The 10-year follow-up of a community-based cohort of people with diabetes: The incidence of foot ulceration and death. Endocrinol Diabetes Metab 2024; 7:e459. [PMID: 37990753 PMCID: PMC10782183 DOI: 10.1002/edm2.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/17/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Identifying people with diabetes who are likely to experience a foot ulcer is an important part of preventative care. Many cohort studies report predictive models for foot ulcerations and for people with diabetes, but reports of long-term outcomes are scarce. AIM We aimed to develop a predictive model for foot ulceration in diabetes using a range of potential risk factors with a follow-up of 10 years after recruitment. A new foot ulceration was the outcome of interest and death was the secondary outcome of interest. DESIGN A 10-year follow-up cohort study. METHODS 1193 people with a diagnosis of diabetes who took part in a study in 2006-2007 were invited to participate in a 10-year follow-up. We developed a prognostic model for the incidence of incident foot ulcerations using a survival analysis, Cox proportional hazards model. We also utilised survival analysis Kaplan-Meier curves, and relevant tests, to assess the association between the predictor variables for foot ulceration and death. RESULTS At 10-year follow-up, 41% of the original study population had died and more than 18% had developed a foot ulcer. The predictive factors for foot ulceration were an inability to feel a 10 g monofilament or vibration from a tuning fork, previous foot ulceration and duration of diabetes. CONCLUSIONS The prognostic model shows an increased risk of ulceration for those with previous history of foot ulcerations, insensitivity to a 10 g monofilament, a tuning fork and duration of diabetes. The incidence of foot ulceration at 10-year follow-up was 18%; however, the risk of death for this community-based population was far greater than the risk of foot ulceration.
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Affiliation(s)
| | - Fay Crawford
- School of Health and Social CareUniversity of EssexColchesterUK
| | - Genevieve Isabelle Cezard
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| | - Michail Papathomas
- School of Mathematics and StatisticsUniversity of St AndrewsSt AndrewsUK
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10
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Veličković VM, Macmillan T, Kottner J, Crompton A, Munro I, Paine A, Savović J, Spelman T, Clark M, Smit HJ, Smola H, Webb N, Steyerberg E. Prognostic models for clinical outcomes in patients with venous leg ulcers: A systematic review. J Vasc Surg Venous Lymphat Disord 2024; 12:101673. [PMID: 37689364 DOI: 10.1016/j.jvsv.2023.06.017] [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: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE The purpose of this review was to identify prognostic models for clinical application in patients with venous leg ulcers (VLUs). METHODS Literature searches were conducted in Embase, Medline, Cochrane, and CINAHL databases from inception to December 22, 2021. Eligible studies reported prognostic models aimed at developing, validating, and adjusting multivariable prognostic models that include multiple prognostic factors combined, and that predicted clinical outcomes. Methodological quality was assessed using the CHARMS checklist and PROBAST short form questionnaire. RESULTS Thirteen studies were identified, of which three were validation studies of previously published models, four reported derivation and validation of models, and the remainder reported derivation models only. There was substantial heterogeneity in the model characteristics, including 11 studies focused on wound healing outcomes reporting 91 different predictors. Three studies shared similar predicted outcomes, follow-up timepoint and used a Cox proportional hazards model. However, these models reported different predictor selection methods and different predictors and it was therefore not feasible to summarize performance, such as discriminative ability. CONCLUSIONS There are no standout risk prediction models in the literature with promising clinical application for patients with VLUs. Future research should focus on developing and validating high-performing models in wider VLU populations.
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Affiliation(s)
- Vladica M Veličković
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Tirol, Austria.
| | | | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Abby Paine
- Source Health Economics, London, United Kingdom
| | - Jelena Savović
- Bristol Population Health Science Institute, Bristol, United Kingdom
| | - Tim Spelman
- Burnet Institute, Melbourne, Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Clark
- Welsh Wound Innovation Centre, Ynysmaerdy, Pontyclun, United Kingdom
| | | | - Hans Smola
- Health Economics and Outcome Research (HEOR) Department, Hartmann Group, Heidenheim, Germany; Department of Dermatology, University of Cologne, Cologne, Germany
| | - Neil Webb
- Source Health Economics, London, United Kingdom
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11
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Chatzistergos PE, Gatt A, Formosa C, Sinclair JK, Chockalingam N. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Res Clin Pract 2023; 204:110914. [PMID: 37742803 DOI: 10.1016/j.diabres.2023.110914] [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: 01/26/2023] [Revised: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. METHODS Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. RESULTS People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. CONCLUSIONS Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.
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Affiliation(s)
- Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jonathan K Sinclair
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom; Faculty of Health Sciences, University of Malta, Msida, Malta
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12
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Sharma K N S, Kumar H A. Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy. J Foot Ankle Res 2023; 16:65. [PMID: 37770911 PMCID: PMC10537102 DOI: 10.1186/s13047-023-00667-3] [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: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
AIMS Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .
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Affiliation(s)
- Srihari Sharma K N
- College of Physiotherapy, Dayananda Sagar University, Shavige Malleshwara Hills, 1st Stage, Kumaraswamy Layout, Bangalore, Karnataka, India, 560111.
| | - Anil Kumar H
- Department of Medicine, Dr Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER), Kanakapura, Karnataka, India
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13
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Khalifa WA, Argoon SA, AbdEllah-Alawi MH. Determinants of healing of diabetic foot ulcer comparing two offloading modalities: A randomized prospective study. Foot (Edinb) 2023; 56:102016. [PMID: 37019041 DOI: 10.1016/j.foot.2023.102016] [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: 09/22/2021] [Revised: 02/11/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Healing of Diabetic Foot ulcer is crucial to prevent amputation. Offloading is key treatment of diabetic foot ulcers, but choosing which offloading modality is still not clear. Besides, other factors that control ulcer healing, is a question that needs to be determined. OBJECTIVE to assess factors that affect ulcer healing, comparing two commonly used offloading devices, removable walker and cast-shoe. METHODS This is a Randomized Clinical Trial which recruited 87 patients with active diabetic foot ulcers randomly assigned to either a removable walker (W-arm) or a cast-shoe (C-arm) at 3:2 ratio. Both groups received the routine ulcer care, and were followed-up for 24 weeks. Different possible factors related to healing were assessed, and a regression model was built for the most predictive factors. RESULTS The 24-week healing rate was 81% for the walker group and 62 % for the cast-shoe group. The mean adherence was 55 % ± 26 % and 46 % ± 29 for the walker and cast shoe groups respectively. Ulcer healing was significantly positively associated with: better adherence, device type (walker), less SINBAD score (2 or less), absence of ischemia, absence of infection, smaller ulcer area, superficial ulcer, better 4-week area reduction, and better blood glucose control. The most important predictors were adherence, total SINBAD score and 4-week area reduction. CONCLUSION SINBAD score at initial presentation and the degree of adherence to offloading device, are two major determinants of ulcer healing. Ulcer area reduction at 4 weeks represents an important clinical parameter to predict and guide the success of ulcer management.
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14
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Naemi R, Balasubramanian G, Darvel T, Chockalingam N. Predicting diabetic foot ulceration using routinely collected data in a foot clinic. What level of prognostic accuracy can be achieved? Diabetes Metab Res Rev 2023; 39:e3674. [PMID: 37350019 DOI: 10.1002/dmrr.3674] [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: 01/12/2023] [Revised: 03/26/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
This study aimed to investigate the efficacy of using routinely collected clinical data in predicting the risk of diabetic foot ulcer (DFU). The first objective was to develop a prognostic model based on the most important risk factors objectively selected from a set of 39 clinical measures. The second objective was to compare the prediction accuracy of the developed model against that of a model based on only the 3 risk factors that were suggested in the systematic review and meta-analyses study (PODUS). In a cohort study, a set of 12 continuous and 27 categorical data from patients (n = 203 M/F:99/104) who attended a specialised diabetic foot clinic were collected at baseline. These patients were then followed-up for 24 months during which 24 (M/F:17/7) patients had DFU. Multivariate logistic regression was used to develop a prognostic model using the identified risk factors that achieved p < 0.2 based on univariate logistic regression. The final prognostic model included 4 risk factors (Adjusted-OR [95% CI]; p) in total. Impaired sensation (116.082 [12.06-1117.287]; p = 0.000) and presence of callus (6.257 [1.312-29.836]; p = 0.021) were significant (p < 0.05), while having dry skin (5.497 [0.866-34.89]; p = 0.071) and Onychomycosis (6.386 [0.856-47.670]; p = 0.071) that stayed in the model were not significant. The accuracy of the model with these 4 risk factors was 92.3%, where sensitivity and specificity were 78.9%, and 94.0% respectively. The 78.9% sensitivity of our prognostic 4-risk factor model was superior to the 50% sensitivity that was achieved when the three risk factors proposed by PODUS were used. Also our proposed model based on the above 4 risk factors showed to predict the DFU with higher overall prognostic accuracy. These findings have implications for developing prognostic models and clinical prediction rules in specific patient populations to more accurately predict DFU.
