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Bouillet B, Ahluwalia R, Iacopi E, Garcia-Klepzig JL, Lüdemann C, Manu C, Meloni M, Saenz De Buruaga VR, Vouillarmet J, Petit JM, Van Acker K, Lázaro-Martínez JL. Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays. J Wound Care 2021; 30:804-808. [PMID: 34644141 DOI: 10.12968/jowc.2021.30.10.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. METHOD In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. RESULTS Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). CONCLUSION The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Benjamin Bouillet
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | | | - Elisabetta Iacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa, Italy
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 Berlin, Germany
| | - Chris Manu
- King's College Hospital, Denmark Hill, London, UK
| | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | | | - Julien Vouillarmet
- CHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite, France
| | - Jean-Michel Petit
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
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Meloni M, Lazaro-Martínez JL, Ahluwalia R, Bouillet B, Izzo V, Di Venanzio M, Iacopi E, Manu C, Garcia-Klepzig JL, Sánchez-Ríos JP, Lüedemann C, De Buruaga VRS, Vouillarmet J, Guillaumat J, Aleandri AR, Giurato L, Edmonds M, Piaggesi A, Van Acker K, Uccioli L. Effectiveness of fast-track pathway for diabetic foot ulcerations. Acta Diabetol 2021; 58:1351-1358. [PMID: 33942178 PMCID: PMC8413149 DOI: 10.1007/s00592-021-01721-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic Department, King ́s College Hospital, London, UK
| | | | - Valentina Izzo
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | - Chris Manu
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | | | | | | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Micheal Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | - Alberto Piaggesi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | | | - Luigi Uccioli
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Jeffcoate W, Game F, Morbach S, Narres M, Van Acker K, Icks A. Assessing data on the incidence of lower limb amputation in diabetes. Diabetologia 2021; 64:1442-1446. [PMID: 33783587 DOI: 10.1007/s00125-021-05440-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/18/2021] [Indexed: 01/22/2023]
Affiliation(s)
- William Jeffcoate
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals Trust, Nottingham, UK.
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Kristien Van Acker
- Centre de Santé des Fagnes Clinique Chimay, Department of Diabetology, Endocrinology and Wound Care, Chimay, Belgium
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Sánchez-Ríos JP, García-Klepzig JL, Manu C, Ahluwalia R, Lüdemann C, Meloni M, Lacopi E, De Buruaga VRS, Bouillet B, Vouillarmet J, Lázaro-Martínez JL, Van Acker K. Referral of patients with diabetic foot ulcers in four European countries: patient follow-up after first GP visit. J Wound Care 2020; 28:S4-S14. [PMID: 31393783 DOI: 10.12968/jowc.2019.28.sup8.s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study aimed to analyse the characteristics of patients, including demographics, medical history and treatment, with a diabetic foot ulcer (DFU) during their first follow-up visit to a general practitioner (GP). METHODS A two-part quantitative online questionnaire was distributed among GPs in France, UK, Germany and Spain. Part one entailed a survey of GPs' perceptions of referrals for DFU. Part two collected data on recently managed DFU cases. The percentage of responses was compared for each question and across the four countries for significant differences. RESULTS In part one of the study, 600 questionnaires were collected (150 per country) and 1188 patients managed for a DFU were included in the second part. About 88% of patients had type 2 diabetes, with a significant proportion of suboptimal control (average HbA1c: 10.64mmol/l). A patient complaint led to diagnosis in 60% of the cases. Wounds were found to be more frequently located in the toes and midfoot, and were superficial (according to the Texas Wound Classification system) in 80% of the cases. More than two-thirds of patients developed small wounds (<5cm2); more than half of them had infected wounds. Approximately 50% of wounds were ischaemic, which triggered the onset of a DFU. Follow-up wound examinations before and after hospitalisation were performed by nurses, except in Germany where GPs undertook this role, including prescribing offloading devices and in the UK where follow-up was managed by podiatrists. Ischaemia, wound necrosis, suspected osteomyelitis and absence of wound healing were the primary reasons for hospital admission during the first month after diagnosis. CONCLUSION Delay in specialised foot care is a recurring topic in the treatment of DFUs, even with different health-care structures across Europe. Knowledge and education on DFUs should be reinforced among GPs and nurses to establish a global DFU care network between primary and specialised care, avoid hospitalisation and adequately manage high-risk patients.
