Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality

Background. Diabetic foot ulceration is a devastating complication of diabetes mellitus and is a major source of morbidity and mortality. So far, there are few published data on diabetic foot ulcers and its determinants among diabetic patients on follow-up at Jimma Medical Center. Hence, the aim of this study was to assess the prevalence of diabetic foot ulcer and its determinants among patients with diabetes mellitus at Jimma Medical Center. Methods. A hospital-based cross-sectional study was conducted from June 1 to August 30, 2019, and systematic random sampling technique was applied. The total number of study subjects who participated in the study was 277. Data were collected using an interview-administered structured questionnaire. Data were entered into EpiData version 3.1 and exported to SPSS version 20 software for analysis. Analysis was done using descriptive statistics and logistic regression. A variable having a p value of <0.25 in the bivariate model was subjected to multivariate analysis to avoid confounding the variable’s effect. Adjusted odds ratios (AOR) were calculated at 95% confidence interval and considered significant with a p value of ≤0.05. Result. The mean of age of participants was 50.1±14.19 years. More than three-fourths of participants (82.7%) were type 2 DM. The mean duration of diabetic patients was 6.00±5.07 years. The prevalence of diabetic foot ulcer was 11.6% among study participants. According to multivariate logistic regression analysis, previous history of ulceration (AOR=5.77; 95% CI: 2.37, 14.0) and peripheral neuropathy (AOR=11.2; 95% CI: 2.8, 44.4) were independent predictors of diabetic foot ulcer. Conclusion. The prevalence of diabetic foot ulcer was 11.6%. Previous history of ulceration and peripheral neuropathy were associated with diabetic foot ulcer. The health care providers are recommended to thoroughly give emphasis during follow-up of patients who had previous history of ulceration and peripheral neuropathy in order to decrease the occurrence of diabetic foot ulcer.

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Operative Intervention Does Not Change Pain Perception in Diabetic Foot Ulcer Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00435 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0043

Author(s):

Olivia Waldman ◽

Jeff R. Houck ◽

Stephanie P. Hao ◽

Nicolette Lee ◽

Judith F. Baumhauer ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Surgical Intervention ◽

Demographic Data ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Pain Level ◽

Clinical Factors ◽

Prevalence Of Depression

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Most diabetic foot ulcer (DFU) patients have peripheral neuropathy (PN), which presents with numbness, pain and weakness. DFU patient’s perceived pain and other clinical factors affecting their pain level have not been reported. Although high prevalence of depression among diabetes patients have been reported, its correlation with perception of pain has not been investigated in patients with ulcers. PROMIS (Patient-Reported Outcomes Measurement Information System) allows accurate quantification of patient’s physical function (PF), pain interference (PI) and Depression. We aimed to investigate 1) if DFU patient’s pre- and postoperative pain level correlate with demographic data/ laboratory values/surgical procedure and 2) if depression level and/or surgical intervention impacts pain. Methods: Prospectively collected PROMIS (PF, PI, D) assessments were obtained for patients who underwent surgical intervention for infected DFU between February 2015 and November 2018 (n=240). Patients who had at least 3 consecutive visits with a minimum follow up of 3 months and had completed all assessments for each visit were included (n=92). Demographic data, BMI, medical comorbidities, Hemoglobin A1C (A1C), procedure performed, wound healing status, PN, depression, and amputation level were collected. The mean follow-up duration was 4.7 (3-12) months. T-score distribution of initial PROMIS scores were calculated and compared to the US population. Chi-Square test and Minimum clinically important differences (MCID) were calculated to assess the co-occurrence of different PROMIS domains. We also analyzed other clinical factors and their influences on MCID changes in PROMIS domains. Results: The 92 patients were 80.4% male (n=74) and had an average age of 60.5 (33-96) and BMI of 34.1 (22.0-57.5). Irrigation and debridement (n=39), forefoot amputations (n=46), mid/hindfoot amputations (n=14) and Syme or above amputations (n=12) were performed. Mean pre-operative PF, PI, and depression PROMIS scores were 34.4, 58.7, and 51.4, respectively. Average scores at final follow up increased 1.7, decreased 0.1, and increased 0.2, respectively. Depression and PI were the most strongly associated co-occurrences (p=0.03) pre-operatively and remained significant (p<0.01) with respect to post-operative MCID. PF and PI also strongly co-occurred pre-operatively (p=0.04) and with post-operative MCID assessment (p=0.02). PF was affected by initial A1C (p=0.03) and wound healing status (p=0.03). PN was the only clinical factor found to affect PI (p=0.03). Conclusion: DFU patients with PN experience a significant amount of pain. Contrary to previous studies, we did not find a higher prevalence of depression in our DFU cohort compared to the average United States population. The study results do not indicate the origin of pain, which can be further investigated using other measures, such as PROMIS Neuropathic Pain Quality Scale. Surgical intervention did not significantly relieve pain in DFU patients. These findings may be referenced for pre-operative patient education and setting expectation for surgery.

