Long-Term Costs for Foot Ulcers in Diabetic Patients in a Multidisciplinary Setting

1995 ◽  
Vol 16 (7) ◽  
pp. 388-394 ◽  
Author(s):  
Jan Apelqvist ◽  
Gunnel Ragnarson-Tennvall ◽  
Jan Larsson ◽  
Ulf Persson
Keyword(s):  
Home Care ◽  
Social Service ◽  
Care Home ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Foot Care ◽  
Critical Ischemia

The purpose of this study was to analyze long-term costs for foot ulcers in diabetic patients. Patients were treated and followed prospectively by a foot care team. A retrospective economic analysis was performed of costs for 274 patients during 3 years from healing of an initial foot ulcer, with or without amputation. Costs were estimated for inpatient care, outpatient care, home care, and social service. The cost calculations include costs due to complications and disability related to the initial ulcer, costs related to recurrence of ulcer, and costs for prevention of new ulcers. Expected total present value cost per patient during 3 years of observation was $26,700 (U.S. dollars) for primary healed patients with critical ischemia and $16,100 for primary healed patients without critical ischemia. For patients who healed with an amputation, the corresponding costs were $43,100 after a minor amputation and $63,100 after a major amputation. When estimating the costs for diabetic foot ulcers, it is not sufficient to calculate short-term costs. Long-term costs are high, mainly due to the need for increased home care and social service, but also due to costs for recurrent ulcers and new amputations.

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

New possibilities of maximal revascularization of the foot as a limb salvage procedure in diabetics

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Sauvant ◽  
Hüttenmoser ◽  
Soyka ◽  
Rüttimann
Keyword(s):  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Salvage Procedure ◽  
Critical Ischemia ◽  
Peripheral Arterial

Diabetics and patients with chronic renal insufficiency often have severe peripheral arterial disease of the distal lower limbs with obstructions of crural and pedal arteries and the imminent risk of critical ischemia and major amputation. Neuroischemic foot ulcers have been shown to fail to heal even after successful arterial revascularization. We report on two diabetic patients with the neuroischemic diabetic foot syndrome and different clinical outcomes after percutaneous transluminal angioplasty of chronic occluded crural arteries and discuss, whether endovascular revascularisation of infrapopliteal and pedal arteries, if possible with complete plantar arch, could promote ulcer healing in neuroischemic diabetic foot ulcers.

scholarly journals SELF CARE PADA PASIEN DIABETES MELITUS DENGAN PENYULIT ULKUS KAKI DIABETIK

2021 ◽  
Vol 5 (1) ◽  
pp. 13
Author(s):  
Sri Dewi Megayanti ◽  
Ns. Putu Inge Suantika, S.Kep.,M.Kep
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Self Care ◽  
Foot Ulcer ◽  
Sampling Technique ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Convenience Sampling

ABSTRAKLatar Belakang: Diabetes self-care merupakan perilaku perawatan diri pasien diabetes yang meliputi pengaturan diet, penggunaan insulin, olahraga dan perawatan kaki. Diabetes self-care memiliki efek langsung pada kontrol glikemik dalam terjadinya ulkus kaki diabetic. Skor PEDIS merupakan form pemeriksaan yang digunakan perawat dalam menilai keparahan ulkus kaki. Keterbatasan intervensi ulkus kaki yang diberikan oleh perawat saat ini disebabkan oleh terbatasnya data tentang self-care pada pasien diabetes. Tujuan penelitian mengetahui self-care pasien diabetes dengan komplikasi ulkus kaki menggunakan metode pengukuran skor PEDIS yang teridiri dari pemeriksaan perfusi, luas luka, kedalaman luka, keberadaan infeksi dan sensasi kaki.Metode: Penelitian ini termasuk penelitian kuantitatif, dimana penentuan responden menggunakan teknik Convenience sampling dengan jumlah sampel adalah 125, analisa data yang digunakan dengan metode  deskriptif.Hasil: Pada penelitian ini 53,8 % reponden memiliki diabetes self-care yang adekuat dan rata- rata responden memiliki Skor PEDIS 2,08.Kesimpulan: dalam penelitian ini sebagian besar responden memiliki diabetes self-care yang tidak adekuat.  Nilai Diabetes self-care dapat digunakan oleh perawat untuk mengetahui tingkat kualitas perawatan diri pasien selama ini sehingga memudahkan dalam menentukan intervensi yang tepat untuk mencegah terajadinya perburukan ulkus kaki. Kata kunci: diabetes mellitus tipe 2, diabetes self-care, dan ulkus kaki diabetik. ABSTRACTBackground: Diabetes self-care is a diabetes patient self-care behavior that includes diet management, insulin use, exercise and foot care. Diabetes self-care has a direct effect on glycemic control in the occurrence of diabetic foot ulcers. The PEDIS score is an examination form that nurses use in assessing the severity of foot ulcers. The limitations of the foot ulcer intervention given by nurses at this time are due to limited data on self-care in diabetic patients. The aim of this study was to determine the self-care of diabetic patients with complications of foot ulcers using the PEDIS score measurement method which consists of examination of perfusion, wound area, wound depth, presence of infection and foot sensation.Methods: This research is a quantitative study, where the determination of the respondents using the convenience sampling technique with a sample size of 125, the data analysis used is the descriptive method.Results: In this study 53.8% of respondents had adequate diabetes self-care and the mean of respondents had a PEDIS score of 2.08. Conclusion: in this study most of the respondents had inadequate self-care diabetes. The value of diabetes self-care can be used by nurses to determine the level of quality of patient self-care so far, making it easier to determine the right intervention to prevent worsening of foot ulcers. Keywords: type 2 diabetes mellitus, diabetes self-care, and diabetic foot ulcers. 

