Incidence and Risk Factors of Diabetic Foot Syndrome in Patients Early After Pancreas or Kidney/Pancreas Transplantation and its Association with Preventive Measures

Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.

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Diabetic Foot Risk Factors and Effectiveness of Education in Saudi Arabia

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i54a33718 ◽

2021 ◽

pp. 48-53

Author(s):

Mohammad Saqib Siddiqui ◽

Abdulaziz Fehaid Alotaibi ◽

Fahad Mohammed Saeed Alharthi ◽

Abdullatif Meshal Almalawi ◽

Ahmed Zayed Asiri ◽

...

Keyword(s):

Risk Factors ◽

Saudi Arabia ◽

Diabetic Foot ◽

Management Practices ◽

Diabetes Education ◽

Previous History ◽

Diabetic Patients ◽

History Of ◽

Artery Disease ◽

Educational Campaigns

Diabetes mellitus (DM) is a chronic disease with a remarkable global burden on the affected patients and healthcare systems. Among the reported complications, the diabetic foot has been reported to be a common one, which might be disabling, resulting in related amputations. Furthermore, we will provide evidence regarding the effect of education on the awareness and knowledge of diabetic Saudis about diabetic foot risk factors and management practices. Different risk factors were reported for developing diabetic foot among patients with DM. These will be studied in the current literature review, focusing on evidence that was conducted in Saudi Arabia. Age, gender, type of diabetes, education, duration of the disease, peripheral neuropathy, erythrocyte sedimentation rate, peripheral vascular disease, ischemic heart disease, renal artery disease, having a previous history of diabetic foot, and hypertension were all reported to be significant factors that were associated with the risk of developing diabetic foot across the Kingdom. The level of knowledge was variable across the different investigations. However, there is a poor attitude in general about the appropriate care practices of diabetic foot. Although it has been demonstrated that educational campaigns are effective, further efforts are still needed to increase awareness and attitude levels among diabetic patients in Saudi Arabia.

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Diabetic Foot and Footwear

Research Journal of Textile and Apparel ◽

10.1108/rjta-19-01-2015-b001 ◽

2015 ◽

Vol 19 (1) ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Luximon Ameersing ◽

Ganesan Balasankar ◽

Younus Abida

Keyword(s):

Diabetic Foot ◽

Plantar Pressure ◽

Arterial Disease ◽

Sensory Loss ◽

Foot Deformities ◽

Diabetic Patients ◽

Body Parts ◽

Foot Ulceration ◽

Materials Used ◽

Peripheral Arterial

Diabetes mellitus is one of the most common diseases around the world, and mainly affects the foot among the human body parts. The main causes of the diabetic foot are neuropathy, peripheral arterial disease and foot deformities; it leads to foot ulceration. Generally, sensory loss, high plantar pressure, foot deformities, inappropriate footwear, blindness, and age are the causing risk factors for developing foot ulceration in diabetic patients. Foot ulceration will result in prolonged hospitalization, high medical expenses, and serious complications with lower extremity amputation. For a long time, appropriate footwear has been recommended by physicians for reducing plantar pressure to prevent foot ulceration, the risk of amputation, and re-ulceration. A review is provided in this article towards the existing literature on the causes and prevalence of the diabetic foot, foot ulceration, off-loading pressure, footwear modification for different types of diabetic foot deformities, and types of footwear and textile materials used in footwear insoles for healing purposes.

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Risk Factors for Diabetic Foot in Tetouan, Morocco - A Case-Control Study

International Journal of Medicine and Surgery ◽

10.15342/ijms.v2i2.79 ◽

2015 ◽

Vol 2 (2) ◽

Author(s):

Hicham AOUFI ◽

Safouane MOUWAFAQ ◽

A LIKOS ◽

Abderrahmane MAAROUFI

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Private Sector ◽

Diabetic Foot ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Public And Private ◽

Public And Private Sector ◽

Control Study

Introduction Diabetes is a globally major public health problem. Its evolution is insidious and silent before the appearance of serious complications as a consequence in terms of morbidity than of mortality. Complications in the feet are among the most frequent and feared. This study helps identify factors associated with diabetic foot in diabetic patients in the province of Tetouan in public and private sector. Methods This is a case-control study in which 136 diabetic patients monitored in the public and private sector in the province of Tetouan were chosen. 68 patients had diabetic foot and 68 were diabetic patients without this complication. Data were collected from patients’ records and supplemented by interviews. The factors compared between the two groups were socio-demographic, biological and related to diabetes and lifestyle. These risk factors were determined by bivariate and multivariate analyses. Results Statistically significant associations were found between diabetic foot and several factors including: the irregular monitoring of patients: ORadjusted = 7.7 [1.9-23], the rate of glycated hemoglobin: ORadjusted = 1.7 [1.2-2.3], diabetes duration: ORadjusted = 1.2 [1.03-1.26], and physical activity ORadjusted = 1.1 [0.02-0.9]. However, no association was found between diabetic foot and the level of education or occupation. Conclusion To prevent the development of diabetic foot, more attention should be given to diabetic patients whose diabetes duration is long, patient monitoring should be regular and diabetes control should be optimal. In addition, physical activity is recommended for diabetic patients as part of promoting healthy lifestyles