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Affiliation(s)
- Juan Pedro Sánchez-Ríos
- Diabetic Foot Unit, Vascular Surgery Department, Foundation Alcorcon University Hospital, Madrid, Spain
| | | | - Chris Manu
- Diabetes Research Fellow; King's College Hospital, London, UK
| | - Raju Ahluwalia
- Trauma and Ortophaedic Department, King's College Hospital, London, UK
| | | | - Marco Meloni
- Diabetic Foot Center, University of Tor Vergata, Rome, Italy
| | | | | | | | | | | | - Kristien Van Acker
- H Familie Ziekenhuis and Centre de Santé des Fagnes, Department of Endocrinology, Rumst and Chimay, Belgium
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5
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Garcia-Klepzig JL, Sánchez-Ríos JP, Manu C, Ahluwalia R, Lüdemann C, Meloni M, Lacopi E, De Buruaga VRS, Bouillet B, Vouillarmet J, Lázaro-Martínez JL, Van Acker K. Perception of diabetic foot ulcers among general practitioners in four European countries: knowledge, skills and urgency. J Wound Care 2019; 27:310-319. [PMID: 29738299 DOI: 10.12968/jowc.2018.27.5.310] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Diabetic foot ulcers (DFU) have the potential to deteriorate rapidly, in the absence of prompt assessment and treatment. The aim of this study was to analyse the awareness and perception of DFU among general practitioners (GPs) from four European countries, and to find possible differences between these countries in terms of management. METHOD A two-part, quantitative, online questionnaire was distributed to GPs across four countries in Europe-the UK, France, Germany and Spain. The first part entailed a survey on the perception and knowledge of the pathogenesis and management of DFU, among GPs. The second part of the questionnaire was used for the collection of data on recently-managed DFU cases. RESULTS For the first part of the study, 600 questionnaires were collected (150 per country) and 1188 patient cases of DFU management were included in the second part. In France, only 49% of GPs mentioned neuropathy as the main causative process in DFU development. However, in Germany and the UK, 82% and 83% of GPs, respectively, considered neuropathy as an important causative factor. DFU care in Spain and the UK is thought to be organised by multidisciplinary teams (MDT) (83% and 84% of GPs, respectively, completely agreed with this statement). In France and Germany, GPs are responsible for follow-up and management. Only UK physicians have clearly identified specialised podiatrists to refer patients to, if needed. Approximately 29-40% of GPs in all countries did not feel they were sufficiently trained in the DFU treatment protocol. Almost 30% of GPs in France and Germany thought that DFU treatment was not well-established due to the absence of clinical guidelines and protocols. CONCLUSION The intra-country and inter-country management of the complex aspects of DFU is quite heterogeneous. The cause of this finding is multifactorial. Although there are international guidelines, it would be beneficial to establish clear and specific competencies for the different health professionals involved in DFU management. As a minimum, intra-country heterogeneity should improve with their development.
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Affiliation(s)
- José Luis Garcia-Klepzig
- Internal Medicine Department, Hospital Clinico San Carlos De Madrid, Calle Profesor Martin Lagos, 28040 Madrid
| | | | - Chris Manu
- Diabetes Research Fellow; King's College Hospital, Denmark Hill, London
| | - Raju Ahluwalia
- Trauma and Ortophaedic Department, King´s College Hospital, London, UK
| | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, Berlin
| | - Marco Meloni
- Diabetic Foot Center, University of Roma Tor Vergata, Viale Oxford 81, Roma
| | - Elisabetta Lacopi
- Diabetic Foot Section, University of Pisa, Ospedale di Cisanello, via Paradisa 2, Pisa
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Lázaro-Martínez JL, Edmonds M, Rayman G, Apelqvist J, Van Acker K, Hartemann A, Martini J, Lobmann R, Bohbot S, Kerihuel JC, Piaggesi A. Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer. J Wound Care 2019; 28:358-367. [DOI: 10.12968/jowc.2019.28.6.358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect. Method: In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location. Results: For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group. Conclusion: This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.