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Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

Journal of Wound Care ◽

10.12968/jowc.2020.29.8.464 ◽

2020 ◽

Vol 29 (8) ◽

pp. 464-471

Author(s):

Georges Ha Van ◽

Chloe Amouyal ◽

Olivier Bourron ◽

Carole Aubert ◽

Aurelie Carlier ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Median Duration ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Minor Amputation ◽

One Year

Objective: To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS). Method: A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method. Results: Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age. Conclusion: This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

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Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Acta Endocrinologica ◽

10.1530/eje-12-0279 ◽

2012 ◽

Vol 167 (3) ◽

pp. 401-407 ◽

Cited By ~ 11

Author(s):

M Monteiro-Soares ◽

A Vaz-Carneiro ◽

S Sampaio ◽

M Dinis-Ribeiro

Keyword(s):

Diabetic Foot ◽

Predictive Value ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Receiver Operating Curve ◽

Predictive Variables ◽

Patients With Diabetes ◽

Good Diagnostic Accuracy ◽

Diabetic Foot Screening

Aims/hypothesisThere are five systems to stratify the risk for the development of a diabetic foot ulcer (DFU). This study aimed to prospectively validate all of them in the same cohort of participants to allow their direct comparison.MethodsA retrospective cohort study was conducted on all patients with diabetes but without an active DFU attending our podiatry section (n=364) from January 2008 to December 2010. Participants' characteristics and all variables composing the stratification systems were assessed at baseline. Follow-up was performed for 1 year or until DFU occurred.ResultsParticipants had a mean age of 64 years; 99.7% had type 2 diabetes and 48.6% were male. Median follow-up was 12 months (1–12) during which 33 subjects (9.1%) developed a DFU. Age, diabetes duration, foot deformity, peripheral vascular disease, diabetic peripheral neuropathy, previous DFU, and previous lower extremity amputation were associated with DFU occurrence. All systems presented greater DFU occurrence frequency as the risk group was higher (χ2,P<0.001) and showed good diagnostic accuracy values, especially negative predictive value (≥95%) and area under the receiver operating curve (≥0.73). The lowest performance concerned positive predictive value (≤29.5%).Conclusions/interpretationAll the currently available stratification systems show high accuracy to detect which patients will develop a DFU with no significant differences among them. Therefore, for diabetic foot screening and resource allocation, it would be desirable to have a single unified system, combining the available systems, prospectively validated in a multicenter context and testing the inclusion of novel predictive variables' pertinence.