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Affiliation(s)
- Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Gayathri Balasubramanian
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Tracey Darvel
- The Hillingdon Hospital, Central and North West London NHS Foundation Trust, Uxbridge, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
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15
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Jepson H, Lazzarini PA, Garrett M, Carroll MR. How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey. J Foot Ankle Res 2023; 16:53. [PMID: 37605269 PMCID: PMC10464278 DOI: 10.1186/s13047-023-00651-x] [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: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations. METHODS A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups. RESULTS Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03). CONCLUSION NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.
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Affiliation(s)
- Hannah Jepson
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Metro North Hospital and Health Service, Allied Health Research Collaborative, Brisbane, QLD, Australia
| | - Michele Garrett
- Community and Long Term Conditions Directorate, Te Toka Tumai, Auckland, New Zealand
| | - Matthew R Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
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16
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Granell R, Curtin JA, Haider S, Kitaba NT, Mathie SA, Gregory LG, Yates LL, Tutino M, Hankinson J, Perretti M, Vonk JM, Arshad HS, Cullinan P, Fontanella S, Roberts GC, Koppelman GH, Simpson A, Turner SW, Murray CS, Lloyd CM, Holloway JW, Custovic A. A meta-analysis of genome-wide association studies of childhood wheezing phenotypes identifies ANXA1 as a susceptibility locus for persistent wheezing. eLife 2023; 12:e84315. [PMID: 37227431 PMCID: PMC10292845 DOI: 10.7554/elife.84315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/22/2023] [Indexed: 05/26/2023] Open
Abstract
Background Many genes associated with asthma explain only a fraction of its heritability. Most genome-wide association studies (GWASs) used a broad definition of 'doctor-diagnosed asthma', thereby diluting genetic signals by not considering asthma heterogeneity. The objective of our study was to identify genetic associates of childhood wheezing phenotypes. Methods We conducted a novel multivariate GWAS meta-analysis of wheezing phenotypes jointly derived using unbiased analysis of data collected from birth to 18 years in 9568 individuals from five UK birth cohorts. Results Forty-four independent SNPs were associated with early-onset persistent, 25 with pre-school remitting, 33 with mid-childhood remitting, and 32 with late-onset wheeze. We identified a novel locus on chr9q21.13 (close to annexin 1 [ANXA1], p<6.7 × 10-9), associated exclusively with early-onset persistent wheeze. We identified rs75260654 as the most likely causative single nucleotide polymorphism (SNP) using Promoter Capture Hi-C loops, and then showed that the risk allele (T) confers a reduction in ANXA1 expression. Finally, in a murine model of house dust mite (HDM)-induced allergic airway disease, we demonstrated that anxa1 protein expression increased and anxa1 mRNA was significantly induced in lung tissue following HDM exposure. Using anxa1-/- deficient mice, we showed that loss of anxa1 results in heightened airway hyperreactivity and Th2 inflammation upon allergen challenge. Conclusions Targeting this pathway in persistent disease may represent an exciting therapeutic prospect. Funding UK Medical Research Council Programme Grant MR/S025340/1 and the Wellcome Trust Strategic Award (108818/15/Z) provided most of the funding for this study.
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Affiliation(s)
- Raquel Granell
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - John A Curtin
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Negusse Tadesse Kitaba
- Human Development and Health, Faculty of Medicine, University of SouthamptonSouthamptonUnited Kingdom
| | - Sara A Mathie
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Lisa G Gregory
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Laura L Yates
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Mauro Tutino
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Jenny Hankinson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine Queen Mary University of LondonLondonUnited Kingdom
| | - Judith M Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen\GroningenNetherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC)GroningenNetherlands
| | - Hasan S Arshad
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation TrustSouthamptonUnited Kingdom
- David Hide Asthma and Allergy Research CentreIsle of WightUnited Kingdom
- Clinical and Experimental Sciences, Faculty of Medicine, University of SouthamptonSouthamptonUnited Kingdom
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Sara Fontanella
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - Graham C Roberts
- Human Development and Health, Faculty of Medicine, University of SouthamptonSouthamptonUnited Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation TrustSouthamptonUnited Kingdom
- David Hide Asthma and Allergy Research CentreIsle of WightUnited Kingdom
| | - Gerard H Koppelman
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC)GroningenNetherlands
- Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalGroningenNetherlands
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Steve W Turner
- Child Health, University of AberdeenAberdeenUnited Kingdom
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of SouthamptonSouthamptonUnited Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College LondonLondonUnited Kingdom
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17
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Matijević T, Talapko J, Meštrović T, Matijević M, Erić S, Erić I, Škrlec I. Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes. World J Clin Cases 2023; 11:1669-1683. [PMID: 36970006 PMCID: PMC10037285 DOI: 10.12998/wjcc.v11.i8.1669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.
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Affiliation(s)
- Tatjana Matijević
- Department of Dermatology and Venereology, University Hospital Center Osijek, Osijek 31000, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation and the Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States
| | - Marijan Matijević
- Department of Surgery, National Memorial Hospital Vukovar, Vukovar 32000, Croatia
| | - Suzana Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Radiotherapy and Oncology, Clinical Hospital Center Osijek, Osijek 31000, Croatia
| | - Ivan Erić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Surgery, Osijek University Hospital Centre, Osijek 31000, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
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18
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Kaka AS, Landsteiner A, Ensrud KE, Logan B, Sowerby C, Ullman K, Yoon P, Wilt TJ, Sultan S. Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews. J Foot Ankle Res 2023; 16:13. [PMID: 36922851 PMCID: PMC10018902 DOI: 10.1186/s13047-023-00610-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality. PURPOSE Identify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible. METHODS We searched for systematic reviews (SRs) of tools predicting DFU or amputation published in multiple databases from initiation to January, 2023. We assessed risk of bias (ROB) and provided a narrative review of reviews describing performance characteristics (calibration and discrimination) of prognostically accurate tools. For such tools, we additionally reviewed original studies to ascertain clinical applicability and usability (variables included, score calculation, and risk categorization). RESULTS We identified 3 eligible SRs predicting DFU or amputation risk. Two recent SRs (2020 and 2021) were rated as moderate and low ROB respectively. Four risk prediction models - Boyko, Martins-Mendes (simplified), Martins-Mendes (original), and PODUS 2020 had good prognostic accuracy for predicting DFU or amputation over time horizons ranging from 1- to 5-years. PODUS 2020 predicts absolute average risk (e.g., 6% risk of DFU at 2 years) and consists of 3-binary variables with a simple, summative scoring (0-4) making it feasible for clinic use. The other 3 models categorize risk subjectively (e.g., high-risk for DFU at 3 years), include 2-7 variables, and require a calculation device. No data exist to inform rescreening intervals. Furthermore, the effectiveness of targeted interventions in decreasing incidence of DFU or amputation in response to prediction scores is unknown. CONCLUSIONS In this review of reviews, we identified 4 prognostically accurate models that predict DFU or amputation in persons with diabetes. The PODUS 2020 model, predicting absolute average DFU risk at 2 years, has the most favorable prognostic accuracy and is clinically feasible. Rescreening intervals and effectiveness of intervention based on prediction score are uncertain.
