Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

AbstractObjective. The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.Methods. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.Results. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004–0.332). This was followed by PAD (OR 0.093; 95% CI 0.028–0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030–0.395), anemia (OR 0.179; 95% CI 0.056–0.571).Conclusion. Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

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The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

Journal of Clinical Medicine ◽

10.3390/jcm10071495 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1495

Author(s):

Yu-Chi Wang ◽

Hsiao-Chen Lee ◽

Chien-Lin Chen ◽

Ming-Chun Kuo ◽

Savitha Ramachandran ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Rate ◽

Early Period ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Management ◽

Control Group ◽

Diabetic Patients ◽

High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

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Effectiveness of Topical Insulin Dressing in Healing of Diabetic Foot Ulcer among Diabetic Patients

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.3761 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 158-161

Author(s):

Meena P ◽

Monisha V

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Sampling Technique ◽

Diabetic Patients ◽

Chronic Hyperglycemia ◽

Post Test ◽

Quasi Experimental ◽

The Rich

Diabetes is previously known as the disease of the rich people, but now there is no partiality between the rich and poor and it has become the third leading cause of death. Diabetic Mellitus (DM) is a metabolic issue that is characteristics by chronic hyperglycemia; it is a typical and conceivably persistent disease. The aims of the present study to assess the effectiveness of insulin dressing of the diabetic foot ulcer among diabetic patients. A quasi-experimental research design with purposive sampling technique was adopted to conduct a study among 30 diabetic foot ulcer patients. Demography data was collected and wound was measured and insulin dressing was done. After one week the wound was measured. Confidentiality was maintained throughout the procedure. The collected data were analyzed by using descriptive and inferential statistics. Among 30 samples pretest mean score of wound healing among patients with diabetic foot ulcer in the topical insulin dressing was 2.67±0.66 and the post test mean score was 1.43±0.57. The calculated paired ‘t’ test value of t = 15.703 was found to be statistically highly significant at p<0.001 level. The above finding clearly infers that topical insulin dressing to patients with diabetic foot ulcer had significant effect which resulted in the improvement in the level of wound healing among patients with diabetic foot ulcer.

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Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections

Journal of Medical Microbiology ◽

10.1099/jmm.0.076034-0 ◽

2014 ◽

Vol 63 (10) ◽

pp. 1377-1385 ◽

Cited By ~ 25

Author(s):

Thokur S. Murali ◽

Shettigar Kavitha ◽

Jain Spoorthi ◽

Deepika V. Bhat ◽

Alevoor S. Bharath Prasad ◽

...

Keyword(s):

Immune Response ◽

Wound Healing ◽

Diabetic Foot ◽

Healing Process ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Healing Process ◽

Diabetic Patients ◽

Bacterial Strains ◽

Microbial Drug Resistance

While virulence factors and the biofilm-forming capabilities of microbes are the key regulators of the wound healing process, the host immune response may also contribute in the events following wound closure or exacerbation of non-closure. We examined samples from diabetic and non-diabetic foot ulcers/wounds for microbial association and tested the microbes for their antibiotic susceptibility and ability to produce biofilms. A total of 1074 bacterial strains were obtained with staphylococci, Pseudomonas, Citrobacter and enterococci as major colonizers in diabetic samples. Though non-diabetic samples had a similar assemblage, the frequency of occurrence of different groups of bacteria was different. Gram-negative bacteria were found to be more prevalent in the diabetic wound environment while Gram-positive bacteria were predominant in non-diabetic ulcers. A higher frequency of monomicrobial infection was observed in samples from non-diabetic individuals when compared to samples from diabetic patients. The prevalence of different groups of bacteria varied when the samples were stratified according to age and sex of the individuals. Several multidrug-resistant strains were observed among the samples tested and most of these strains produced moderate to high levels of biofilms. The weakened immune response in diabetic individuals and synergism among pathogenic micro-organisms may be the critical factors that determine the delicate balance of the wound healing process.

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Synthesis And Evaluation Of Wound Healing Properties of HyDrO-DiAb Hydrogel Loaded With Green-Synthetized AGNPS: In Vitro And In Ex Vivo Studies

10.21203/rs.3.rs-627032/v1 ◽

2021 ◽

Author(s):

Mariarosa Ruffo ◽

Ortensia Ilaria Parisi ◽

Marco Dattilo ◽

Francesco Patitucci ◽

Rocco Malivindi ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Ex Vivo ◽

Foot Ulcer ◽

Vascular Diseases ◽

Diabetic Foot Ulcer ◽

Wound Dressings ◽

Diabetic Patients ◽

Wound Healing Activity

Abstract In diabetic patients, the presence of neuropathy, peripheral vascular diseases and ischemia, leads to the formation of foot ulcerations with a higher risk of infection because the normal response to bacterial infection is missing. In the aim to control and treat Diabetic Foot Ulcerations (DFUs), wound dressings able to absorb exudate, to prevent infections and to promote wound healing, are needed. For this reason, the aim of the present research was to synthetize a biocompatible hydrogel composed by Carboxymethylcellulose (HyDrO-DiAb) loaded with Silver nanoparticles (AgNPs) for the treatment of diabetic foot ulcer. In this study, AgNPs were obtained by a green synthesis and, then, were dissolved in CMC hydrogel that, after freeze drying process become a flexible and porous structure. The in vitro and in ex-vivo wound healing activity of the obtained HyDrO-DiAb hydrogel was evaluated.