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Impaired dermal microvascular reactivity and implications for diabetic wound formation and healing: an evidence review

Journal of Wound Care ◽

10.12968/jowc.2020.29.sup9.s21 ◽

2020 ◽

Vol 29 (Sup9) ◽

pp. S21-S28

Author(s):

Todd D O'Brien

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Arterial Disease ◽

Foot Deformities ◽

Additional Risk ◽

Microvascular Reactivity ◽

Emerging Risk ◽

Patients With Diabetes ◽

Evidence Review ◽

Peripheral Arterial

Diabetic foot ulcers (DFUs) are among the most consequential and costly complications faced by patients with diabetes and the global healthcare system. Acknowledged risk factors for DFUs include diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), microtrauma and foot deformities. Research on additional risk factors for DFUs has recently focused on dysregulated, autonomic vasomotor control in the skin of patients with DPN. In particular, impaired dermal microvascular reactivity (IDMR) with its attendant reduction in nutritive capillary blood flow has been identified as an emerging risk factor. This especially relates to refractory wounds noted in patients without overt PAD signs. In this paper, evidence will be reviewed supporting the evolving understanding of IDMR and its impact on DFU formation and healing. Advances in diagnostic instrumentation driving this research along with the most promising potential therapies aimed at improving microvascular function in the diabetic foot will be discussed in brief.

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Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

10.21203/rs.3.rs-17261/v1 ◽

2020 ◽

Author(s):

Baha Zantour ◽

Soumaya Bouchareb ◽

Zohra El Ati ◽

Fadia Boubaker ◽

Wafa Alaya ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Univariate Analysis ◽

Foot Ulcer ◽

Risk Groups ◽

School Level ◽

Foot Deformities ◽

Diabetic Patients ◽

Foot Ulceration ◽

Factors Associated

Abstract BackgroundDiabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk gradeMethodsCross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. ResultsAmong 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher–risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR=2.529, CI95 [1.131-5.655], p=0.024), hyperkeratosis (OR=2.658, CI95 [1.222-5.783], p=0.014) and school level (OR=0.489, CI95 [0.253-9.44], p=0.033)Conclusions Risk factors for foot ulceration were rather common in diabetic outpatients. The screening of diabetic patients at risk for foot ulceration should start early, integrated with sustainable patient education

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Prevalence and risk factors of diabetic foot ulcer at a tertiary care hospital among diabetic patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183907 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1274 ◽

Cited By ~ 1

Author(s):

Manohar Shankarrao Chavan

Keyword(s):

Risk Factors ◽

Family History ◽

Alcohol Use ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Care Hospital ◽

Family History Of Diabetes ◽

History Of

Background: Foot ulceration is preventable, and relatively simple interventions can reduce amputations by up to 80%. The objective of the present research was to study the prevalence and risk factors of diabetic foot ulcer among diabetic patients Methods: Present study was hospital based cross sectional study carried out at outpatient department of General Medicine for a period of January 2018 to June 2018 among 200 diabetic patients. All eligible patients willing to participate were included in the present study. Diabetic foot ulcer was diagnosed as per the standard criteria and based on the physician acumen. An attempt was made to identify the risk factors like smoking etc. The diagnosed patient was given appropriate treatment.Results: Males were more than females. majority of the patients were found in the age group of 51-60 years (35.5%). Majority of the diabetic patients were from rural area i.e. 84.5%. Majority were illiterate i.e. 69%. 21.5% were found to be smokers. 40% were using alcohol regularly. 36.5% were overweight and 14% were obese. Prevalence of diabetic foot ulcer among diabetic patients was found to be 16%. Age, residence, literacy, duration of diabetes and obesity were not found to be significantly associated with DFU. Diabetic foot ulcer was found to be significantly associated with being male, tobacco chewers, tobacco chewers + smokers, alcoholics, smokers + alcoholics, Family history of diabetes, and insulin users.Conclusions: Prevalence of diabetic foot ulcer among diabetic patients was very high. Tobacco use, alcohol use, mixed of tobacco and alcohol use, and family history of diabetes were significant risk factors for diabetic foot ulcer.

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Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00112 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0011

Author(s):

D. Anthony Barcel ◽

Susan M. Odum ◽

Taylor Rowe ◽

Jefferson B. Sabatini ◽

Samuel E. Ford ◽

...

