Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders

2019 ◽  
pp. 193864001989592
Author(s):  
Alexandria Riopelle ◽  
Ryan LeDuc ◽  
Michael Wesolowski ◽  
Adam P. Schiff ◽  
Michael S. Pinzur
Keyword(s):  
Glycemic Control ◽  
Diabetic Foot ◽  
Retrospective Chart Review ◽  
Poor Glycemic Control ◽  
Morbidly Obese ◽  
Diabetic Patients ◽  
Good Glycemic Control ◽  
Orthopaedic Practice ◽  
Total Contact Cast ◽  
Foot Morbidity

The custom-fabricated total contact cast is commonly used in the treatment of diabetic foot disorders. This resource-consuming treatment option has been associated with iatrogenic morbidity as well as the need for urgent cast removal and inspection of the underlying limb when potential problems arise. Over a 10-year period, 381 diabetic patients had 2265 total contact cast applications by certified orthopaedic technologists, in a university orthopaedic practice, under the supervision of university faculty. Patients were stratified by glycemic control based on hemoglobin A1c levels, and obesity based on body mass index (BMI). Complications were grouped as (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change or removal. At least 1 complication was observed in 159 of 381 patients. The odds of experiencing a cast-related event for patients with a BMI greater than 30 kg/m2 was 1.55 times greater than patients with a BMI less than 25 kg/m2. As compared to patients with good glycemic control, the odds of experiencing a cast-associated complication was 1.27 times greater in patients with moderate glycemic control and 1.48 times greater in patients with poor glycemic control. The total contact cast is commonly used in the treatment of diabetic foot morbidity. Treatment-associated morbidity may well be greater than previously appreciated. Complications are more likely in patients who have poor glycemic control and are morbidly obese. This information will hopefully stimulate interest in developing commercially available nonrigid alternatives that retain the attributes of the resource-consuming rigid device, with the potential advantage of avoiding the associated morbidity. Levels of Evidence: Level IV, retrospective chart review

Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 179-183 ◽  
Author(s):  
Mai-Szu Wu ◽  
Chun-Chen Yu ◽  
Ching-Herng Wu ◽  
Jeng Yi Haung ◽  
Mei-Lin Leu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Serum Albumin ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Diabetic Patients ◽  
Type Ii ◽  
Good Glycemic Control ◽  
Cholesterol Levels ◽  
Significant Difference

Objective To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO). Materials and Methods One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded. Results The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.

scholarly journals Impact of plasmatic lipids in glycemic control and its influence in the cardiometabolic risk in morbidly obese subjects

2009 ◽  
Vol 53 (6) ◽  
pp. 747-754 ◽  
Author(s):  
Ary Serpa Neto ◽  
Felipe Martin Bianco Rossi ◽  
Rodrigo Dal Moro Amarante ◽  
Nara Alves Buriti ◽  
Marçal Rossi
Keyword(s):  
Glycemic Control ◽  
Clinical Utility ◽  
Cardiometabolic Risk ◽  
Poor Glycemic Control ◽  
Morbidly Obese ◽  
Factor Analyses ◽  
Good Glycemic Control ◽  
Reasonable Degree ◽  
Obese Subjects ◽  
Cardiometabolic Factors

OBJECTIVES: To evaluate whether biochemical parameters are associated with a good glycemic control and to identify the occurrence of cardiometabolic risk variables. MATERIAL AND METHODS: One hundred forty Brazilians were evaluated. The subjects were characterized with regard to glycemic control as good, fair and poor and were divided into tertiles by TG and HbA1c. We use the ROC curve to determine which variables were predicted of poor glycemic control and the factor analyses to identify the domains that segregated among the risk variables. RESULTS: Fasting glucose and insulin levels, TG level, VLDL-C and HOMA-IR increased significantly across HbA1c tertiles. The best marker for identification of poor glycemic control was triglycerides. The presence of cardiometabolic abnormalities did not alter the glycemic control, but HOMA-IR was significantly higher in subjects with abnormalities. CONCLUSION: The use of TG levels offers a reasonable degree of clinical utility. In morbidly obese subjects insulin resistance is associated with individual cardiometabolic factors.