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Affiliation(s)
| | | | - Gerry Rayman
- The Ipswich Diabetic Foot Unit, Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | | | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jacques Martini
- Department of Endocrinology, Rangueil University Hospital, Toulouse, France
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Germany
| | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO, Paris, France
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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7
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Claessen H, Avalosse H, Guillaume J, Narres M, Kvitkina T, Arend W, Morbach S, Lauwers P, Nobels F, Boly J, Van Hul C, Doggen K, Dumont I, Felix P, Van Acker K, Icks A. Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium. Diabetologia 2018; 61:1966-1977. [PMID: 29909501 PMCID: PMC6096627 DOI: 10.1007/s00125-018-4655-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends. METHODS Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted. RESULTS A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001). CONCLUSIONS/INTERPRETATION In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Herve Avalosse
- IMA/AIM (InterMutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Joeri Guillaume
- IMA/AIM (InterMutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Nationaal Verbond der Socialistische Mutualiteiten/Union Nationale des Mutualités Socialistes, Brussels, Belgium
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Werner Arend
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Patrick Lauwers
- Diabetes Liga, Ghent, Belgium
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank Nobels
- Nationaal Verbond der Socialistische Mutualiteiten/Union Nationale des Mutualités Socialistes, Brussels, Belgium
- Department of Endocrinology, Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Jacques Boly
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Chris Van Hul
- Landsbond van Onafhankelijke Ziekenfondsen/Union des Mutualités Libres, Anderlecht, Belgium
| | - Kris Doggen
- Scientific Institute of Public Health, Brussels, Belgium
| | - Isabelle Dumont
- Association Belge du Diabète, Brussels, Belgium
- Centre Multidisciplinaire du Pied Diabetique, Ransart, Belgium
| | - Patricia Felix
- Association Belge du Diabète, Brussels, Belgium
- Department of Endocrinology, CHR de la Citadelle, Liège, Belgium
| | - Kristien Van Acker
- D-Foot International (International Working Group on the Diabetic Foot- Implementation), Department of Diabetology and Endocrinology, CSF, Chimay, Belgium
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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8
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Manu C, Lacopi E, Bouillet B, Vouillarmet J, Ahluwalia R, Lüdemann C, Garcia-Klepzig JL, Meloni M, De Buruaga VRS, Sánchez-Ríos JP, Edmonds M, Apelqvist J, Martinez JLL, Van Acker K. Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units. J Wound Care 2018; 27:186-192. [DOI: 10.12968/jowc.2018.27.3.186] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Chris Manu
- King's College Hospital, Denmark Hill, SE5 9RS London
| | - Elisabetta Lacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa
| | - Benjamin Bouillet
- CHU de Dijon, 2 boulevard Maréchal de Lattre de Tassigny, 21000 DIJON
| | - Julien Vouillarmet
- JCHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 BERLIN
| | | | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma
| | | | | | - Mike Edmonds
- King's College Hospital, Denmark Hill, SE5 9RS London
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, S-205 02 Malmö, Sweden
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9
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Narres M, Kvitkina T, Claessen H, Droste S, Schuster B, Morbach S, Rümenapf G, Van Acker K, Icks A. Incidence of lower extremity amputations in the diabetic compared with the non-diabetic population: A systematic review. PLoS One 2017; 12:e0182081. [PMID: 28846690 PMCID: PMC5573217 DOI: 10.1371/journal.pone.0182081] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/12/2017] [Indexed: 12/16/2022] Open
Abstract
Lower extremity amputation (LEA) in patients with diabetes results in high mortality, reduced quality of life, and increased medical costs. Exact data on incidences of LEA in diabetic and non-diabetic patients are important for improvements in preventative diabetic foot care, avoidance of fatal outcomes, as well as a solid basis for health policy and the economy. However, published data are conflicting, underlining the necessity for the present systematic review of population-based studies on incidence, relative risks and changes of amputation rates over time. It was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Nineteen out of 1582 studies retrieved were included in the analysis. The incidence of LEA in the diabetic population ranged from 78 to 704 per 100,000 person-years and the relative risks between diabetic and non-diabetic patients varied between 7.4 and 41.3. Study designs, statistical methods, definitions of major and minor amputations, as well as the methods to identify patients with diabetes differed greatly, explaining in part these considerable differences. Some studies found a decrease in incidence of LEA as well as relative risks over time. This obvious lack of evidence should be overcome by new studies using a standardized design with comparable methods and definitions.
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Affiliation(s)
- Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- * E-mail:
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sigrid Droste
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
| | - Björn Schuster
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
- Department of Diabetology and Angiology, Virgin Mary Hospital Soest, Germany
| | - Gerhard Rümenapf
- Clinic for Vascular Surgery, Deaconess Foundation Hospital, Upper Rhine Vascular Center Speyer-Mannheim, Speyer, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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11
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Van Olmen J, Kegels G, Korachais C, de Man J, Van Acker K, Kalobu JC, van Pelt M, Ku GM, Hen H, Kanda D, Malombo B, Darras C, Schellevis F. The effect of text message support on diabetes self-management in developing countries - A randomised trial. J Clin Transl Endocrinol 2017; 7:33-41. [PMID: 29067248 PMCID: PMC5651290 DOI: 10.1016/j.jcte.2016.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 01/05/2023]
Abstract
Report of a randomised trial on an mHealth intervention in 3 low income countries. There was no additional effect of the text message self-management support. Coverage, routine care and disease progression interfere with the potential impact.
