Cause-Specific Risk Factors of Death in Individuals with Diabetes: A Competing Risks Modeling

The value of administering intravenous antibiotics during haemodialysis in the treatment of diabetic foot infections

OBJECTIVE

People with diabetes who are on haemodialysis (HD) are at a high risk of diabetic foot infections (DFI) and related complications. We explored the value of treating DFI with intravenous (IV) antibiotics during HD.

METHOD

This was an observational study of consecutively treated patients with DFIs with IV antibiotics during HD. Data collected included baseline characteristics, IV antibiotics used, details of multidisciplinary interventions and DFI treatment outcome.

RESULTS

A cohort of 11 patients, mean (±standard deviation) age 62.4±12.7 years, had 15 episodes of treatment with IV antibiotics during HD. Of the patients, six (54.5%) were male and nine (81.8%) had type 2 diabetes. The estimated mean glomerular filtration rate (eGFR) was 11.4±3.9ml/minute. All patients had infected foot ulceration, soft tissue infection, six (54.5%) patients had osteomyelitis, and two (18.2%) had wet gangrene. The commonest IV antibiotic used was vancomycin (10/15 episodes, 66.7%). Other IV antibiotics used were daptomycin and meropenem. In three episodes, oral ciprofloxacin was used with IV antibiotics. The mean duration of antibiotic treatment was 9.2±4.9 weeks. Of the episodes, 11 (73.3%) were treated successfully with IV antibiotics alone and two (13.3%) episodes required minor surgical debridement/amputation. Some 10 (90.9%) members of the cohort had peripheral arterial disease and of those, five (50%) underwent angioplasty during IV antibiotic treatment.

CONCLUSION

HD provides a good opportunity for treatment with IV antibiotics in DFI. This mode of administration of IV antibiotics, along with multidisciplinary intervention, is associated with ulcer healing and resolution of infection in over three-quarters of patients with DFI.

DECLARATION OF INTEREST

The authors have no conflicts of interest to declare.

Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta

BACKGROUND

Poor self-management behavior is one of the causes of the high number of patients with type 2 diabetes mellitus (T2DM) in Indonesia.

OBJECTIVES

The aim of this study was to measure the effectiveness of TPA-based community empowerment as a form of education in improving the blood glucose control practices of patients with T2DM in Yogyakarta.

METHODS

This study used quantitative methods with a quasi-experimental non-equivalent pre-posttest control group design. The subjects of this study were "Prolanis member" patients with T2DM in the four primary health care centers in Sleman, Yogyakarta, Indonesia. Purposive sampling was done at four primary care in Sleman, Yogyakarta, Indonesia. From 138 T2DM patients, only 102 were eligible to become respondents. The questionnaires were adapted to the recommendations of endocrine experts' associations to measure the level of T2DM patients' knowledge, attitude and practices. Intervention was done for three months, from October to December 2019. Measurements were made before and after the TPA.

RESULTS

Attitude and behavior scores showed a significant increase (P < 0.05) after TPA intervention. Meanwhile, the average score of knowledge after the TPA intervention showed no significant increase (P > 0.05). Good self-management behavior in patients with T2DM was observed in Sleman Regency. Education through TPA based community empowerment should be considered as an appropriate intervention to improve DM management practice. Patients can receive material that is delivered easily because of the relaxed and pleasant environment during TPA.

CONCLUSIONS

TPA-based community empowerment can create a relaxed and pleasant environment to improve blood glucose control practices in patients with T2DM.