Diabetic Foot: Clinical Presentations and Management Outcome

The diabetic foot, the foot of diabetic patients with ulceration, infection and/ or destruction of the deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb is quite common. A descriptive, cross-sectional study was carried out with an objective of assessing the common presentations and management outcome of diabetic foot. The study was carried out in the Surgery Department of Mymensingh Medical College Hospital, Mymensingh with a conveniently selected 130 patients of diabetic foot according to inclusion and exclusion criteria. The study period was one year. Out of 130 cases, the highest number of patients 55(42.4%) were in age group 50 to 59 years with a mean age of 60.1 years and standard deviation (SD) of 9.8 years. Majority of the patients 91(70.0%) were male. Of them, 83(91.2%) were smokers. Of 130, 51(39.2%) patients were illiterate and 41(31.5%) were farmer. Majority 67(51.53%) patients had history of uncontrolled diabetes for 10-15 years. Most of the patients, 97(74.6%) were presented with neuropathic ulcer, whereas 24(18.4%) ischemic ulcers and 9(7.0%) were infective ulcers, and majority of the lesions 49(37.7%) were located on toes. Highest number of patients, 44(33.8%) were treated conservatively, while 37(28.4%) were treated by debridement, dressing and resurfacing, 17(13.1%) were treated by incision and drainage, and 32(24.6%) patients were treated by amputation. Most of the patients, 108(83.1%) were cured, of them, 36(33.3%) were treated conservatively, while 31(28.7%) by debridement and dressing, 17(15.7%) were treated by toe disarticulation, 13(12.0%) by incision and drainage, 4(3.7%) by above knee amputation, 4(3.7%) by ray amputation and 3(2.8%) by below knee amputation. Illiterate male smokers in their 6th and 7th decades of life with uncontrolled diabetes are the victim of diabetic foot. Neuropathy, vasculopathy, infections and trauma are identified risk factors. Conservative treatment, debridement and dressing, off-loading, culture-guided antibiotics therapy and amputations are the most successful modalities. CBMJ 2017 July: Vol. 06 No. 02 P: 25-31

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DOES INSULIN LIKE GROWTH FACTOR-1 (IGF-1) DEFICIENCY HAVE A “PROTECTIVE” ROLE IN THE DEVELOPMENT OF DIABETIC RETINOPATHY IN THALASSEMIA MAJOR PATIENTS?

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2015.038 ◽

2015 ◽

Vol 7 ◽

pp. e2015038 ◽

Cited By ~ 4

Author(s):

Vincenzo De Sanctis

Keyword(s):

Diabetic Retinopathy ◽

Growth Factor ◽

Cross Sectional Study ◽

Protective Role ◽

Dependent Diabetes Mellitus ◽

Diabetic Patients ◽

Italian Population ◽

Sectional Study ◽

Cross Sectional ◽

Number Of Patients

Objective: This cross-sectional study was designed to give insights into relationship between Insulin-Growth-Factor 1 (IGF-1) levels and diabetic retinopathy (DR) in a sample of thalassaemia major(TM) patients with insulin dependent diabetes mellitus (IDDM). Τhis relation was not previously evaluated, despite the fact that both diseases co-exist in the same patient. The study also describes the clinical and biochemical profile of the associated complications in TM patients with and without IDDM. Design: A population-based cross-sectional study. Participants:The study includes 19 consecutive TM patients with IDDM and 31 age- and sex-matched TM patients without IDDM who visited our out-patient clinics for an endocrine assessment Methods: An extensive medical history, with data on associated complications and current medications, was obtained. Blood samples were drawn in the morning after an overnight fast to measure the serum concentrations of IGF-1, glucose, fructosamine , free thyroxine (FT4), thyrotropin (TSH) and biochemical analysis . Serologic screening assays for hepatitis C virus seropositivity (HCVab and HCV-RNA) were also evaluated, applying routine laboratory methods.Plasma total IGF-1 was measured by a chemiluminescent immunometric assay (CLIA) method. Ophthalmology evaluation was done by the same researcher using stereoscopic fundus biomicroscopy through dilated pupils. DR was graded using the scale developed by the Global Diabetic Retinopathy Group. Iron stores were assessed by direct and indirect methods. Results:Eighteen TM patients with IDDM (94.7 %) and 10 non-diabetic patients (32.2 %) had IGF-1 levels below the 2.5th percentile of the normal values for the Italian population. The mean serum IGF-1 concentrations were significantly lower in the diabetic versus the non-diabetic TM groups (p < 0.001). DR was present in in 4 (21 %) of 19 TM patients with IDDM and was associated with the main classical risk factors, namely inefficient glycemic control and duration of disease but not hypertension. Using the scale developed by the Global Diabetic Retinopathy Group, the DR in our patients was classified as non proliferative diabetic retinopathy (NPDR). Only few numbers of microaneurysms [1-3] were detected. Our data also confirm the strong association of IDDM in TM patients with other endocrine and non-endocrine complications.Conclusions: These results , although on a small number of patients, suggest a possible ‘protective’ role of low IGF-1 in the development of DR in TM patients

