Prospective 2-Years Follow-up Quality of Life Study after Infrageniculate Bypass Surgery for Limb Salvage: Lasting Improvements Only in Non-diabetic Patients

Abstract Background To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods. Methods Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed. Results Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”. Conclusions The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness. Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 – Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1

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Randomized controlled clinical trial evaluating the efficacy of hyperbaric oxygen therapy in facilitating the healing of chronic foot ulcers in diabetic patients: the study protocol

Trials ◽

10.1186/s13063-020-04757-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jocefábia Reika Alves Lopes ◽

Mariza D’Agostino Dias ◽

João Antonio Correa ◽

Maria Alice Bragagnolo Batalha ◽

Luanda Karla Dantas Guerra

Keyword(s):

Quality Of Life ◽

Diabetic Foot ◽

Oxygen Therapy ◽

Standard Treatment ◽

Foot Ulcers ◽

Control Group ◽

Diabetic Patients ◽

Diabetic Foot Ulcers

Abstract Background Diabetic limb ulcers are highly prevalent and contribute to a significant increase in cost for the treatment of these patients in health services. However, healing of these wounds is a major health problem and may even lead to amputation. The primary aim of the current study is to evaluate the efficacy of hyperbaric oxygen therapy (HBOT) in facilitating the healing of diabetic foot ulcers, in addition to secondarily evaluating whether it reduces the number of amputations and improves the quality of life in these patients. Methods A non-blind randomized clinical study will be conducted in the city of Imperatriz, Maranhão state, Brazil, from 2019 to 2020, in diabetic patients with chronic foot ulcers (classified as Wagner grades 2, 3 and 4, persisting for more than 1 month). The outpatient follow-up for diabetic foot patients will be done at the Unified Health System, with a sample size of 120 patients (the randomization allocation will be 1:1, being 60 patients for each arm). Half of the patients will receive standard treatment, i.e. dressings, debridement, antibiotics and load relief, along with HBOT (HBOT group), and the other half will receive only standard treatment (control group). The patients of the HBOT group will be evaluated upon admission, after 10, 20, 30 and 35 HBOT sessions, and after 6 months and 1 year. The patients of the control group will also be evaluated at equivalent periods (upon admission, after 2, 4, 6 and 7 weeks, 6 months and 1 year). The SF-36 quality of life questionnaire will be filled upon admission and after 3 months of follow-up in both groups. The primary and secondary endpoints will be assessed with 1 year of follow-up. Discussion Diabetic foot ulcers are a highly prevalent complication of diabetes with serious consequences. A study to assess the efficacy of HBOT in healing the ulcers and reducing the rate of amputations in diabetic patients is justified, which will eventually aid in the development of guidelines for treating these ulcers. Trial registration Registration number RBR-7bd3xy. Registered on 17 July 2019—Retrospectively registered.

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Infectious Disease Concepts and Considerations in the Diabetic Patient

Journal of Pharmacy Practice ◽

10.1177/0897190009332659 ◽

2009 ◽

Vol 22 (6) ◽

pp. 571-574

Author(s):

Michael D. Schwartz ◽

Scott E. Kincaid

Keyword(s):

Quality Of Life ◽

Infectious Disease ◽

Invasive Disease ◽

Diabetic Patients ◽

Targeted Prevention ◽

Aggressive Treatment ◽

Prevention And Treatment ◽

Disease Concepts

Diabetic patients present their providers with unique clinical challenges when dealing with prevention and treatment of infectious diseases. By the very nature of their diabetes, these patients are at much higher risk of complications from seemingly benign infections as well as increasingly susceptible to more resistant or invasive disease. Targeted prevention where possible, regular follow-up, and early, aggressive treatment are crucial to diabetic patients’ longevity and quality of life. This review will focus on key vaccine-preventable issues as well as management of common conditions such as urinary tract infection and skin and soft tissue infection often seen in diabetic patients.