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Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

10.21203/rs.2.16549/v2 ◽

2020 ◽

Author(s):

Olufunmilayo O Adeleye ◽

Ejiofor T Ugwu ◽

Ibrahim D Gezawa ◽

Innocent Okpe ◽

Ignatius Ezeani ◽

...

Keyword(s):

Renal Impairment ◽

Diabetic Foot ◽

Arterial Disease ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Low Hdl ◽

Vascular Stenosis ◽

Grade 3 ◽

Peripheral Arterial

Abstract Background/Objective: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study is to document contributory factors that predict mortality in patients hospitalized for DFU in Nigeria. Methods: Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results: Mean age 55.9 +/- 12.5 years. 96.1% had type 2 diabetes (DM), the mean duration of DM was 8.5 ± 5.7 years. The duration of ulcers was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects (45-64 years) had significantly high mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252.Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis (< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anaemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (OR 2.831; 95% CI 1.346 – 5.953). Conclusions: Mortality among Nigerian diabetic patients admitted for DFU is high. The majority who died during hospitalization for DFU belong to the working-age population. Predictors of mortality were older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anaemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

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PENATALAKSANAAN ULKUS KAKI DIABETES SECARA TERPADU

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.3.2.2011.864 ◽

2013 ◽

Vol 3 (2) ◽

Author(s):

Yuanita A. Langi

Keyword(s):

Wound Healing ◽

Growth Factors ◽

Peripheral Arterial Disease ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Peripheral Arterial

Abstract: A diabetic foot ulcer is a common and fearful chronic complication of diabetes mellitus often resulting in amputation, and even death. A diabetic foot ulcer can be prevented by early screening and education in high risk individuals, and the management of underlying conditions such as neuropathy, peripheral arterial disease, and deformity. The prevalence of diabetic foot ulcer patients is 4-10% of the general population, with a higher prevalence in elderly people. Around 14-24 % of diabetic foot ulcer patients need amputations with a recurrence rate of 50% after three years. The main pathogenesis of diabetic foot ulcer is neuropathy and peripheral arterial disease (PAD). PAD contributes to diabetic foot ulcers in 50% of cases; however, it rarely stands alone. Other factors such as smoking, hypertension, and hyperlipidemia may contribute, too. In addition, PAD reduces the access of oxygen and antibiotics to the ulcers. Management of diabetic foot ulcers includes treatment of ischemia by promoting tissue perfusion, debridement for removing necrotic tissues, wound treatment for creating moist wound healing, off-loading the affected foot, surgery intervention, management of the co-morbidities and infections, and prevention of wound recurrences. Other adjuvant modalities include hyperbaric oxygen treatment, GCSF, growth factors, and bioengineered tissues. Key words: diabetic ulcer, debridement, off loading. Abstrak: Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes melitus yang sering dijumpai dan ditakuti oleh karena pengelolaannya sering mengecewakan dan berakhir dengan amputasi, bahkan kematian. UKD dapat dicegah dengan melakukan skrining dini serta edukasi pada kelompok berisiko tinggi, dan penanganan penyebab dasar seperti neuropati, penyakit artei perifer dan deformitas. Prevalensi pasien UKD berkisar 4-10% dari populasi umumnya, dengan prevalensi yang lebih tinggi pada manula. Sekitar 14-24% pasien UKD memerlukan amputasi dengan rekurensi 50 % setelah tiga tahun. Patogenesis utama UKD yaitu neuropati dan penyakit arteri perifer (PAP). PAP berkontribusi 50% pada pasien UKD, tetapi hal ini jarang dijumpai tunggal. Terdapat faktor-faktor lain yang turut berperan seperti merokok, hipertensi dan hiperlipidemia. Selain itu PAP menurunkan akses oksigen dan antibiotik ke dalam ulkus. Penatalaksanaan UKD meliputi penanganan iskemia dengan meningkatkan perfusi jaringan, debridemen untuk mengeluarkan jaringan nekrotik, perawatan luka untuk menghasilkan moist wound healing, off-loading kaki yang terkena, intervensi bedah, pananganan komorbiditas dan infeksi, serta pencegahan rekurensi luka. Terapi ajuvan meliputi terapi oksigen hiperbarik, pemberian granulocyte colony stimulating factors (GCSF), growth factors dan bioengineerd tissues. Kata kunci: ulkus diabetes, debridemen, off loading.