Objective mHealth interventions have the potential to facilitate self-management. This TEXT4DSM study implemented a mobile phone intervention in existing diabetes programmes in three low- and middle-income countries (Democratic Republic of Congo, Cambodia, and the Philippines). Research design and methods Sub-studies with a similar randomised controlled trial design were conducted in three different countries. Each sub-study included 480 adults with diabetes. Subjects were randomised to receive either routine care or routine care plus text message self-management support. The primary outcome was the difference in the proportion of subjects with well-controlled diabetes after 2 years. Results Baseline and 2-year HbA1c measurements were available for 781 individuals. After 2 years, the proportion of subjects with controlled HbA1c was 2.8% higher in the intervention group than in the control group (difference not statistically significant). In the logistic regression model, the odds ratio for having controlled diabetes after the intervention was 1.1, after adjusting for baseline HbA1c level, sex, receiving insulin treatment, and participating in the routine programme. The HbA1c dynamics over time differed between programmes; the number of people with controlled diabetes tended to increase in DR Congo and decrease in Cambodia. Conclusion This study was the first to test the same mHealth intervention in different countries. The finding that text messages did not show an additional effect on diabetes control implied that expectations about mHealth should be cautious. The degree of coverage, the quality of the routine programme, and the progression of disease can interfere with the expected impact. Trial registration: ISRCTN registry (86247213).
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Affiliation(s)
- Josefien Van Olmen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Catherine Korachais
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jeroen de Man
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Van Acker
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | | | | | - Grace Marie Ku
- Veterans Memorial Medical Center, Philippines.,Institute of Health Policy & Development Studies, National Institutes of Health, University of the Philippines Manila, Philippines
| | | | - Dominique Kanda
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | - Billy Malombo
- Algemeen ziekenhuis Heilige Familie Reet en Centre de Santé des Fagnes, Chimay, Belgium
| | | | - François Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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12
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Abstract
The International Working Group on the Diabetic Foot recommends that auditing should be part of the organization of diabetic foot care, the efforts required for data collection and analysis being balanced by the expected benefits. In Germany legislature demands measures of quality management for in- and out-patient facilities, and, in 2003, the Germany Working Group on the Diabetic Foot defined and developed a certification procedure for diabetic foot centres to be recognized as 'specialized'. This includes a description of management facilities, treatment procedures and outcomes, as well as the organization of mutual auditing visits between the centres. Outcome data is collected at baseline and 6 months on 30 consecutive patients. By 2014 almost 24,000 cases had been collected and analysed. Since 2005 Belgian multidisciplinary diabetic foot clinics could apply for recognition by health authorities. For continued recognition diabetic foot clinics need to treat at least 52 patients with a new foot problem (Wagner 2 or more or active Charcot foot) per annum. Baseline and 6-month outcome data of these patients are included in an audit-feedback initiative. Although originally fully independent of each other, the common goal of these two initiatives is quality improvement of national diabetic foot care, and hence exchanges between systems has commenced. In future, the German and Belgian accreditation models might serve as templates for comparable initiatives in other countries. Just recently the International Working Group on the Diabetic Foot initiated a working group for further discussion of accreditation and auditing models (International Working Group on the Diabetic Foot AB(B)A Working Group).
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Affiliation(s)
| | | | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Stuttgart, Germany
| | | | - Kris Doggen
- Scientific Institute of Public Health, OD Public Health and Surveillance, Brussels, Belgium
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14
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Doggen K, Van Acker K, Beele H, Dumont I, Félix P, Lauwers P, Lavens A, Matricali GA, Randon C, Weber E, Van Casteren V, Nobels F. Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results. Diabetes Metab Res Rev 2014; 30:435-43. [PMID: 24446240 DOI: 10.1002/dmrr.2524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/24/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. METHODS Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. RESULTS The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. CONCLUSIONS A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics.
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15
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van Olmen J, Ku GM, van Pelt M, Kalobu JC, Hen H, Darras C, Van Acker K, Villaraza B, Schellevis F, Kegels G. The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the Philippines. BMC Public Health 2013; 13:423. [PMID: 23635331 PMCID: PMC3658970 DOI: 10.1186/1471-2458-13-423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/19/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention. DESIGN/METHODS The study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients' assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed. DISCUSSION The intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology. TRIAL REGISTRATION ISRCTN86247213.