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Affiliation(s)
- Anjum S Kaka
- Section of Infectious Diseases, Minneapolis VA Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 111F55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Adrienne Landsteiner
- Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.,Section of General Internal Medicine, Minneapolis VA Affairs Health Care System, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brittany Logan
- Section of Podiatry, Minneapolis VA Affairs Health Care System, Minneapolis, MN, USA
| | - Catherine Sowerby
- Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Kristen Ullman
- Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Patrick Yoon
- Section of Orthopedics, Minneapolis VA Affairs Health Care System, Minneapolis, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Wilt
- Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Section of General Internal Medicine, Minneapolis VA Affairs Health Care System, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Shahnaz Sultan
- Evidence Synthesis Program, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Division of Gastroenterology, University of Minnesota Medical School, Minneapolis, MN, USA
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19
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Annersten Gershater M, Apelqvist J, Alm Roijer C. Re-Ulceration Is Common in Persons with Diabetes and Healed Foot Ulcer After Participant-Driven Education in Group: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2023; 12:117-126. [PMID: 35088617 DOI: 10.1089/wound.2021.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective: To compare the number of ulcer-free days during 24 months in persons with diabetes and a healed foot ulcer below the ankle provided with adjusted therapeutic shoes who were given standard information and participated in participant-driven group education compared with standard information alone. Methods: A randomized controlled trial was designed to evaluate the number of ulcer-free days after participant-driven group education in addition to standard information compared with standard information alone. The number needed to treat (N = 174) was not met, as only 138 persons with diabetes and previously healed foot ulcer were recruited (age median 63 years [34-79], 101 men/37 women). Results: A total of 138 persons were recruited, of whom 107 (77.5%) completed the study, 7 (5%) dropped out, and 12 (9%) deceased. No statistically significant difference was found between the intervention group compared with the control group after 6, 18, or 24 months. After 12 months, more patients in the intervention group had developed ulcers. Seventy-seven participants (56%) developed new foot ulcers, irrespective of side and site. Development of one ulcer appeared in 36 participants, two ulcers in 19, and 22 participants developed three ulcers. Forty-eight participants remained ulcer-free (35%) during the 24-month follow-up. Median ulcer-free days until first ulceration were 368 (4-720); until second ulceration, 404 (206-631); and until third ulceration, 660 (505-701). The participants wore prescribed therapeutic shoes during 88% of the follow-up visits. Conclusions: One-third of the participants remained ulcer-free for 24 months. Patient-driven education in groups did not give better results than standard information in this underpowered study. This study illustrates the challenges to perform comparative preventive studies in this group of patients with extensive comorbidity. Further studies are needed to evaluate interventions on ulceration in persons with a healed foot ulcer.
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Affiliation(s)
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Malmö, Sweden
| | - Carin Alm Roijer
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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20
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Iacopi E, Pieruzzi L, Riitano N, Abbruzzese L, Goretti C, Piaggesi A. The Weakness of the Strong Sex: Differences Between Men and Women Affected by Diabetic Foot Disease. INT J LOW EXTR WOUND 2023; 22:19-26. [PMID: 33480296 DOI: 10.1177/1534734620984604] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m2; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P = .02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.
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21
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Sousa LB, Almeida I, Bernardes RA, Leite TR, Negrão R, Apóstolo J, Salgueiro-Oliveira A, Parreira P. A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration. Front Public Health 2023; 11:1061383. [PMID: 36794077 PMCID: PMC9922787 DOI: 10.3389/fpubh.2023.1061383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023] Open
Abstract
Background The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters. Method This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC). Results The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies. Discussion The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.
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Affiliation(s)
- Liliana B. Sousa
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal,*Correspondence: Liliana B. Sousa ✉
| | - Inês Almeida
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Teófilo R. Leite
- Indústrias e Comércio de Calçado S. A. (ICC), Sol-Pinheiro, Guimarães, Portugal
| | - Rui Negrão
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - João Apóstolo
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Pedro Parreira
- Health Sciences Research Unit, Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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22
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Pallin JA, Van Netten JJ, Kearney PM, Dinneen SF, Buckley CM. Do we screen, examine or assess to identify the "at-risk" foot in diabetes-time for agreed terms and definitions? Diabet Med 2023; 40:e14976. [PMID: 36251428 PMCID: PMC10092276 DOI: 10.1111/dme.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Jaap J Van Netten
- Amsterdam UMC Location University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Sean F Dinneen
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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23
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Diabetic Capital Punishment: Time for Amnesty. J Clin Med 2022; 11:jcm11216562. [PMID: 36362790 PMCID: PMC9656903 DOI: 10.3390/jcm11216562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
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24
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Askø Andersen J, Rasmussen A, Engberg S, Bencke J, Frimodt-Møller M, Kirketerp-Møller K, Rossing P. Flexor Tendon Tenotomy Treatment of the Diabetic Foot: A Multicenter Randomized Controlled Trial. Diabetes Care 2022; 45:2492-2500. [PMID: 36151947 DOI: 10.2337/dc22-0085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of needle flexor tendon tenotomy treatment of the diabetic hammertoe deformity. RESEARCH DESIGN AND METHODS A multicenter randomized controlled trial of individuals with diabetes and ulcers or impending ulcers associated with hammertoes was performed between 1 November 2019 and 31 March 2021. Participants were stratified by the presence of ulcers or impending ulcers. Participants were randomly assigned to tenotomy and standard nonsurgical treatment or to standard nonsurgical treatment alone. Primary outcomes were time to ulcer healing and progression from impending ulcer to active ulcer. RESULTS Of 224 screened participants with diabetes, 95 (59.0% men) were included. The mean follow-up was 291 ± 70 days, 28 (29.5%) had type 1 diabetes, mean diabetes (presented with 25-75% quartile) duration was 20 (13-26) years, and mean age was 67.7 ± 9.8 years. Of the included participants, 16 had ulcers, of whom 8 were randomly assigned to intervention. Of the remaining 79 with impending ulcers, 39 were randomly assigned to intervention. For participants with ulcers, healing rates favored tenotomy (100% vs. 37.5%, P = 0.026) as did time to ulcer healing (P = 0.04). For those with impending ulcers, incidence of progression to an active ulcer was lower (1 vs. 7, P = 0.028) and the number of ulcer-free days higher (P = 0.043) in the tenotomy group. No serious adverse events were recorded. CONCLUSIONS This randomized study showed that the simple procedure of needle flexor tendon tenotomy was effective and safe when treating and preventing ulcers associated with the diabetic hammertoe deformity.
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Affiliation(s)
- Jonas Askø Andersen
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Orthopedic Department, North Zealand Hospital, Hillerød Hospital, Hillerød, Denmark
| | | | - Susanne Engberg
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Novo Nordisk A/S, Søborg, Denmark
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital at Amager-Hvidovre, Hvidovre, Denmark
| | | | - Klaus Kirketerp-Møller
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Copenhagen Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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25
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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26
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Drechsel TJ, Zippenfennig C, Schmidt D, Milani TL. The Effect of Subliminal Electrical Noise Stimulation on Plantar Vibration Sensitivity in Persons with Diabetes Mellitus. Biomedicines 2022; 10:biomedicines10081880. [PMID: 36009427 PMCID: PMC9405277 DOI: 10.3390/biomedicines10081880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Subliminal electrical noise (SEN) enhances sensitivity in healthy individuals of various ages. Diabetes and its neurodegenerative profile, such as marked decreases in foot sensitivity, highlights the potential benefits of SEN in such populations. Accordingly, this study aimed to investigate the effect of SEN on vibration sensitivity in diabetes. Vibration perception thresholds (VPT) and corresponding VPT variations (coefficient of variation, CoV) of two experimental groups with diabetes mellitus were determined using a customized vibration exciter (30 and 200 Hz). Plantar measurements were taken at the metatarsal area with and without SEN stimulation. Wilcoxon signed-rank and t tests were used to test for differences in VPT and CoV within frequencies, between the conditions with and without SEN. We found no statistically significant effects of SEN on VPT and CoV (p > 0.05). CoV showed descriptively lower mean variations of 4 and 7% for VPT in experiment 1. SEN did not demonstrate improvements in VPT in diabetic individuals. Interestingly, taking into account the most severely affected (neuropathy severity) individuals, SEN seems to positively influence vibratory perception. However, the descriptively reduced variations in experiment 1 indicate that participants felt more consistently. It is possible that the effect of SEN on thick, myelinated Aβ-fibers is only marginally present.