scholarly journals Analysis of Reasons For Readmission of Diabetic Patients: 2015-2019

2022 ◽  
Author(s):  
Junmei Wang ◽  
Jiayao Xiong ◽  
Chao Yang ◽  
Xianshu Jiang ◽  
Min Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glycemic Control ◽  
Influencing Factors ◽  
Diabetic Foot ◽  
Readmission Rate ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Spearman Correlation ◽  
Diabetic Foot Infection ◽  
Duration Of Diabetes

Abstract Background: Among patients with diabetes who had been hospitalized, 30% had twice or more hospitalisations rate, accounting for more than 50% of total hospitalizations and hospitalization expense. The purpose of our study was to to find available strategies to reduce the readmission rate of diabetics in rural areas.Methods: This retrospective single-center study used the data from Yongchuan Hospital of Chongqing Medical University. The t-test and the chi-square test or Fisher's exact test were used to compare continuous and categorical variables, respectively. We used the Spearman correlation coefficient to examine the relationship between variables. Multiple linear regression was performed to analyze the influencing factors of hospitalisation time, and dummy variables were set for categorical independent variables. Results: There were a total of 1721 readmissions during a five-year period; among them, 829 were females and 892 males. The readmission rate of diabetic patients in the endocrinology department was 32.40%. The age, times of hospitalisation, and duration of all subjects were 64.67 ± 13.82, 2.69 ± 1.41 and 10.60 ± 6.78, respectively. Among all the diabetic patients, type 2 diabetes accounted for 98.55% (n = 1696). Most of the patients were readmitted due to poor glycemic control, infection, edema, dizziness, and weakness, accounting for approximately 56%. During the 5-year period, the majority of readmitted diabetic patients were hospitalized twice. Times of hospitalisation was weakly positively correlated with age (Rho = 0.206, P≤0.001), diabetic duration (Rho = 0.248, P ≤ 0.001) and hospitalisation expenses (Rho = 0.008, P = 0.035) by Spearman correlation analysis. Age, duration of diabetes, systolic blood pressure (SBP), diastolic blood pressure (DBP) and alanine aminotransferase (ALT) were the main factors affecting times of hospitalisation in diabetes patients (all P < 0.05). Compared with current smokers, non-smokers and cessation smokers had high hospitalisations rate (all P for trend < 0.05). When taking diabetic foot infection as a reference, edema was more accountable than diabetic foot infection for hospitalisation times, which was statistically significant (P for trend = 0.048).Conclusion: Age, duration of diabetes and hospitalisation costs were positively correlated with times of hospitalisation. Age, duration of diabetes, blood pressure, ALT, smoking status and edema are the influencing factors of hospitalisation times. The most common causes of hospitalisation for diabetics are poor glycemic control, infection, edema, dizziness, and weakness. Controlling these factors may be key to developing rational health strategies for rural diabetics.

ASSOCIATION OF SERUM FERRITIN WITH GLYCEMIC CONTROLAMONG TYPE 2 DIABETIC PATIENTS

2021 ◽  
pp. 34-36
Author(s):  
Mallam Srikanth Goud ◽  
Sohil Sharda ◽  
Gangurde Bhushan Daulatrao
Keyword(s):  
Glycemic Control ◽  
Serum Ferritin ◽  
Blood Donation ◽  
Tertiary Care ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Strong Positive Correlation ◽  
Good Glycemic Control ◽  
Positive Correlation ◽  
Iron Stores

Introduction: Serum ferritin is a marker for iron stores and is an acute phase reactant. Its role in pathogenesis of Diabetes is suggested by improvement in insulin sensitivity and insulin secretion with frequent blood donation and decreased iron stores. Objective of the present study is to determine correlation of serum ferritin with glycemic control. Material and Methods: This analytical cross sectional study was conducted at a tertiary care centre of southern India, including 50 diabetic patients with good glycemic control and 50 patients with poor glycemic control. Results: Mean serum ferritin level of diabetics was signicantly lower in diabetics with good glycemic control (119.07±58.99 ng/ml) as compared to those with poor glycemic control (331.11±140.69 ng/ml). Serum ferritin showed strong positive correlation (p <0.001)with the duration of diabetes (r = 0.651) and HbA1C (r = 0.828). Conclusion: Serum ferritin levels were higher in diabetic individuals with poor glycemic control and serum ferrition showed strong positive correlation with glycemic control (HbA1C). Serum ferritin may be used as marker for screening poor glycemic control and patients at high risk of developing complications.