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Affiliation(s)
- Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The netherlands
| | - Grace Marie Ku
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Veterans Memorial Medical Center, Quezon, Philippines
| | | | | | | | | | - Kristien Van Acker
- Diabetologist, working at Algemeen ziekenhuis Heilige Familie, Reet & Centre de Santé des Fagnes, Chimay, Belgium
| | | | - Francois Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands & Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research VU University Medical Center, Amsterdam, The Netherlands
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
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Lambers S, Van Laethem C, Van Acker K, Calders P. Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Clin Rehabil 2008; 22:483-92. [PMID: 18511528 DOI: 10.1177/0269215508084582] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. DESIGN A double-blind randomized controlled trial with patients receiving either combination (COM), endurance (END) or no training (C). SETTING Sint-Jozef hospital (Belgium), general practice (Holland). SUBJECTS Forty-six type 2 diabetes patients (17 female, 29 male). INTERVENTIONS COM versus END and C. Patients exercised for three months, three times a week for 1 hour. MAIN MEASURES Six-minute walk test (6MW T), peak Vo(2), strength in upper and lower limbs, sit-to-stand, height, weight, body mass index, fat mass, glycosylated haemoglobin (HbA1c), glycaemia, triglycerides, high-density lipoprotein (HDL), total cholesterol and quality of life (General Health Survey Short Form (SF-36)). RESULTS COM had significant better results on sit-to-stand (P<0.05), 6MW T (P<0.01), strength in upper (P<0.001) and lower limbs (P<0.001) compared with C. A different evolution among COM and C was found for HbA1c (P<0.05) and cholesterol (P<0.01), both decreased in COM and increased in C. HDL increased in COM and decreased in C (P<0.01). END had significant higher results on the 6MW T (P<0.01) compared with C. Compared with END, COM had significantly higher results on strength in upper (P<0.01) and lower limbs (P<0.01). The evolution of SF-36 items was not significantly different between the three groups. CONCLUSION In diabetes type 2 patients, COM had significant better effects on indices of physical condition, diabetes and cardiovascular risk compared with C. Compared with END, COM gave a tendency towards better results, however more research with a larger number of participants is needed.
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Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Tennvall GR, Reike H, Spraul M, Uccioli L, Urbancic V, Van Acker K, Van Baal J, Van Merode F, Schaper N. Optimal organization of health care in diabetic foot disease: introduction to the Eurodiale study. INT J LOW EXTR WOUND 2007; 6:11-7. [PMID: 17344196 DOI: 10.1177/1534734606297245] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes the rationale and protocol of a large data collection study in patients with new diabetic foot ulcers by the Eurodiale study group, a consortium of centers of expertise in the field of diabetic foot disease within Europe. This study is a multicenter, observational, prospective data collection study. Its main aim is to determine the major factors determining clinical outcome and outcome in terms of health-related quality of life and health care consumption. Between September 1, 2003, and October 1, 2004, in 14 European centers, all consecutive patients with diabetes and a new foot ulcer were included in the study and followed until the end point or for a maximum of 1 year. End points were healing of the foot, major amputation, or death. Data were collected on patient, foot, and ulcer characteristics and on diagnostic and management procedures. Furthermore, data were collected on health care organization, quality of life, and resource use. A total of 1232 patients were included in the study. Sixty-three percent of the patients were referred by their general practitioner or were self-referrals. Twenty-seven percent of the patients were admitted at the time of inclusion; 1088 patients were followed until the end point. "Optimal Organization of Health Care in Diabetic Foot Disease" is one of the first large multicenter studies in the field of diabetic foot disease on clinical presentation, clinical outcome, quality of life, resource utilization, and health care organization and their interrelationships. These data will provide us with new insights that enable us to improve care for these patients and guide the development of new studies in this area. The results of this study are the subject of a separate presentation.
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Affiliation(s)
- Leonne Prompers
- Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands.
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18
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Abstract
Diabetes mellitus (DM) is diagnosed in 3% to 4% of the population. This metabolic disorder is characterized by hyperglycemia caused by the body's deficient management of insulin. Two main types of DM exist: type 1 is a total deficiency in insulin secretion, and type 2 is a combination of resistance to insulin action and inadequate compensatory insulin secretion. Diagnosis and monitoring of DM is based on blood glucose concentration or glycosylated hemoglobin concentration. The dental practitioner should be aware of the oral manifestations of DM in order to spot initial symptoms of the disease. When treating DM patients, the practitioner must understand the consequences of the disease in relation to dental treatment. In this review, we examine the implications of DM when orthodontic treatment is planned.
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Affiliation(s)
- Luc Bensch
- Special Care Dentistry Unit, University Hospital Antwerp, Belgium
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