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Affiliation(s)
- Tina J. Drechsel
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
- Correspondence: ; Tel.: +49-371-531-30022
| | - Claudio Zippenfennig
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Daniel Schmidt
- Motor Control, Cognition and Neurophysiology, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
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27
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Pallin JA, McIntosh C, Kavanagh P, Dinneen SF, Kearney PM, Buckley CM. A scoping review protocol to map the evidence on the risks and benefits of population based diabetic foot screening. HRB Open Res 2022; 5:50. [PMID: 37601115 PMCID: PMC10432895 DOI: 10.12688/hrbopenres.13585.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 08/22/2023] Open
Abstract
Background: Diabetic foot ulcers are one of the most common lower extremity complications of diabetes, with the lifetime risk of a person developing a DFU estimated to be as high as 34%. It is recommended that those with diabetes receive an annual review of their feet, by a trained healthcare professional, to identify risk factors for ulceration and allow for subsequent risk stratification, patient education and provision of appropriate care to prevent ulceration and amputation. Internationally, while many countries have a diabetic foot care pathway, it is not a structured population health screening programme unlike other areas of preventive care for people with diabetes such as retinopathy screening. A structured diabetic foot screening pathway could allow for earlier identification of the at-risk foot. However, the introduction of any population screening programme should meet the Wilson and Jungner principles of screening. This paper presents a protocol for a scoping review of existing evidence on screening for the at-risk-foot against the Wilson and Junger principles. Methods: The scoping review will be conducted in line with the six-stage methodological framework by Arksey & O'Mally and the Joanna Briggs Institute (JBI) scoping review methodology. Medline (EBSCO), Scopus, ScienceDirect and EMBASE databases will be searched. Studies relating to the burden of diabetic foot ulcers, their pathophysiology and screening tests for peripheral neuropathy and peripheral artery disease, and screening programmes will be included. A data extraction tool will be used to facilitate a chronological narrative synthesis of results. Results: These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Conclusion: This scoping review will evaluate and map the evidence surrounding diabetic foot ulcers using the Wilson and Jungner principles of screening as a framework.
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Affiliation(s)
- Jennifer A. Pallin
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, National University of Ireland, Galway, Galway City, Galway, H91 TK33, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis Street, Health Service Executive, Dublin 1, D01 W596, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland Galway, Galway City, Galway, H91 TK33, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, University College Hospital, Galway, Galway, H91 YR71, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Claire M. Buckley
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
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28
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Kaminski MR, Golledge J, Lasschuit JWJ, Schott KH, Charles J, Cheney J, Raspovic A. Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:53. [PMID: 35791023 PMCID: PMC9258081 DOI: 10.1186/s13047-022-00534-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no current Australian guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples. METHODS The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This guideline underwent public consultation, further revision, and approval by national peak bodies. RESULTS Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered. CONCLUSIONS This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.
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Affiliation(s)
- Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia. .,Department of Podiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, 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, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Joel W J Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, New South Wales, Australia.,Healthy Ageing, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Karl-Heinz Schott
- Southern Cross University School of Health and Human Sciences / Pedorthics, Gold Coast, Queensland, Australia
| | - James Charles
- First Peoples Health Unit, Health Group, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Cheney
- Diabetes Victoria, Melbourne, Victoria, Australia
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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29
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Jia H, Wang X, Cheng J. Knowledge, Attitudes, and Practices Associated With Diabetic Foot Prevention Among Rural Adults With Diabetes in North China. Front Public Health 2022; 10:876105. [PMID: 35669753 PMCID: PMC9163951 DOI: 10.3389/fpubh.2022.876105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China. Method This cross-sectional survey included 1,080 rural adults from North China, cluster sampled 12 villages and surveyed diabetic patients without diabetic foot who participated in community diabetes management. The self-administered knowledge and attitude questionnaire and the Chinese version of the Nottingham Assessment of Functional Foot-care Questionnaire were used. Result Of the 1,080 subjects, 51.6% received moderate knowledge scores, 63.9% had a positive attitude and 71.4% received poor practice scores. In terms of knowledge, parameters of knowledge about foot examinations and treatment of foot problems showed the lowest scores. In terms of practice, in line with the results of the low knowledge score, parameters of the pursuit of medical treatment for foot problems and routine foot examinations were associated with the lowest scores. Multiple regression analysis revealed that participants who were current smokers (β: -0.049, 95% CI: -0.088 to -0.011) had lower knowledge scores than those who never smoke; participants who were current smokers (β: -0.818, 95% CI: -1.067 to -0.569) and past smokers (β: -0.299, 95% CI: -0.485 to -0.112) had lower attitude scores than those who had never smoked; participants who had higher knowledge scores (β: 1.964, 95% CI: 1.572-2.356) achieved higher scores on attitudes; women had better practice scores than men (β: 0.180, 95% CI: 0.122-0.239); patients with a long diabetes duration (6-10 years) had better practice scores than those who had a short diabetes duration (<2 years; β: 0.072, 95% CI: 0.012-0.131). Knowledge (β: 0.130, 95% CI: 0.001-0.258) and attitudes (β: 0.268, 95% CI: 0.249-0.287) were significantly associated with good practices. Conclusions Increasing knowledge regarding diabetic foot would help instill positive attitudes and cultivate better practices toward diabetic foot prevention. The results of this study may help guide future promotional resources to those groups most in need, which may help lower the incidence of diabetic foot among adults in North China.
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Affiliation(s)
- Huimin Jia
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaocheng Wang
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jingmin Cheng
- School of Management, Shanxi Medical University, Taiyuan, China
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30
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Chen C, Wang X, Liang C, Liu H. Effect of Micropower Vacuum Dressing on Promoting Wound Healing in Patients with I-II Diabetic Foot. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2577601. [PMID: 35571727 PMCID: PMC9106449 DOI: 10.1155/2022/2577601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
Objective Discuss the effectiveness and value of micropower vacuum dressing (MVD) in promoting the healing of I-II grades diabetic foot wounds. Methods Sixty patients diagnosed with diabetic foot ulcers and Wagner grades I-II were selected and randomly divided into the control group and experimental group, with 30 cases in each group. The control group was covered with conventional treatments and petrolatum gauze dressings, and the experimental group was treated with MVD on the basis of conventional reatments. The therapeutic effects of the two groups were observed, including healing rate, ulcer area reduction rate, ulcer healing time, dressing change times, ulcer recurrence rate, adverse events, and so on. Results The healing rate (100%) of the experimental group was higher than that of the control group (56.7%); the wound reduction rate was higher than that of the control group (P < 0.05); the healing time, the number of dressing changes, and the 1-month recurrence rate were all low in the control group (P < 0.05). The incidence of adverse reactions in the experimental group (6.7%) was lower than that in the control group (46.7%) (P < 0.05). Conclusion MVD has significant effects in the treatment of I-II grades diabetic foot wounds and has few adverse reactions. It is an effective new method that can promote the growth of granulation tissue and epithelium and promote wound healing.
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Affiliation(s)
- Cunren Chen
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, China
| | - Xixiong Wang
- Department of Breast Surgery, Boao Yiling Life Care Center, Qionghai 571400, Hainan, China
| | - Changli Liang
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, China
| | - Haiwei Liu
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, China
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Røikjer J, Werkman NCC, Ejskjaer N, van den Bergh JPW, Vestergaard P, Schaper NC, Jensen MH, Klungel O, de Vries F, Nielen JTH, Driessen JHM. Incidence, hospitalization and mortality and their changes over time in people with a first ever diabetic foot ulcer. Diabet Med 2022; 39:e14725. [PMID: 34657300 DOI: 10.1111/dme.14725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 10/15/2021] [Indexed: 01/13/2023]
Abstract
AIMS A diabetic foot ulcer (DFU) is a severe condition associated with morbidity and mortality. Population-based studies are rare and limited by access to reliable data. Without this data, efforts in primary prevention cannot be evaluated. Therefore, we examined the incidence and changes over time for the first DFU in people with diabetes. We also examined hospitalization and all-cause mortality and their changes over time. METHODS From the UK primary care CPRD GOLD database (2007-2017), we identified 129,624 people with diabetes by a prescription for insulin or a non-insulin anti-diabetic drug. DFUs were identified using Read codes and expressed as incidence rates (IRs). Changes over time were described using Poisson and logistic regression and expressed as incidence rate ratios (IRRs) and odds ratios (ORs) respectively. RESULTS The mean IR of first registered DFUs was 2.5 [95% CI: 2.1-2.9] per 1000 person-years for people with type 2 diabetes and 1.6 [1.3-1.9] per 1000 person-years for people with type 1. The IRs declined for people with type 2 diabetes (IRR per year: 0.97 [0.96-0.99]), while no changes were observed for people with type 1 diabetes (IRR per year: 0.96 [0.89-1.04]). Average hospitalization and 1-year mortality risk for people with type 2 diabetes were 8.2% [SD: 4.7] and 11.7% [SD: 2.2] respectively. Both declined over time (OR: 0.89 [0.84, 0.94] and 0.94 [0.89, 0.99]). CONCLUSION The decline in all IRs, hospitalizations and mortality in people with type 2 diabetes suggests that prevention and care of the first DFU has improved for this group in primary care in the UK.
