Geographic and Ethnic Inequalities in Diabetes-Related Amputations

Efficacy of continuous topical oxygen therapy in hard-to-heal wounds in Colombia: a retrospective analysis

OBJECTIVE

To evaluate the use of continuous topical oxygen therapy (cTOT) in hard-to-heal or chronic wounds in Colombia, South America.

METHOD

This multicentre, retrospective analysis studied the efficacy of treating hard-to-heal wounds using a cTOT device in patients over a 3-6-month period. Data were collected retrospectively from patient records. Descriptive statistics were used to summarise the characteristics of the patient population, types of wounds and treatment outcomes. Patients were divided into two groups: a continuous cTOT-treated group (n=47) and a discontinuous cTOT-treated group (n=22). The duration of treatment and wound size reduction were compared. Changes in pain medication usage and the incidence of infections were also analysed.

RESULTS

A total of 69 patients were included in the analysis. Complete healing was achieved in 64% of the continuous cTOT-treated group and 36% of the discontinuous cTOT-treated group, with most patients being pain-free and not requiring medication after treatment.

CONCLUSION

The results of this study suggest the benefits of cTOT over traditional treatments in accelerating wound healing and reducing pain, medication necessity and wound infection.

A Composite Indicator for Primary Diabetes Care: A Cross-Sectional Study in Hungary

Background: Since the effectiveness of primary DM care (PDMC) is influenced by both health-care-related and external factors, its indicator set must include indicators that are easy-to-understand for all stakeholders, such as composite indicator-based ranking. Objectives: Our study aimed to prepare a composite PDMC indicator, which is adjusted with the GP-independent characteristics of a GMP, in order to evaluate the usefulness of composite indicators in performance-improving programs. Methods: Using indicators standardized by age, sex, and eligibility for exemption certificates (on hemoglobin A1C, lipid status, serum creatinine, and ophthalmological examination, and on influenza vaccination) for Hungarian adult DM care, factor analysis was applied to create a composite DM care quality indicator (CDMI). It was adjusted (ACDMI) by a multivariable linear regression model of the association between structural characteristics of GMPs and the CDMI. Results: There were 516,052 DM patients provided for by 4784 GMPs. The CDMI exhibited significant associations with patients' lower education (β = -0.139, 95%CI: -0.182; -0.095), GPs' age over 65 (β = -0.083, 95%CI: -0.109; -0.056), GMPs with more than 2000 adult patients (β = -0.059, 95%CI: -0.090; -0.027), and urban location (β = 0.096, 95%CI: 0.058; 0.134). The average difference in GMPs' ranks by the CDMI and ACDMI was 583. Extreme poor (N = 147) and extreme good (N = 176) performances of GMPs were identified, and those were categorized further by the role of GP-independent factors in causing the extreme performances (Nhealthcareunrelated = 84; Nhealthcarerelated = 239). Conclusions: Our findings suggest a stepwise and widely communicable process for PDMC monitoring, which starts with the evaluation of the CDMI and ACDMI to identify the GMPs requiring interventions, making a distinction between extreme GMPs requiring health-care-related interventions and those requiring non-health-care-related interventions.

Partial hand and finger amputations in Sweden: an observational study of 6918 patients

BACKGROUND

We aimed to use open source data to understand the incidence, trends, and regional differences of finger and partial hand amputations on a national level in individuals aged 15 or older in Sweden.

METHODS

We analyzed 6,918 patients aged 15 and older who had experienced finger and partial hand amputations. Incidence rates, trends, and regional disparities were assessed using negative binomial regression models and Student's t-tests. Future trend prediction was performed using Poisson regression.

RESULTS

Finger amputations declined most, followed by partial hand and thumb amputations. Regional variations existed, with Stockholm having the lowest and Gotland highest incidence respectively. Overall, the incidence of finger, thumb and partial hand amputations in Sweden decreased slightly. Future trend analysis indicated decreasing incidence.

CONCLUSION

Although, lacking in definition, publicly available data can be used for monitoring of finger, thumb, and partial hand amputation incidence on a national level. Sex, age, and regional differences were observed, suggesting the need for targeted interventions to address disparities and mitigate the burden of finger and partial hand amputations on affected individuals.

Diabetes-related amputations in Germany: analysis of time trend from 2015 to 2022 and differences by area-level socioeconomic deprivation

Background

Diabetes-related amputations reduce health-related quality of life and are an indicator of the quality of care of diabetes.

Methods

Population-based age-standardized rates for diabetes-related cases of major and minor amputation were calculated and reported for the years 2015 - 2022 using the Diagnosis-related groups statistics. For 2022 these rates were also reported according to area-level socioeconomic deprivation.

Results

Diabetes-related major amputations decreased from 6.8 to 5.2 per 100,000 residents in women and from 18.6 to 17.5 per 100,000 residents in men between 2015 and 2022. In 2021 and 2022, there was no further decrease in men compared to the previous year. Diabetes-related minor amputations decreased in women between 2015 and 2022, but increased in men. Amputation rates were higher in regions with high deprivation than in regions with low deprivation.

Conclusions

Diabetes care should consider socioeconomic differences into account. The monitoring of the trends in amputations needs to be continued.

Multi-disciplinary diabetic limb salvage programme in octogenarians with diabetic foot ulcers is not futile: An observational study with historical controls

This study evaluated the effectiveness of a multi-disciplinary diabetic limb salvage programme in improving clinical outcomes and optimising healthcare utilisation in 406 patients aged ≥80 years with diabetic foot ulcers (DFUs), compared to 2392 younger patients enrolled from June 2020 to June 2021 and against 1716 historical controls using one-to-one propensity score matching. Results showed that elderly programme patients had lower odds of amputation-free survival (odds ratio: 0.64, 95% CI: 0.47, 0.88) and shorter cumulative length of stay (LOS) compared to younger programme patients (incidence rate ratio: 0.45, 95% CI: 0.29, 0.69). Compared to the matched controls, participating in the programme was associated with 5% higher probability of minor lower extremity amputation, reduced inpatient admissions and emergency visits, shorter LOS but increased specialist and primary care visits (all p-values <0.05). The findings suggest that the programme yielded favourable impacts on the clinical outcomes of patients aged≥80 years with DFUs. Further research is needed to develop specific interventions tailoring to the needs of the elderly population and to determine their effectiveness on patient outcomes while accounting for potential confounding factors.