Use of GBT013, a Collagen-Based Dressing, for the Healing of Diabetic Foot Ulcers

2018 ◽  
Vol 108 (5) ◽  
pp. 419-429
Author(s):  
Isabelle J. Dumont ◽  
Marc Lepeut ◽  
Coralie Segalen ◽  
Yannis Guillemin ◽  
Jean Noel Gouze
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Complete Healing ◽  
Ease Of Use ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Foot Care ◽  
University Of Texas

The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (>44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients.

scholarly journals Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Targ Elgzyri ◽  
Jan Apelqvist ◽  
Eero Lindholm ◽  
Hedvig Örneholm ◽  
Magdalena Annersten Gershater
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Severe Form ◽  
Foot Ulcers ◽  
Vascular Intervention ◽  
Co Morbidity ◽  
Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

The Feasibility and Effectiveness of Wearable Sensor Technology in the Management of Elderly Diabetics with Foot Ulcer Remission: A Proof-Of-Concept Pilot Study with Six Cases

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Chenzhen Du ◽  
Hongyan Wang ◽  
Heming Chen ◽  
Xiaoyun Fan ◽  
Dongliang Liu ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Stride Length ◽  
Wearable Sensors ◽  
Foot Ulcer ◽  
Wearable Devices ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Wearable Sensor ◽  
Double Support ◽  
Gait Parameters

Aims: Using specials wearable sensors, we explored changes in gait and balance parameters, over time, in elderly patients at high risk of diabetic foot, wearing different types of footwear. This assessed the relationship between gait and balance changes in elderly diabetic patients and the development of foot ulcers, in a bid to uncover potential benefits of wearable devices in the prognosis and management of the aforementioned complication. Methods: A wearable sensor-based monitoring system was used in middle-elderly patients with diabetes who recently recovered from neuropathic plantar foot ulcers. A total of 6 patients (age range: 55–80 years) were divided into 2 groups: the therapeutic footwear group (n = 3) and the regular footwear (n = 3) group. All subjects were assessed for gait and balance throughout the study period. Walking ability and gait pattern were assessed by allowing participants to walk normally for 1 min at habitual speed. The balance assessment program incorporated the “feet together” standing test and the instrumented modified Clinical Test of Sensory Integration and Balance. Biomechanical information was monitored at least 3 times. Results: We found significant differences in stride length (p < 0.0001), stride velocity (p < 0.0001), and double support (p < 0.0001) between the offloading footwear group (OG) and the regular footwear group on a group × time interaction. The balance test embracing eyes-open condition revealed a significant difference in Hip Sway (p = 0.004), COM Range ML (p = 0.008), and COM Position (p = 0.004) between the 2 groups. Longitudinally, the offloading group exhibited slight improvement in the performance of gait parameters over time. The stride length (odds ratio 3.54, 95% CI 1.34–9.34, p = 0.018) and velocity (odds ratio 3.13, 95% CI 1.19–8.19, p = 0.033) of OG patients increased, converse to the double-support period (odds ratio 6.20, 95% CI 1.97–19.55, p = 0.002), which decreased. Conclusions: Special wearable devices can accurately monitor gait and balance parameters in patients in real time. The finding reveals the feasibility and effectiveness of advanced wearable sensors in the prevention and management of diabetic foot ulcer and provides a solid background for future research. In addition, the development of foot ulcers in elderly diabetic patients may be associated with changes in gait parameters and the nature of footwear. Even so, larger follow-up studies are needed to validate our findings.

scholarly journals Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

2013 ◽  
Vol 20 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Teodora Chiţă ◽  
Delia Muntean ◽  
Luminiţa Badiţoiu ◽  
Bogdan Timar ◽  
Roxana Moldovan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Resistance Pattern ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Bacterial Strains ◽  
Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

scholarly journals The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Julia Lowe ◽  
R. Gary Sibbald ◽  
Nashwah Y. Taha ◽  
Gerald Lebovic ◽  
Madan Rambaran ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Health Care Professionals ◽  
Phase 1 ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Quality Improvement Intervention ◽  
Foot Care ◽  
Middle Income ◽  
Increased Risk ◽  
Two Phases

Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases.Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P<0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented.Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.