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Affiliation(s)
- Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nikki C C Werkman
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University medical Centre+, Maastricht, the Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Joop P W van den Bergh
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venray, the Netherlands
- Biomedical Research Centre, Hasselt University, Hasselt, Belgium
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Nicolaas C Schaper
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Olaf Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Frank de Vries
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University medical Centre+, Maastricht, the Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Johannes T H Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University medical Centre+, Maastricht, the Netherlands
| | - Johanna H M Driessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University medical Centre+, Maastricht, the Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
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32
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Kulzer B. [Physical and psychological long-term consequences of diabetes mellitus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:503-510. [PMID: 35294561 PMCID: PMC8979877 DOI: 10.1007/s00103-022-03517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
Trotz Verbesserungen in der Therapie des Diabetes und besseren Versorgungbedingungen weisen die Betroffenen aktuell im Vergleich zur Allgemeinbevölkerung noch immer ein deutlich erhöhtes Risiko für physische wie psychische Folgeerkrankungen sowie eine reduzierte Lebensqualität auf. Etwa 21 % aller Todesfälle sind in Deutschland auf Diabetes und seine Folgeerkrankungen zurückzuführen, das Mortalitätsrisiko ist für Menschen mit Diabetes um mehr als das 1,5-Fache gegenüber Menschen ohne Diabetes erhöht. In dieser Übersicht werden die Verbreitung und die Risikofaktoren für die häufigsten körperlichen und psychischen Folgen des Diabetes beschrieben sowie deren Einflüsse auf die Lebensqualität der Patienten. Zusammenhänge zwischen den Folgeerkrankungen und einer erhöhten Mortalität werden aufgezeigt. In großen Interventionsstudien konnte die Bedeutung einer guten Glukoseeinstellung – vor allem zu Beginn der Erkrankung – in Hinblick auf eine Senkung der Mortalitätsrate gezeigt werden, weitere wichtige Einflussfaktoren sind z. B. Blutdruck, Blutfette und Rauchen. Weltweite Studienergebnisse deuten auf einen stabilen Trend hinsichtlich einer verbesserten Lebenserwartung von Menschen mit Diabetes in den letzten Jahren hin. Zukünftig könnte der positive Trend durch bessere Versorgungsstrukturen und neue Technologien sowie digitale Anwendungen in der Forschung und Therapie fortgesetzt werden. Mithilfe der Präzisionsmedizin könnten individuelle Risikofaktoren und protektive Faktoren erkannt werden, um der Entstehung von Folgekomplikationen noch besser vorzubeugen.
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Affiliation(s)
- Bernhard Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980, Bad Mergentheim, Deutschland. .,Diabetes-Klinik Bad Mergentheim, Bad Mergentheim, Deutschland. .,Lehrstuhl für klinische Psychologie, Universität Bamberg, Bamberg, Deutschland.
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33
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Yoshikawa Y, Maeshige N, Uemura M, Tanaka M, Kawabe N, Yamaguchi A, Fujino H, Terashi H. Prediction of callus and ulcer development in patients with diabetic peripheral neuropathy by isosceles triangle-forming tuning fork. SAGE Open Med 2022; 10:20503121221085097. [PMID: 35310932 PMCID: PMC8928360 DOI: 10.1177/20503121221085097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/15/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Tuning fork vibration sensation testing is widely used as a diagnostic test to detect diabetic neuropathy. However, evidence-based literature indicates that reliability between examiners is low. Attaching isosceles triangle diagrams on tuning forks lowers the discrepancy between examiners. This study aimed to analyze the relationship between vibration sensation measurement using an improved tuning fork and the presence of callus and wound development in patients with diabetic peripheral neuropathy. Methods: Participants included 56 general older adults and 52 patients with diabetic peripheral neuropathy. The methods included confirmation of the presence or absence of callus, range of motion of the ankle and the first metatarsophalangeal joint, vibratory sensitivity of the medial malleolus and the dorsal aspect of the first distal phalanx using an improved tuning fork, and touch-pressure sensitivity of the plantar aspect of the hallux. Patients with diabetic peripheral neuropathy were followed up for 3 years to check for the presence or absence of wounds. Results: When compared with the general older adults, the patients with diabetic peripheral neuropathy had significantly lower touch-pressure sensitivity (p < 0.01), vibratory sensitivity at the distal phalanx (p < 0.01) and medial malleolus (p < 0.01), ankle dorsiflexion range of motion (p < 0.01), and metatarsophalangeal joint extension range of motion (p < 0.01). The area under the receiver operating characteristic curve with callus formation was 0.93 for the medial malleolus and 0.96 for the distal phalanx, indicating that the accuracy of the distal phalanx was higher (p < 0.01) than the medial malleolus. According to the Cox proportional hazard analysis, the vibratory sensitivity of the distal phalanx was a significant risk factor for ulcer development (p < 0.05). Conclusion: These findings suggest that the vibration sensation test, which we improved via the technique described in this study, is useful for predicting the occurrence of callus and ulcer.
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Affiliation(s)
- Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Department of Rehabilitation, Faculty of Health Science, Kansai University of Welfare Sciences, Osaka, Japan
| | - Masayuki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences, Okayama Healthcare Professional University, Okayama, Japan
| | - Nobuhide Kawabe
- Faculty of Makuhari Human Care, Tohto University, Chiba, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Bhadauria SS, Malviya R. Advancement in Nanoformulations for the Management of Diabetic Wound Healing. Endocr Metab Immune Disord Drug Targets 2022; 22:911-926. [PMID: 35249512 DOI: 10.2174/1871530322666220304214106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/01/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
People with diabetes have a very slow tendency for wound healing. Wound healing is a vast process where several factors inhibit the sequence of healing. Nano formulation plays a major role during acute and chronic wound healing. The present manuscript aims to discuss the role of nanoformulation in the treatment of diabetic wound healing. Diabetes is a common disease that has harmful consequences which lead to bad health. During the literature survey, it was observed that nanotechnology has significant advantages in the treatment of diabetic wound healing. The present manuscript summarized the role of nanomaterials in wound healing, challenges in diabetic wound healing, physiology of wound healing, a limitation that comes during wound repair, and treatments available for wound healing. After a comprehensive literature survey, it can be concluded that health worker needs more focus on the area of wound healing in diabetic patients. Medical practitioners, pharmaceutical and biomedical researchers need more attention towards the utilization of nanoformulations for the treatment of wound healing, specifically in the case of diabetes.
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Affiliation(s)
- Shailendra Singh Bhadauria
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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35
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Thomas MC. The clustering of Cardiovascular, Renal, Adipo-Metabolic Eye and Liver disease with type 2 diabetes. Metabolism 2022; 128:154961. [PMID: 34958818 DOI: 10.1016/j.metabol.2021.154961] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes is associated with an increased risk of cardiovascular disease, heart failure, chronic kidney disease, fatty liver disease, eye and foot disease. But equally, these conditions are associated with an increased risk of type 2 diabetes. Rather than being simply considered complications of diabetes, as exists within a 'pure' type 1 diabetes paradigm, both type 2 diabetes and its comorbidities are primarily caused by a failure to efficiently sequester excess energy leading to the accumulation of sick fat (adiposopathy). Type 2 diabetes is a symptom of a chronic disease complex, just as cardiovascular, renal, eye, foot and/or liver disease, are. In addition, each of these conditions feed forward so that dysfunction in one system accelerates dysfunction in another, partly through their shared pathogenesis and partly due dysfunction that follows in their wake. This review will explore the sticky, brittle conglomeration of CArdiac, Renal, Adipo-Metabolic, Eye and Liver disease (hereafter collectively known as CARAMEL disease) that is coincident in most patients with type 2 diabetes and contextualise the recent changes in diabetes guidelines that now specifically focus on identifying and aggressively managing these high-risk individuals with it.