Keyword(s):

Risk Factors ◽

Conversion Rate ◽

Significant Risk ◽

High Rate ◽

Administrative Database ◽

Categorical Variables ◽

Diabetic Patients ◽

Knee Amputation ◽

History Of ◽

Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

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Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China

Journal of International Medical Research ◽

10.1177/0300060520987398 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098739

Author(s):

Yuxia Cheng ◽

Ping Zu ◽

Jie Zhao ◽

Lintao Shi ◽

Hongyan Shi ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Blood Glucose Control ◽

Diabetes Duration ◽

Chinese Patients ◽

Foot Care ◽

Vascular Intervention ◽

History Of ◽

Independent Risk Factors ◽

Recurrence Group

Objective To investigate the characteristics of diabetic foot ulcer (DFU) recurrence. Methods A total of 573 patients with DFUs were recruited and divided into an initial group (395 patients) and a recurrence group (178 patients). The factors related to recurrence were analyzed using multivariate regression. Results The recurrence group had longer diabetes duration (odds ratio [OR] 192; 95% confidence interval 120, 252 vs. 156; 96, 240); lower glycated hemoglobin levels (OR 8.1; 95% CI 6.8, 9.6 vs. 9.1; 7.4, 10.5), and higher rates than the initial group of amputation (37.5% vs. 2.0%), history of vascular intervention (21.3% vs. 3.9%), retinopathy (77.7% vs. 64.7%), callus (44.4% vs. 20.8%), foot deformity (51.2% vs. 24.6%), and outdoor sports shoe wearing (34.0% vs. 21.2%). Multiple factor logistic regression analysis showed that diabetes duration (OR 1.004), callus (OR 2.769), vascular intervention (OR 2.824) and amputation (OR 22.256) were independent risk factors for DFU recurrence. Conclusion Diabetes duration, callus, history of vascular intervention, and amputation were independent risk factors for recurrent DFUs in a cohort of Chinese patients with active DFU. The prevention and treatment of DFUs, especially callus treatment, foot care, and blood glucose control, should be improved in China.

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Modifiable and Non-Modifiable Risk Factors for Atherothrombotic Ischemic Stroke among Subjects in the Malmö Diet and Cancer Study

Nutrients ◽

10.3390/nu13061952 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1952

Author(s):

Anna Johansson ◽

Isabel Drake ◽

Gunnar Engström ◽

Stefan Acosta

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Body Mass Index ◽

Ischemic Stroke ◽

Family History ◽

Diet Quality ◽

Alcohol Intake ◽

Modifiable Risk Factors ◽

History Of ◽

Diet And Cancer

Risk factors for ischemic stroke is suggested to differ by etiologic subtypes. The purpose of this study was to examine the associations between modifiable and non-modifiable risk factors and atherothrombotic stroke (i.e., excluding cardioembolic stroke), and to examine if the potential benefit of modifiable lifestyle factors differs among subjects with and without predisposing comorbidities. After a median follow-up of 21.2 years, 2339 individuals were diagnosed with atherothrombotic stroke out of 26,547 study participants from the Malmö Diet and Cancer study. Using multivariable Cox regression, we examined non-modifiable (demographics and family history of stroke), semi-modifiable comorbidities (hypertension, dyslipidemia, diabetes mellitus and atherosclerotic disease), and modifiable (smoking, body mass index, diet quality, physical activity, and alcohol intake) risk factors in relation to atherothrombotic stroke. Higher age, male gender, family history of stroke, and low educational level increased the risk of atherothrombotic stroke as did predisposing comorbidities. Non-smoking (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.56–0.68), high diet quality (HR = 0.83, 95% CI 0.72–0.97) and high leisure-time physical activity (HR = 0.89, 95% CI 0.80–0.98) decreased the risk of atherothrombotic ischemic stroke independent of established risk factors, with non-significant associations with body mass index and alcohol intake. The effect of the lifestyle factors was independent of predisposing comorbidities at baseline. The adverse effects of several cardiovascular risk factors were confirmed in this study of atherothrombotic stroke. Smoking cessation, improving diet quality and increasing physical activity level is likely to lower risk of atherothrombotic stroke in the general population as well as in patient groups at high risk.

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Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽

10.1177/00033197211042684 ◽

2021 ◽

pp. 000331972110426

Author(s):

Martyna Schönborn ◽

Patrycja Łączak ◽

Paweł Pasieka ◽

Sebastian Borys ◽

Anna Płotek ◽

...

Keyword(s):

Diabetic Foot ◽

Healing Process ◽

Arterial Disease ◽

Angiogenic Factors ◽

Diabetic Foot Syndrome ◽

Tissue Loss ◽

Comprehensive Treatment ◽

Diabetic Patients ◽

Impaired Wound Healing ◽

Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

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