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

Journal of the American Podiatric Medical Association ◽

10.7547/16-102 ◽

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.

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Fibroblast Growth Factor in Diabetic Foot Ulcer: Progress and Therapeutic Prospects

Frontiers in Endocrinology ◽

10.3389/fendo.2021.744868 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ye Liu ◽

Yiqiu Liu ◽

Junyu Deng ◽

Wei Li ◽

Xuqiang Nie

Keyword(s):

Wound Healing ◽

Growth Factor ◽

Fibroblast Growth Factor ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Ulcer Formation ◽

Therapeutic Effects ◽

Fibroblast Growth

Diabetic foot ulcer (DFU) is a combination of neuropathy and various degrees of peripheral vasculopathy in diabetic patients resulting in lower extremity infection, ulcer formation, and deep-tissue necrosis. The difficulty of wound healing in diabetic patients is caused by a high glucose environment and various biological factors in the patient. The patients’ skin local microenvironment changes and immune chemotactic response dysfunction. Wounds are easy to be damaged and ulcerated repeatedly, but difficult to heal, and eventually develop into chronic ulcers. DFU is a complex biological process in which many cells interact with each other. A variety of growth factors released from wounds are necessary for coordination and promotion of healing. Fibroblast growth factor (FGF) is a family of cell signaling proteins, which can mediate various processes such as angiogenesis, wound healing, metabolic regulation and embryonic development through its specific receptors. FGF can stimulate angiogenesis and proliferation of fibroblasts, and it is a powerful angiogenesis factor. Twenty-three subtypes have been identified and divided into seven subfamilies. Traditional treatments for DFU can only remove necrotic tissue, delay disease progression, and have a limited ability to repair wounds. In recent years, with the increasing understanding of the function of FGF, more and more researchers have been applying FGF-1, FGF-2, FGF-4, FGF-7, FGF-21 and FGF-23 topically to DFU with good therapeutic effects. This review elaborates on the recently developed FGF family members, outlining their mechanisms of action, and describing their potential therapeutics in DFU.

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Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

10.21203/rs.2.16549/v1 ◽

2019 ◽

Author(s):

OLUFUNMILAYO OLUBUSOLA ADELEYE ◽

Ejiofor T Ugwu ◽

Ibrahim D Gezawa ◽

Innocent Okpe ◽

Ignatius Ezeani ◽

...

Keyword(s):

Renal Impairment ◽

Diabetic Foot ◽

Arterial Disease ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Low Hdl ◽

Vascular Stenosis ◽

Grade 3 ◽

Peripheral Arterial

Abstract Background/Objective : Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. We sought to document contributory factors which predict mortality in patients hospitalized for DFU. Methods : Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria ( MEDFUN ), one-year observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results : Mean age 55.9 12.5 years.96.1% had type 2 diabetes (DM), mean duration of DM was 8.5 ± 5.7 years. Duration of ulcer was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects ( 45-64 years) had significantly higher mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252, and P-value 0.022. Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality ; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis(< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (adjusted OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (adjusted OR 2.831; 95% C.I. for OR 1.346 – 5.953). Conclusions : Mortality among Nigerian diabetic patients admitted for DFU is high, univariate predictors of mortality: older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

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Risk of Diabetic Foot in Diabetic Patients with Peripheral Arterial Disease

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i1.33358 ◽

2020 ◽

Vol 18 (1) ◽

pp. 38-41

Author(s):

A. Joshi

Keyword(s):

Peripheral Arterial Disease ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Diabetic Patients ◽

Medical Sciences ◽

Institutional Review ◽

Peripheral Arterial ◽

Ethical Clearance

Background The prevalence of peripheral arterial disease is higher in diabetic patients. And 11.6% of the patients with diabetic foot ulcer have associated peripheral arterial disease. Objective The main objective of the study is to assess the risk of diabetic foot in diabetic patients with peripheral arterial disease. Method This was a case control study conducted in Bir Hospital, National Academy of Medical Sciences (NAMS). The sample size was 173 out of which cases (diabetic foot) and unmatched controls (diabetics without diabetic foot) were divided in the ratio of 1:2. The Odds Ratio (OR) of peripheral arterial disease in diabetic foot was calculated. The study was conducted after taking ethical clearance from Institutional Review Board of National Academy of Medical Sciences. Result There were 173 participants enrolled in the study. Four were excluded, 55 participants were cases of diabetic foot (cases) and 114 participants were diabetics without diabetic foot (controls). The odds of diabetic foot in patients with peripheral arterial disease was 4.12, p < 0.001. Conclusion The risk of diabetic foot in diabetic patients with peripheral arterial disease was higher as compared to diabetic patients without peripheral arterial disease.

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