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Affiliation(s)
- M C Thomas
- Department of Diabetes, Monash University, Melbourne, Australia.
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36
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Abbott CA, Chatwin KE, Rajbhandari SM, John KM, Pabbineedi S, Bowling FL, Boulton AJM, Reeves ND. Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting. Medicina (B Aires) 2022; 58:medicina58020166. [PMID: 35208490 PMCID: PMC8877109 DOI: 10.3390/medicina58020166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/22/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Barefoot peak plantar pressures (PPPs) are elevated in diabetes patients with neuropathic foot ulcer (DFU) history; however, there is limited reported evidence for a causative link between high barefoot PPP and DFU risk. We aimed to determine, using a simple mat-based methodology, the site-specific, barefoot PPP critical threshold that will identify a plantar site with a previous DFU. Materials and Methods: In a cross-sectional study, barefoot, site-specific PPPs were measured with normal gait for patients with DFU history (n = 21) and healthy controls (n = 12), using a validated carbon footprint system. For each participant, PPP was recorded at twelve distinct plantar sites (1st–5th toes, 1st–5th metatarsal heads (MTHs), midfoot and heel), per right and left foot, resulting in the analysis of n = 504 distinct plantar sites in the diabetes group, and n = 288 sites in the control group. Receiver operator characteristic curve analysis determined the optimal critical threshold for sites with DFU history. Results: Median PPPs for the groups were: diabetes sites with DFU history (n = 32) = 5.0 (3.25–7.5) kg/cm2, diabetes sites without DFU history (n = 472) = 3.25 (2.0–5.0) kg/cm2, control sites (n = 288) = 2.0 (2.0–3.25) kg/cm2; (p < 0.0001). Diabetes sites with elevated PPP (>6 kg/cm2) were six times more likely to have had DFU than diabetes sites with PPP ≤ 6 kg/cm2 (OR = 6.4 (2.8–14.6, 95% CI), p < 0.0001). PPP > 4.1 kg/cm2 was determined as the optimal critical threshold for identifying DFU at a specific plantar site, with sensitivity/specificity = 100%/79% at midfoot; 80%/65% at 5th metatarsal head; 73%/62% at combined midfoot/metatarsal head areas. Conclusions: We have demonstrated, for the first time, a strong, site-specific relationship between elevated barefoot PPP and previous DFU. We have determined a critical, highly-sensitive, barefoot PPP threshold value of >4.1 kg/cm2, which may be easily used to identify sites of previous DFU occurrence and, therefore, increased risk of re-ulceration. This site-specific approach may have implications for how high PPPs should be investigated in future trials.
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Affiliation(s)
- Caroline A. Abbott
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (K.E.C.); (K.M.J.); (S.P.); (N.D.R.)
- Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK
- Correspondence: ; Tel.: +44-(0)161-247-1143; Fax: +44-(0)161-247-6831
| | - Katie E. Chatwin
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (K.E.C.); (K.M.J.); (S.P.); (N.D.R.)
| | - Satyan M. Rajbhandari
- Diabetes Centre, Chorley and South Ribble Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, UK;
| | - Kanwal M. John
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (K.E.C.); (K.M.J.); (S.P.); (N.D.R.)
| | - Sushma Pabbineedi
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (K.E.C.); (K.M.J.); (S.P.); (N.D.R.)
| | - Frank L. Bowling
- School of Medicine, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UK;
| | - Andrew J. M. Boulton
- Manchester Diabetes Centre, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UK;
- Diabetes Research Institute, University of Miami, Miami, FL 33136, USA
| | - Neil D. Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (K.E.C.); (K.M.J.); (S.P.); (N.D.R.)
- Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK
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Doğruel H, Aydemir M, Balci MK. Management of diabetic foot ulcers and the challenging points: An endocrine view. World J Diabetes 2022; 13:27-36. [PMID: 35070057 PMCID: PMC8771264 DOI: 10.4239/wjd.v13.i1.27] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcers (DFU) are one of the most challenging complications of diabetes. Up to one-third of patients with diabetes mellitus (DM) may suffer from DFUs during their life. DFU is one of the leading causes of morbidity in patients with DM. The treatment period is challenging, and the recurrence rate of DFUs is high. Hence, establishing prevention strategies is the most important point to be emphasized. A multidisciplinary approach is necessary in the prevention and treatment of DFUs. Patients at risk should be identified, and prevention measures should be taken based on the risk category. Once a DFU is formed, the appropriate classification and evidence-based treatment interventions should be executed. Glycemic control, diagnosis and treatment of vascular disease, local wound care, diagnosis, and treatment of infection should be addressed along with the proper evaluation and management of general health status.
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Affiliation(s)
- Hakan Doğruel
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Aydemir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Kemal Balci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Konyaaltı 07059, Antalya, Turkey
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Luo B, Cai Y, Chen D, Wang C, Huang H, Chen L, Gao Y, Ran X. Effects of Special Therapeutic Footwear on the Prevention of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Diabetes Res 2022; 2022:9742665. [PMID: 36204487 PMCID: PMC9530919 DOI: 10.1155/2022/9742665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To reduce diabetic foot ulcer (DFU) occurrence or recurrence, diabetic therapeutic footwear is widely recommended in clinical practice for at-risk patients. However, the effectiveness of therapeutic footwear is controversial. Thus, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine whether special therapeutic footwear could reduce the incidence of DFU. METHOD We systematically searched multiple electronic databases (Medline, EMBASE, and EMB databases) to identify eligible studies published from inception to June 11, 2021. The database search, quality assessment, and data extraction were independently performed by two reviewers. Efficacy (i.e., incidence of DFU) was explored using the R'meta' package (version 4.15-1). To obtain more robust results, the random-effects model and the Hartung-Knapp-Sidik-Jonkman method were selected to assess pooled data. Metaregression analysis and sensitivity analysis were performed to explore heterogeneity, and publication bias was assessed by a visual inspection of funnel plots and the AS-Thompson test. RESULTS Eight RCTs with a total of 1,587 participants were identified from the search strategy. Compared with conventional footwear, special therapeutic footwear significantly reduced the incidence of DFU (RR 0.49; 95% CI, 0.28-0.84), with no evidence of publication bias (P = 0.69). Unexpectedly, the effectiveness of special therapeutic footwear had a reverse correlation with the intervention time (coefficient = 0.085, P < 0.05) in the metaregression analysis. CONCLUSION Special therapeutic footwear with offloading properties is effective in reducing the incidence of DFU. However, the effect may decrease gradually over time. Despite undefined reasons, the optimal utility time and renewal frequency of special therapeutic footwear should be considered.