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Outcomes after foot surgery in people with a diabetic foot ulcer and a 12-month follow-up

Journal of Wound Care ◽

10.12968/jowc.2017.26.5.218 ◽

2017 ◽

Vol 26 (5) ◽

pp. 218-227 ◽

Cited By ~ 12

Author(s):

E. Lenselink ◽

S. Holloway ◽

D. Eefting

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Foot Surgery

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Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup6.s34 ◽

2021 ◽

Vol 30 (Sup6) ◽

pp. S34-S41

Author(s):

Georges Ha Van ◽

Chloe Amouyal ◽

Olivier Bourron ◽

Carole Aubert ◽

Aurelie Carlier ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Median Duration ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Minor Amputation ◽

One Year

Objective: To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS). Method: A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method. Results: Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age. Conclusion: This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

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Referral of patients with diabetic foot ulcers in four European countries: patient follow-up after first GP visit

Journal of Wound Care ◽

10.12968/jowc.2019.28.sup8.s4 ◽

2019 ◽

Vol 28 (Sup8) ◽

pp. S4-S14

Author(s):

Juan Pedro Sánchez-Ríos ◽

JL García-Klepzig ◽

Chris Manu ◽

Raju Ahluwalia ◽

Claas Lüdemann ◽

...

Keyword(s):

Diabetic Foot ◽

Significant Proportion ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Suboptimal Control ◽

Foot Care ◽

Online Questionnaire ◽

Before And After ◽

The Uk

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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Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001697 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001697

Author(s):

Brian J Petersen ◽

Sicco A Bus ◽

Gary M Rothenberg ◽

David R Linders ◽

Lawrence A Lavery ◽

...

Keyword(s):

Diabetic Foot ◽

Home Monitoring ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Interval Censoring ◽

Recurrence Rates ◽

Multicenter Studies ◽

Design And Methods ◽

The Impact

IntroductionFoot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation.Research design and methodsWe aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) recurrence coincided with typical intervals between routine preventive care appointments, which would suggest that delays exist between ulcer development and identification. We completed an analysis of existing data from two multicenter studies in 300 total participants. We analyzed unadjusted counts of DFU binned in weekly intervals and defined ‘exam periods’ as intervals from 2 to 4 weeks, from 6 to 8 weeks, within 1 week of 3 months and within 1 week of 6 months. We tested whether recurrence rates during exam periods were equivalent to rates outside exam periods. We estimated the delay between DFU development and DFU identification such that the rate of development would have been constant.ResultsDuring exam periods, a total of 43 DFUs were identified (43/86=50%) despite the fact that these periods represent only 23.5% of follow-up in aggregate. Accounting for censoring, the annualized incidence during exam periods was 0.68 DFU/year (CI 0.48 to 0.89) in contrast to 0.25 DFU/year (CI 0.18 to 0.32) outside exam periods (incidence ratio=2.8, CI 1.8 to 4.3). We estimated delays between DFU occurrence and identification to average 15.3 days (IQR 7.4–23.7 days).ConclusionsThese findings have potential implications for practice, particularly related to the value of telehealth and in-home monitoring of patients in diabetic foot remission. Additionally, there are implications for study design, which should consider the impact of interval censoring and attempt to control for confounders related to frequency and timing of exams.

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Case report on the use of a honey on diabetic foot ulcer patients

International Journal of Indonesian National Nurses Association (IJINNA) ◽

10.32944/ijinna.v1i1.23 ◽

2018 ◽

Vol 1 (1) ◽

pp. 98-104

Author(s):

Suriadi (Corresponding author) ◽

Rhamdaniyati ◽

Wuriani Sudirjo ◽

Sukarni Ali ◽

Arina Nurpiyanti ◽

...

Keyword(s):

Diabetic Foot ◽

Healing Process ◽

Clinical Signs ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Improve Wound Healing ◽

Surrounding Skin

This article describes four infected diabetic foot ulcer patients who were treated with honey dressing as fragmented therapy. Quantitative and qualitative descriptions of the ulcer-healing process were documented. All four ulcers showed positive wound contraction and reduction in size, and clinical signs of infection were absent at the end of the follow-up period. Moreover, surrounding skin maceration and trauma were absent in all wounds. Adequate moisture control was also achieved, evidenced by a healthy red granulating base and a thin layer of clear light exudate in all fours cases. These reports provide little evidence that the use of honey dressing is effective in combating wound infection. Honey dressing can be used to improve wound healing in chronic diabetic foot ulcers.

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