Predialysis Glycemic Control is An Independent Predictor of Clinical Outcome in Type Ii Diabetics on Continuous Ambula Tory Peritoneal Dialysis

1997 ◽  
Vol 17 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Chun-Chen Yu ◽  
Mai-Szu Wu ◽  
Ching-Herng Wu ◽  
Chih-Wei Yang ◽  
Jeng-Yi Huang ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Patient Survival ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Type Ii ◽  
Peritoneal Membrane ◽  
Good Glycemic Control ◽  
Cholesterol Levels ◽  
Significant Difference ◽  
Type Ii Diabetics

Objective To evaluate the correlation between predialysis glycemic control and clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). Design Sixty type II diabetic patients on CAPD were classified into 2 groups according to the status of glycemic control. In group G (good glycemic control), more than 50% of blood glucose determinations were within 3.3 11 mmol/L and the glycosylated hemoglobin (HbA 1 C) level was within 5 -10% at all times. In group P (poor glycemic control), fewer than 50% of blood glucose determinations were within 3.3 -11 mmol/L or HbA 1 C level was above 10% at least once during the follow-up duration. In addition to glycemic control status, predialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and the modes of glycemic control were also recorded. Setting Dialysis Unit, Department of Nephrology of a single university hospital. Patients From February 1988 to October 1995, 60 type II diabetic patients receiving CAPD for at least 3 months were enrolled. Main Outcome Measures Morbidities before and during the dialysis period, patient survival, and causes of mortality. Results The patients with good glycemic control had significantly better survival than patients with poor glycemic control (p < 0.01). There was no significant difference in predialysis morbidity between the two groups. No significant differences were observed in patient survival between the patients with serum albumin greater than 30 g/L and those with less than 30 g/L (p = 0.77), with cholesterol levels greater or less than 5.18 mmol/L (p = 0.73), and with different peritoneal membrane solutetrans port characteristics evaluated by peritoneal equilibration test (p = 0.12). Furthermore, there was no significant difference in survival whether the patients controlled blood sugar by diet or with insulin (p = 0.33). Cardiovascular disease and infection were the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetics maintained on CAPD. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetics on CAPD. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.

scholarly journals Risk factors of amputation in diabetic foot infections

2018 ◽  
Vol 5 (4) ◽  
pp. 1399 ◽  
Author(s):  
Quraysh Shabbir Sadriwala ◽  
Bapuji S. Gedam ◽  
Murtaza A. Akhtar
Keyword(s):  
Risk Factors ◽  
Peripheral Neuropathy ◽  
Glycemic Control ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Factors Associated ◽  
Diabetic Foot Infections

Background: Diabetes is the most common underlying cause of foot ulcers, infection, and ischemia, leading to hospitalization and the most frequent cause of non-traumatic lower extremity amputation. Despite well-defined risk factors for diabetic foot ulcer development, limited data are available as to which factors predict amputation in a diabetic foot ulcer episode. Therefore, to predict lower limb amputation occurrence and to determine the factors associated with the risk of amputation in diabetic patients, we conducted this study.Methods: A hospital based longitudinal study was carried out to assess the risk factors associated with amputation in diabetic foot infection. Patients with foot infections, who were either a diagnosed case of diabetes mellitus or were diagnosed at the institute were included in the study. We excluded patients receiving immunosuppressive therapy or radiotherapy, and infections at or above the ankle joint. Study factors were demographic details, biochemical parameters, Wagner grading, peripheral neuropathy as evaluated by nerve conduction test and vasculopathy as assessed by Ankle brachial index. The primary outcome factor was amputation. The data was presented as descriptive statistics and analyzed by dividing the patients into amputation and non-amputation group, and univariate and multivariate analysis was done.Results: A total of 64 patients were included in the study, out of which the amputation rate was 39.1%. Poor glycemic control, osteomyelitis, vasculopathy, peripheral neuropathy and Wagner grading were statistically significant.Conclusions: In the present study, poor glycemic control, vasculopathy, peripheral neuropathy and higher Wagner grade are significant risk factors for amputation in diabetic foot infections.