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Access to Anti-Diabetic Medicines among Patients Attending Tertiary Health Facilities in Oyo State, Nigeria

Iranian journal of diabetes and obesity ◽

10.18502/ijdo.v13i4.7995 ◽

2021 ◽

Author(s):

Oluwaseun Oladapo Akinyemi ◽

Babatunde Ayeni ◽

Olayinka Stephen Ilesanmi ◽

Oluwatomi Owopetu

Keyword(s):

Formal Education ◽

Tertiary Education ◽

Cross Sectional Study ◽

Health Care Facilities ◽

University Teaching ◽

P Value ◽

Diabetic Patients ◽

College Hospital ◽

Cross Sectional ◽

Close Relatives

Objective: The management of Diabetes Mellitus (DM) is long-term and can be expensive. This study aimed to describe access to anti-diabetic medicines among patients in tertiary health care facilities in Oyo State, Nigeria. Materials and Methods: This was a hospital-based cross-sectional study. The study sites were the University College Hospital (UCH), Ibadan, and Ladoke Akintola University Teaching Hospital, Ogbomosho. It was conducted among 366 diabetic patients who had been attending the endocrinology clinic of these two tertiary health institutions for at least one year. Data analysis was done with the Statistical Program for Social Sciences. Results: Female participants were 186 (50.8%) and 298 (85.6%) depended on close relatives to purchase their drugs. Those who had difficulties affording their anti-diabetic medications were 142 (38.8%) and 80 (56.3%) preferred buying a cheaper brand of anti-diabetic medication. Also, 136 (37.2%) respondents had missed their required drugs at some point due to insufficient funds. Males who were able to afford their anti-diabetic medication were 96 (53.3%) compared to 128 (68.8%) females (P-value= 0.002). Those with no formal education had the highest proportion of respondents who could not easily afford anti-diabetic drugs (60.9%), those with tertiary education had the highest proportion of respondents who could afford their medication (77.5%), (P-value=< 0.001). Among those in the 61-70 years age group, 78 (66.1%) achieved glycaemic control compared to 34 (42.5%) of those above 70 years (P-value=< 0.001). Conclusion: To improve affordability, subsidizing the cost of anti-diabetic medications and encouraging patients to enrol in the Health Insurance Scheme will be beneficial.

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Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

Journal of Diabetes Research ◽

10.1155/2017/2879249 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 22

Author(s):

Tesfamichael G. Mariam ◽

Abebaw Alemayehu ◽

Eleni Tesfaye ◽

Worku Mequannt ◽

Kiber Temesgen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cross Sectional Study ◽

Care Practice ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

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A Study of Comorbidities Among Stroke Patients Admitted In A Tertiary Level Hospital

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44419 ◽

2019 ◽

Vol 10 (3) ◽

pp. 152-155

Author(s):

Mohammad Iqbal Hossain ◽

Ahmed Manadir Hossain ◽

Quazi Shihab Uddin Ibrahimi

Keyword(s):

Ischemic Stroke ◽

Recurrent Stroke ◽

Cross Sectional Study ◽

Comorbid Condition ◽

Stroke Patients ◽

Stroke Event ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Number Of Patients

Introduction: Stroke is an important cause of disability among adults and is one of the leading causes of death worldwide. The reported prevalence of stroke in Bangladesh is 0.3%. Stroke patients have comorbidity Comorbidity is an important factor in stroke outcomes and burden. Objectives: This study was carried out with a view to find out the common comorbidities prevalent in stroke patients. Materials and Method: This cross sectional study was carried out in Faridpur Medical College Hospital from November 2018 to April 2019 to see the comorbidities and associated factors among admitted stroke patients. A total of 390 stroke patients were included. Data were collected by detailed history from patients or their relatives followed by thorough physical examination; Results: Among total respondents, majority was male (56.4%) and ischemic stroke was the commonest type of stroke (65.6%) diagnosed. The substantial number of patients (85.6%) had one or more comorbidities. Hypertension was the predominant comorbid condition (74.1%) followed by coronary heart disease ((19.5%), diabetes mellitus (17.4%), obesity (6.2%), hyperlipidemia (6.2%), CKD (4.9%), COPD (3.3%), malignancy (0.8%), hypothyroidism (0.5%),CLD (0.5%) and parkinsonism (0.3%). Comorbidities were present in 88.28% of ischemic stroke, 81.81% of intracerebral haemorrhage and 69.23% of subarachnoid hemorrhage cases. Patients with first stroke event have comorbidities in 83.64% cases where as in 95.45% cases of recurrent stroke patients. The relationship between comorbidity and mortality risk is not clear with approximately 16% death in both with or without comorbidity. Conclusion: The results of the study concluded that the prevalence of comorbidities in stroke patients remains high in our settings and the patients with increasing age and those with recurrent stroke events have statistically significant number of comorbid conditions. KYAMC Journal Vol. 10, No.-3, October 2019, Page 152-155