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Affiliation(s)
- Bo Luo
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Yuying Cai
- West China Medical School, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Dawei Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Chun Wang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Hui Huang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Lihong Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Yun Gao
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
| | - Xingwu Ran
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China
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Seghieri G, Policardo L, Gualdani E, Francesconi P. Gender Differences in the Risk of Adverse Outcomes After Incident Diabetic Foot Hospitalization: A Population Cohort Study. Curr Diabetes Rev 2022; 18:e270821195904. [PMID: 34455962 DOI: 10.2174/1573399817666210827121937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic Foot Disease (DFD) is more prevalent among males and is associated with an excess risk of cardiovascular events or mortality. AIMS This study aimed at exploring the risk of cardiovascular events, renal failure, and all-cause mortality after incident DFD hospitalizations, separately in males and females, to detect any gender difference in a cohort of 322,140 people with diabetes retrospectively followed up through administrative data sources in Tuscany, Italy, over the years 2011-2018. METHODS The Hazard Ratio (HR) for incident adverse outcomes after first hospitalizations for DFD, categorized as major/minor amputations (No.=449;3.89%), lower limbs' revascularizations (LLR: No.=2854;24.75%), and lower-extremity-arterial-disease (LEAD) with no procedures (LEAD-no proc: No.=6282;54.49%), was compared to the risk of patients having a background of DFD (ulcers, infections, Charcot-neuroarthropathy: No.=1,944;16.86%). RESULTS DFD incidence rate was higher among males compared to females (1.57(95% CI:1.54-1.61) vs. 0.97(0.94-1.00)/100,000p-years]. After DFD, the overall risk of coronary artery disease was significantly associated with the male gender and of stroke with the female gender. LEAD-no proc and LLR were associated with the risk of stroke only in females, whereas they were found to be associated with the risk of coronary artery disease among females to a significantly greater extent compared to males. The incident of renal failure was not associated with any DFD category. Amputations and LEAD-no proc significantly predicted high mortality risk only in females, while LLR showed reduced risk in both genders. Moreover, females had a greater risk of composite outcomes (death or cardiovascular events). Compared to the background of DFD, the risk was found to be 34% higher after amputations (HR: 1.34(1.04-1.72)) and 10% higher after LEAD-no proc (HR:1.10(1.03-1.18)), confirming that after incident DFD associated with vascular pathogenesis, females are at an increased risk of adverse events. CONCLUSION After incident DFD hospitalizations, females with DFD associated with amputations or arterial disease are at a greater risk of subsequent adverse cardiovascular events than those with a DFD background.
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Affiliation(s)
- Giuseppe Seghieri
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Laura Policardo
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Elisa Gualdani
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Paolo Francesconi
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
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Abstract
Diabetic painless and painful peripheral neuropathy remains the most frequent complication of diabetes mellitus, but the pathophysiology remains undescribed, there are no robust clinical endpoints and no efficient treatment exists. This hampers good clinical practice, fruitful clinical research and successful pharmacological trials, necessary for the development of early detection, prevention and treatment. This chapter supplies an update on background and treatment of diabetic peripheral neuropathy. Goals and perspectives for future clinical and scientific approaches are also described.
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Affiliation(s)
- Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Faculty of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Yunir E, Hidayah CD, Harimurti K, Kshanti IAM. Three Years Survival and Factor Predicting Amputation or Mortality in Patients with High Risk for Diabetic Foot Ulcer in Fatmawati General Hospital, Jakarta. J Prim Care Community Health 2022; 13:21501319211063707. [PMID: 34986684 PMCID: PMC8744153 DOI: 10.1177/21501319211063707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Diabetic foot is one of major complication in diabetes patients with
unfavorable outcome. Survival study in outpatients is limited and factors
related are inconsistent. Survival and its modifiable risk factors should be
identified early since the foot at risk status to reduce
amputation/mortality in type 2 diabetes mellitus (T2DM). Objective: The aims of this study were to investigate survival probability for
amputation or mortality, compare different ulcer risk classification, and
figure out the relation of status of ulcer risk, age, gender, diabetes
duration, body mass index, fasting plasma glucose, HbA1C, and LDL with
amputation or mortality. Methods: This is a retrospective cohort study of 487 T2DM subjects who visited
internal medicine outpatient clinic in Fatmawati General Hospital since
January-December 2016. Status of ulcer risk and risk factors were extracted
from medical record and lower-extremity amputation or mortality was observed
in 3 years from baseline. Result: Three years overall survival is 85.7% (SE 0.17). Patients with high risk for
foot ulcer have survival probability of 80.2% (SE 0.027), which is lower
compared to non-high risk for foot ulcer with survival probability of 91.8%
(SE 0.019). Patients with high risk for foot ulcer (aHR 2.386 [95% CI
1.356-4.20]; P = .003), aged ≥60 years old (aHR 2.051 [95%
CI 1.173-3.585]; P = .012), and HbA1C ≥7% (aHR 2.022 [95%
CI 1.067-3.830]; P = .031) were independently associated
with amputation or mortality. Conclusion: T2DM patients with high risk for foot ulcer have lower survival probability
and higher risk for amputation or mortality in 3 years compared to patients
with non-high risk for foot ulcer. Status of ulcer risk, age ≥60 years, and
HbA1C ≥7% were associated with amputation or mortality in 3 years
observation.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Canggih Dian Hidayah
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Clinical Epidemiological Unit, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.,Division of Geriatrics, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ida Ayu Made Kshanti
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Fatmawati General Hospital, Jakarta, Indonesia
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Dupraz J, Zuercher E, Taffé P, Peytremann-Bridevaux I. Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:841774. [PMID: 35498410 PMCID: PMC9043606 DOI: 10.3389/fendo.2022.841774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the growing burden of diabetes worldwide, evidence regarding the optimal models of care to improve the quality of diabetes care remains equivocal. This study aimed to identify profiles of patients with distinct ambulatory care use patterns and to examine the association of these profiles with the quality of diabetes care. METHODS We performed a cross-sectional study of the baseline data of 550 non-institutionalized adults included in a prospective, community-based, cohort study on diabetes care conducted in Switzerland. Clusters of participants with distinct patterns of ambulatory healthcare use were identified using discrete mixture models. To measure the quality of diabetes care, we used both processes of care indicators (eye and foot examination, microalbuminuria screening, blood cholesterol and glycated hemoglobin measurement [HbA1c], influenza immunization, blood pressure measurement, physical activity and diet advice) and outcome indicators (12-Item Short-Form Health Survey [SF-12], Audit of Diabetes-Dependent Quality of Life [ADDQoL], Patient Assessment of Chronic Illness Care [PACIC], Diabetes Self-Efficacy Scale, HbA1c value, and blood pressure <140/90 mmHg). For each profile of ambulatory healthcare use, we calculated adjusted probabilities of receiving processes of care and estimated adjusted outcomes of care using logistic and linear regression models, respectively. RESULTS Four profiles of ambulatory healthcare use were identified: participants with more visits to the general practitioner [GP] than to the diabetologist and receiving concomitant podiatry care ("GP & podiatrist", n=86); participants visiting almost exclusively their GP ("GP only", n=195); participants with a substantially higher use of all ambulatory services ("High users", n=96); and participants reporting more visits to the diabetologist and less visits to the GP than other profiles ("Diabetologist first", n=173). Whereas participants belonging to the "GP only" profile were less likely to report most processes related to the quality of diabetes care, outcomes of care were relatively comparable across all ambulatory healthcare use profiles. CONCLUSIONS Slight differences in quality of diabetes care appear across the four ambulatory healthcare use profiles identified in this study. Overall, however, results suggest that room for improvement exists in all profiles, and further investigation is necessary to determine whether individual characteristics (like diabetes-related factors) and/or healthcare factors contribute to the differences observed between profiles.
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Chamberlain RC, Fleetwood K, Wild SH, Colhoun HM, Lindsay RS, Petrie JR, McCrimmon RJ, Gibb F, Philip S, Sattar N, Kennon B, Leese GP. Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study. Diabetes Care 2022; 45:83-91. [PMID: 34782354 DOI: 10.2337/dc21-1596] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. RESEARCH DESIGN AND METHODS The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival. RESULTS The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6-7.9) and 11.2 (11.0-11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89-2.31) for type 1 diabetes and 1.65 (1.60-1.70) for type 2 diabetes. CONCLUSIONS The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.
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Affiliation(s)
| | | | - Sarah H Wild
- 3Usher Institute, University of Edinburgh, Edinburgh, U.K
| | - Helen M Colhoun
- 4Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, U.K
| | - Robert S Lindsay
- 5Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - John R Petrie
- 6Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K
| | | | - Fraser Gibb
- 8Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, U.K
| | - Sam Philip
- 9Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, U.K
| | - Naveed Sattar
- 10Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Brian Kennon
- 11Diabetes Centre, New Victoria Hospital, Glasgow, U.K
| | - Graham P Leese
- 12Department of Diabetes and Endocrinology, Ninewells Hospital, Dundee, U.K
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44
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Lyon MM. Diabetic Ulcer Prevention. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Bedriñana-Marañón B, Rubio-Rodríguez M, Yovera-Aldana M, Garcia-Villasante E, Pinedo-Torres I. Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America. INT J LOW EXTR WOUND 2021:15347346211063266. [PMID: 34889665 DOI: 10.1177/15347346211063266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.