scholarly journals Individual Lipids and Lipid Ratios in Type-2 Diabetic Patients: Association with Glycemic Control Status

2017 ◽  
Vol 03 ◽  
pp. 42
Author(s):  
Ni Putu Tesi Maratni ◽  
Dwijo Anargha Sindhughosa ◽  
I Gusti Ayu Mardewi ◽  
Ida Bagus Amertha Putra Manuaba ◽  
Made Ratna Saraswati ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Good Glycemic Control ◽  
Lipid Ratios

The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients with diabetes. HbA1c also predicts the risk for the development of diabetic complications such as cardiovascular disease (CVD). Patients with type-2 diabetes and the characteristic of dyslipidemia are frequently found. Also, dyslipidemia plays as an independent risk factor for CVD. This study was aimed to evaluate the relationship between glycemic control status with serum individual lipid profiles and lipid ratios in patients with type-2 diabetes. This cross-sectional study consisted of 80 patients. Depending on the HbA1c level, the patients were divided into two groups, good glycemic control group (HbA1c < 7.0%, n = 15) and poor glycemic control group (HbA1c ≥ 7.0%, n = 65). The association of HbA1c with individual lipids (TC, TG, HDL-C, LDL-C, Non- HDL-C) and lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, monocyte/HDL-C) were analyzed. The value of individual lipids and lipid ratios did not correlate with HbA1c level (p-value ≥ 0.05). Parameters of individual lipids and lipid ratios were not independently associated with poor glycemic control, which was analyzed by logistic regression. ROC analysis found both LDL-C and LDL-C/HDL-C were not accurate to be used as a prognostic indicator of poor glycemic control in patients with type-2 diabetes (p = 0.155, p = 0.297, respectively). The present study found that there was no association between individual lipids and lipid ratios with glycemic control status.

scholarly journals A cross-sectional study on the telemedicine usage and glycemic status of diabetic patients during the COVID-19 pandemic

2021 ◽  
Vol 30 (3) ◽  
pp. 215-20
Author(s):  
Novi Sulistia Wati ◽  
Pokkate Wongsasuluk ◽  
Pradana Soewondo
Keyword(s):  
Glycemic Control ◽  
Healthy Lifestyle ◽  
Blood Glucose Control ◽  
Cross Sectional Study ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Glycemic Status ◽  
Good Glycemic Control ◽  
Cross Sectional

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupts selfmanagement in diabetic patients in Indonesia. This study aimed to determine the telemedicine usage and factors contributing to glycemic control in type 2 diabetes mellitus (T2DM) patients during the pandemic. METHODS A cross-sectional study was conducted in T2DM patients aged 25–54 years. The questionnaire included general characteristics, diabetes conditions, consultation factors, and self-care management. Glycemic status was evaluated using glycated hemoglobin (HbA1c) levels, which was categorized into poor (HbA1c≥7%) and good glycemic control (HbA1c<7%). Data were analyzed using chi-square and binary logistic regression. RESULTS Of 264 patients, only 19.2% used telemedicine and 60.2% had poor glycemic control during the pandemic. Overweight or obesity (odds ratio [OR] = 5.740 [95% confidence interval [CI] = 2.554–12.899]; p<0.001), insulin injection (OR = 3.083 [95% CI = 1.238–7.677]; p = 0.016), and frequent fried food consumption (OR = 5.204 [95% CI = 1.631–16.606]; p = 0.005) were the factors contributing to poor glycemic control. The risk is lower if exercised regularly (OR = 0.036 [95% CI = 0.007–0.195]; p<0.001) and consulted with a doctor using telemedicine (OR = 0.193 [95% CI = 0.044–0.846]; p = 0.029) or in-person visits (OR = 0.065 [95% CI = 0.016–0.260]; p<0.001). CONCLUSIONS Glycemic control was not optimal during the COVID-19 pandemic. Therefore, keeping a healthy lifestyle and staying connected with a doctor are important to ensure optimal blood glucose control and reduce the risk of diabetesrelated complications.