The diabetic foot

2011 ◽  
pp. 1976-1989
Author(s):  
Michael Edmonds ◽  
Alethea. Foster
Keyword(s):  
Diabetic Foot ◽  
Early Recognition ◽  
Treatment Plan ◽  
Staging System ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Tissue Destruction ◽  
National Guidelines ◽  
International Consensus

At some time in their life, 15% of people with diabetes develop foot ulcers, which are highly susceptible to infection. This may spread rapidly leading to overwhelming tissue destruction and amputation: indeed, 85% of amputations are preceded by an ulcer and there is an amputation in a person with diabetes every 30 seconds throughout the world (1). Evidence-based protocols for diabetic foot ulcers have been developed (2), and diabetic foot programmes that have promoted a multidisciplinary approach to heal foot ulcers with aggressive management of infection and ischaemia have achieved a substantial decrease in amputation rates (3, 4). Furthermore, a reduction in amputations has been reported nationwide in diabetic patients throughout the Netherlands (5). Recently, a decrease in major amputation incidence has been reported in diabetic as well as in nondiabetic patients in Helsinki (6). These reports have stressed the importance of early recognition of the ‘at-risk’ foot, the prompt institution of preventive measures, and the provision of rapid and intensive treatment of foot infection and also evascularization in multidisciplinary foot clinics. Such measures can reduce the number of amputations in diabetic patients. Systematic reviews on prevention and treatment have been carried out, e.g. see Eldor et al. (7), and national guidelines have recently been formulated (8, 9). An International Consensus developed in 1999 was re-launched in revised form as an interactive DVD (10, 11) in 2007. This chapter outlines a simple classification of the diabetic foot into the neuropathic and neuroischaemic foot. It then describes a simple staging system of the natural history of the diabetic foot and a treatment plan for each stage. Successful management of the diabetic foot needs the expertise of a multidisciplinary team which should include physician, podiatrist, nurse, orthotist, radiologist, and surgeon working closely together, within the focus of a diabetic foot clinic.

scholarly journals Assessment of Prevalence, Associations ,Knowledge, and Practices about Diabetic Foot Disease in a Tertiary Care Hospital in Colombo, Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
V. T. S. Kaluarachchi ◽  
D. U. S. Bulugahapitiya ◽  
M. H. Arambewela ◽  
M. D. Jayasooriya ◽  
C. H. De Silva ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Sri Lanka ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Foot Care ◽  
Diabetic Foot Disease ◽  
Care Practices ◽  
Foot Disease

Background. One in five adults in Sri Lanka has either diabetes or prediabetes, and one-third of those with diabetes are undiagnosed. Diabetic foot is a debilitating condition affecting up to 50% of patients with both type 1 and type 2 diabetes. The risk of nontraumatic lower limb amputations is 15 times higher in diabetic patients when compared with nondiabetics. Patient education about correct foot care practices is the cornerstone of prevention of diabetic foot disease. Objective. To assess the prevalence of diabetic foot disease, knowledge, and practices about diabetic foot care among diabetic patients. Methods. 334 patients attending the diabetic clinic in Colombo South Teaching Hospital were recruited according to the inclusion and exclusion criteria. Data were collected using 3 questionnaires, and they were filled using the foot examination findings, patients’ medical records, and direct interviewing of the patients. Results. The mean age of the patients included in the study was 58.23 ± 10.65 years while the median duration of diabetes was 10.54 ± 7.32 years. 34.1% patients had peripheral neuropathy, and 29.5% had peripheral vascular disease. Diabetic foot disease according to the WHO definition was present only in 23 (6.9%) patients. There was a significant association between peripheral neuropathy and current or past foot ulcer which took more than 2 weeks to heal ( p < 0.05 ). Knowledge about foot care was less among the studied population, and it was associated with poor foot care practices. Presence of diabetic foot and current or past foot ulcer which took more than 2 weeks to heal were significantly associated with the foot care knowledge and practices ( p < 0.05 ) Conclusion. Improvement of patients’ knowledge about foot care and their practices have a significant impact on the reduction of diabetic foot disease.

Sign in / Sign up

Export Citation Format

Share Document