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Improving Limb Salvage for Chronic Limb-Threatening Ischemia With Spinal Cord Stimulation: A Retrospective Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420985765 ◽

2021 ◽

pp. 153857442098576

Author(s):

Anna E. Cyrek ◽

Nora Henn ◽

Fabian Meinhardt ◽

Martin Lainka ◽

Arkadius Pacha ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Pain Intensity ◽

Skin Temperature ◽

Limb Salvage ◽

Spinal Cord Stimulation ◽

Stage Iii ◽

Fontaine Stage

Introduction: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease (PAD). Up to a third of CLTI patients are not eligible to receive first-line treatments such as bypass surgery or endovascular interventions. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow and relieve ischemic pain in CTLI patients. The aim of the study was to evaluate limb salvage, ulcer closure, and clinical changes of SCS implanted CTLI patients at 1-year follow-up. Methods: Eligible patients had end-stage lower limb PAD unresponsive to medical therapy and not amenable to surgical reconstruction. Patients were candidates for amputation, but limb loss was not inevitable (Fontaine stage III and IV). Pain intensity and skin temperature in the ischemic area (visual analogue scale), quality of life (WHOQoL-BREF), and ankle/brachial blood pressure index (ABI) were recorded at routine follow-up visits. Data were analyzed retrospectively. Results: 29 patients underwent SCS implantation at one vascular center. The minimum follow-up period was 30 months. Limb survival at 1-year follow-up was 97% (28/29) and 73% (11/15) had complete closure of limb ulcers. Pain intensity, skin temperature, and quality of life progressively improved up to 12 months after implant, with Fontaine stage III patients improving more substantially than Fontaine stage IV patients. SCS therapy did not affect ABI measurement. No complications related to the device or procedure occurred. Conclusions: SCS is a valid alternative in patients unsuitable for revascularization. The quality of results depends on both a strict selection of patients by vascular specialists and the frequency of follow-up controls. The therapy may be more beneficial in patients classified as Fontaine stage III.

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Predictors of health related quality of life among diabetic patients on follow up at Nekemte Specialized Hospital, Western Ethiopia: A cross sectional study

10.1101/19013516 ◽

2019 ◽

Author(s):

Bikila Regassa Feyisa ◽

Mekdes Tigistu Yilma ◽

Belachew Etana Tolessa

Keyword(s):

Quality Of Life ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Health Related Quality ◽

Cross Sectional ◽

Related Quality ◽

Health Related ◽

Western Ethiopia

AbstractObjectiveTo assess health related quality of life (HRQoL) and its predictors among diabetic patients on follow up at Nekemte Specialized Hospital (NSH) in Western Ethiopia.Design, setting and participantsThis facility based cross sectional study was conducted among 224 diabetic patients on follow up at one of the public hospitals in western Ethiopia.Main outcome measuredHRQoL was measured by using the Medical Outcome Study 36-item Short Form Health Survey from 15th April to 5th June. Structured questionnaire was used for data the collection from participants selected by systematic random sampling. Multiple linear regression was used for final model.ResultA total of 215 diabetic patients were involved in the study with the response rate of 96%. The mean score of the overall HRQoL of the study participants was found to be 50.30 ± 18.08 with highest mean score in physical functioning and lowest mean score in general health domain. Age, education status, history of smoking, feeling of stigmatized and Body mass index (BMI) were inversely associated while being male, being married, absence of co morbidity and absence of chronic complications related to diabetes mellitus were found to be positively associated with overall HRQoL.ConclusionThe overall HRQoL of diabetic patients on follow up at the study area was found to be moderate. General health, mental health, bodily pain and vitality were the most affected domains. Both the mental and physical components need to be considered when caring the diabetic patients on follow up beyond provision of treatment.Strength and limitations of this studyThe study was the first of its kind in assessing the predictors of health-related quality of life (HRQoL) among both diabetes mellitus type I and type II in Ethiopia.The tools used was validated across different culturesEight domains of HRQoL and two component summary scores were used to make the measurement more specific.The cross sectional nature of the study design made the result of the study difficult to identify either the cause or the effect comes first.

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