scholarly journals Self-management activities and diabetes control of diabetic patients in Muang district, Nan province

2021 ◽  
Vol 60 (2) ◽  
Author(s):  
W Sritharathikun ◽  
◽  
K Pinyopornpanish ◽  
C Aramrat ◽  
N Buawangpong ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Glycemic Control ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Self Care ◽  
Poor Glycemic Control ◽  
P Value ◽  
Diabetic Patients ◽  
Foot Care ◽  
Good Glycemic Control

Objectives To evaluate the prevalence of uncontrolled diabetes and diabetic self-care activities in type 2 diabetic patients in Muang District, Nan Province and to explore the association between self-care activities and glycemic control. Methods Participants were interviewed for general information, self-care activities and self-efficacy. Self-care activities in diabetic patients were assessed using the Summary Diabetes Self-Care Activities (SDSCA) questionnaire. Hemoglobin A1c (HbA1c) was collected to evaluate glycemic control. The data was analyzed using logistic regression analysis. Results Of 222 patients, more than half (56.76%) had poor glycemic control. Using multivariate regression analysis, lower SDSCA scores in diet and foot care activities were found to be associated with poor glycemic control (adjusted odds ratio = 2.29, p < 0.001 and adjusted odds ratio = 1.52, respectively; p-value 0.022). Conclusion The majority of the diabetic patients had poor glycemic control. Healthy diet is an important factor in good glycemic control. The association between foot care activity and glycemic control may not be straight forward; however, good foot care may represent adherence to prescribed diabetes treatment and appropriate life-style modification.

Characteristics of monitored diabetic patients by glycated haemoglobin (HbA1c)

2016 ◽  
Vol 5 (05) ◽  
pp. 4563
Author(s):  
Tariq A. Zafar
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Glycated Haemoglobin ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Age Group ◽  
Hba1c Test ◽  
Significant Difference ◽  
Tract Infections ◽  
The Impact

Glycated haemoglobin (HbA1c) test indicates the blood glucose levels for the previous two to three months. Using HbA1c test may overcome many of the practical issues and prevent infections such as urinary tract infections (UTIs). The study aimed to evaluate the impact of glycemic control using HbA1c test to understand patient characteristics and UTIs prevalence. Glycemic control was evaluated by measuring HbA1c for a total of 208 diabetes patients who were regularly attending diabetes center in Al-Noor specialist hospital in Makkah.  The results showed that good and moderate glycemic controlled patients were 14.9% and 16.9% respectively while the poor glycemic patients were 68.3%. Among the good improved glycemic control, 83.9% were females, 48.4% were from age group (15-44y). Among the moderately improved glycemic control, 68.4% were females, 54.3% were from age group (45-64 y) with no significant difference. The total number of the patients with positive UTIs was 55 (26.4%) while the total number of patients with negative was UTIs 153 (73.6%). Among the positive UTIs, 76.3% were with poor glycemic control while only 12.3% and 11% were moderate and good improved glycemic control respectively. Among the negative UTIs, 65.3% were with poor glycemic control while only 19% and 15.7% were with moderate and good improved glycemic control respectively.  Prevalence of UTIs among diabetic patients was not significant (p > 0.05). It was concluded that HbA1c was useful monitoring tool for diabetes mellitus and may lead to improved outcomes. Using a HbA1c test may overcome many of the practical issues that affect the blood glucose tests.

Sign in / Sign up

Export Citation Format

Share Document