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Affiliation(s)
| | | | - Marlon Yovera-Aldana
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
| | - Eilhart Garcia-Villasante
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
- 269034Hospital Nacional Daniel Alcides Carrion, Callao, Perú
| | - Isabel Pinedo-Torres
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
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Optimism in adults born preterm: Systematic review and individual-participant-data meta-analysis. PLoS One 2021; 16:e0259463. [PMID: 34793498 PMCID: PMC8601551 DOI: 10.1371/journal.pone.0259463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022] Open
Abstract
Aim Preterm birth(<37 gestational weeks) is associated with numerous adversities, however, data on positive developmental outcomes remain limited. We examined if preterm and term born(≥37 gestational weeks) adults differ in dispositional optimism/pessimism, a personality trait associated with health and wellbeing. We assessed if birth weight z-score, neurosensory impairments and parental education modified the outcome. Methods We systematically searched PubMed and Web of Science for cohort or case-control studies(born ≥ 1970) with data on gestational age and optimism/pessimism reported using the Life-Orientation-Test-Revised in adulthood(≥18 years). The three identified studies(Helsinki Study of Very Low Birth Weight Adults; Arvo Ylppö Longitudinal Study; Avon Longitudinal Study of Parents and Children) provided data for the two-step random-effects linear regression Individual-Participant-Data meta-analysis. Results Preterm and term borns did not differ on optimism(p = 0.76). Preterms scored higher on pessimism than term borns(Mean difference = 0.35, 95%Confidence Interval 0.36, 0.60, p = 0.007), although not after full adjustment. Preterm born participants, but not term born participants, with higher birth weight z-score, had higher optimism scores (0.30 raw score units per standard deviation increase, 95% CI 0.10, 0.49, p = 0.003); preterm vs term x birth weight z-score interaction p = 0.004). Conclusions Preterm and term born adults display similar optimism. In preterms, higher birth weight may foster developmental trajectories promoting more optimistic life orientations.
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Predictors and outcomes of diabetic foot ulcer infection with ESBL-producing bacteria in a large tertiary center. Int J Infect Dis 2021; 113:318-324. [PMID: 34653657 DOI: 10.1016/j.ijid.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 09/04/2021] [Accepted: 10/06/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the predictors and outcomes of infection with extended-spectrum beta-lactamase (ESBL)-producing bacteria in patients with an acute diabetic foot infection (DFI). METHODS The records of patients admitted with acute DFI to a large tertiary hospital during the years 2014-2018 were reviewed. Demographic, clinical, and laboratory data were collected, as well as outcomes regarding amputations and mortality. Only cultures obtained during the first 2 weeks following admission were considered. RESULTS Cultures were available for 493 patients; 121 (24.5%) included bacteria suspected of being ESBL producers. Patients infected with ESBL-producing bacteria were older, more likely to have peripheral vascular disease (PVD), and had higher SINBAD and Wagner scores upon admission. They were also more likely to have been hospitalized in the recent 6 months. Major amputations were more prevalent in patients with versus without an ESBL-producing bacterial infection (30.6% vs 19.4%; P = 0.010), yet overall amputations and mortality rates were similar. CONCLUSIONS ESBL-producing bacteria are common pathogens in DFI, more prevalent in older patients with PVD, advanced ulcers, and recent hospitalization. They are associated with higher rates of major amputation. These considerations may support the choice of empirical antibiotic therapy in patients admitted with an acute DFI.
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48
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Chicharro-Luna E, Ortega-Avila AB, Requena-Martínez A, Gijon Nogueron G. Concordance between sudomotor disorder and the clinical diagnosis of diabetic peripheral neuropathy, according to various clinical guidelines. Prim Care Diabetes 2021; 15:853-858. [PMID: 34108112 DOI: 10.1016/j.pcd.2021.05.012] [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: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the concordance between variations in Neuropad® results and the those in different diagnostic criteria of Diabetic Peripheral Neuropathy, according to various clinical guidelines. METHODS A descriptive observational study was conducted of 111 patients with a confirmed diagnosis of diabetes mellitus. The criteria for inclusion in the study were that patients should be aged 18 years or more and have at least 10 years' history of diabetes mellitus. RESULTS 73 (65.8%) were male and 38 (34.2%) were female. Their mean age was 57.92 ± 13.24 years (95% CI 55.45-60.38). Healthy Neuropad® findings were obtained for 35 right feet (31.5%) and 31 left feet (27.9%). CONCLUSION Neuropad® is an effective instrument for detecting macro and microvascular complications such as early-stage neuropathy, although its use should always be accompanied by a clinical examination of the foot.
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Affiliation(s)
- Esther Chicharro-Luna
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, Alicante, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain.
| | - Aranza Requena-Martínez
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, Alicante, Spain
| | - Gabriel Gijon Nogueron
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain
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Lee EJ, Jeong IS, Kim IJ, Cho YH, Kim YJ. Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea. Int J Nurs Pract 2021; 28:e13012. [PMID: 34545667 DOI: 10.1111/ijn.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 07/01/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. METHODS A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. RESULTS Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. CONCLUSIONS As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.
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Affiliation(s)
- Eun Joo Lee
- Department of Nursing, Dong-Eui University, Busan, Republic of Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Republic of Korea
| | - In Ju Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University Yangsan Hospital & Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CL. Continuation of Antidepressants vs Sequential Psychological Interventions to Prevent Relapse in Depression: An Individual Participant Data Meta-analysis. JAMA Psychiatry 2021; 78:868-875. [PMID: 34009273 PMCID: PMC8135055 DOI: 10.1001/jamapsychiatry.2021.0823] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Depression frequently recurs. To prevent relapse, antidepressant medication is often taken in the long term. Sequentially delivering a psychological intervention while undergoing tapering of antidepressant medication might be an alternative to long-term antidepressant use. However, evidence is lacking on which patients may benefit from tapering antidepressant medication while receiving a psychological intervention and which should continue the antidepressant therapy. A meta-analysis of individual patient data with more power and precision than individual randomized clinical trials or a standard meta-analysis is warranted. OBJECTIVES To compare the associations between use of a psychological intervention during and/or after antidepressant tapering vs antidepressant use alone on the risk of relapse of depression and estimate associations of individual clinical factors with relapse. DATA SOURCES PubMed, the Cochrane Library, Embase, and PsycInfo were last searched on January 23, 2021. Requests for individual participant data from included randomized clinical trials (RCTs) were sent. STUDY SELECTION Randomized clinical trials that compared use of a psychological intervention while tapering antidepressant medication with antidepressant monotherapy were included. Patients had to be in full or partial remission from depression. Two independent assessors conducted screening and study selection. DATA EXTRACTION AND SYNTHESIS Of 15 792 screened studies, 236 full-text articles were retrieved, and 4 RCTs that provided individual participant data were included. MAIN OUTCOMES AND MEASURES Time to relapse and relapse status over 15 months measured via a blinded assessor using a diagnostic clinical interview. RESULTS Individual data from 714 participants (mean [SD] age, 49.2 [11.5] years; 522 [73.1%] female) from 4 RCTs that compared preventive cognitive therapy or mindfulness-based cognitive therapy during and/or after antidepressant tapering vs antidepressant monotherapy were available. Two-stage random-effects meta-analysis found no significant difference in time to depressive relapse between use of a psychological intervention during tapering of antidepressant medication vs antidepressant therapy alone (hazard ratio [HR], 0.86; 95% CI, 0.60-1.23). Younger age at onset (HR, 0.98; 95% CI, 0.97-0.99), shorter duration of remission (HR, 0.99; 95% CI, 0.98-1.00), and higher levels of residual depressive symptoms at baseline (HR, 1.07; 95% CI, 1.04-1.10) were associated with a higher overall risk of relapse. None of the included moderators were associated with risk of relapse. CONCLUSIONS AND RELEVANCE The findings of this individual participant data meta-analysis suggest that regardless of the clinical factors included in these studies, the sequential delivery of a psychological intervention during and/or after tapering may be an effective relapse prevention strategy instead of long-term use of antidepressants. These results could be used to inform shared decision-making in clinical practice.
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Affiliation(s)
- Josefien J. F. Breedvelt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fiona C. Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Zindel Segal
- Department of Clinical Psychological Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Claudi L. Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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