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Diabetic Foot Care - A Public Health Problem

Journal of Medicine ◽

10.3329/jom.v12i2.7604 ◽

2011 ◽

Vol 12 (2) ◽

pp. 109-114 ◽

Cited By ~ 1

Author(s):

Jamil Ahmed Somroo ◽

Anjum Hashmi ◽

Zafar Iqbal ◽

Aslam Ghori

Keyword(s):

Diabetic Foot ◽

Fungal Infections ◽

Public Health Problem ◽

Global Scale ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Foot Care ◽

Cross Sectional ◽

Foot Health ◽

Care Practices

Background: Diabetes is global epidemic with devastating human, social and economic consequences. The disease claims as many lives per year as HIV/AIDS and places a severe burden on healthcare systems and economies everywhere, with the heaviest burden falling on low- and middle-income countries. Despite this, awareness of the global scale of the diabetes threat remains pitifully low, inappropriate diabetic foot care affects, feet health leading to callosities, cracks, fissures, fungal infections, ingrown toe nails and patients end up in ulcers and amputations. Objectives: To assess diabetic patients taking proper foot care according to International Guidelines and its impact on their foot health. Methods: A cross sectional study was conducted at outdoor patients department of Medicine, Liaquat University of Medical Sciences Hospital Hyderabad from 17th January 2008 to 16th January 2009. 100 diabetic patients were selected by non probability convenience sampling according to Performa having questions regarding diabetic foot care derived from American Diabetic Association Guidelines for Diabetic Foot care. Results: Diabetic patients taking proper foot care was only 6%. There were 45(45%) males and 55(55%) females. Mean age was 51.57+10.72 years. 38% patients knew about foot care. 17% used to inspect their feet daily, 20% washed their feet daily, while 73% washed their feet more than once. 23% patients dried their feet after every foot wash, 27% applied emollients, 25% checked shoes before wearing, 24% used to wear correct shoes, 8% used to wear cotton socks and 36% used to walk bare feet. Foot care practices on foot health has statistically highly significant association (p<0.01) e.g. number of foot washes with foot hygiene, fungal infections with proper foot drying, emollient application with skin texture, cracks and fissures. Associations of proper foot care were statistically significant with literacy status of patients and foot care teachings (p<0.05). Conclusion: Few diabetic patients are taking proper foot care. Proper Foot care practices were associated with provision of education of foot care and literacy status of patients. Community health education programs regarding diabetic foot care will likely to reduce diabetic foot complications. Keyword: Diabetes, Foot care education, Diabetic foot care, Diabetic foot, Ulceration; Prevention. DOI: http://dx.doi.org/10.3329/jom.v12i2.7604 JOM 2011; 12(2): 109-114

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Factors associated with wound healing outcome among Diabetic Foot patients- A cross sectional Study

International Journal of AYUSH Case Reports ◽

10.52482/ijacare.v5i1.170 ◽

2021 ◽

Vol 5 (1) ◽

pp. 36-46

Author(s):

M Jayalakshmi ◽

P Thenmozhi

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cross Sectional Study ◽

Wound Management ◽

Diabetic Patients ◽

Foot Care ◽

Cross Sectional ◽

Patients With Diabetes ◽

One Year

Diabetic foot ulcer (DFU) has been identified as the leading reason for hospitalization among patients with diabetes. Patients with diabetes are at greater risk of complications, the most important of them are diabetic neuropathy and peripheral vascular disorders leading to the development of foot ulcers. The problem is generally faced and as well is considered as one among the most common complications of diabetes that affect millions of people all over the world. The current study, aimed to document the clinical profile and healing outcome of diabetic foot ulcer management which may become guidance for further improvement in wound management among diabetic foot ulcer patients. Cross sectional descriptive study was conducted over one-year period of time. A total of 246 Diabetic patients with a foot ulcer of Grade 1 to 3 participated in the study. Patients with higher grade ulcers of Grade 4 and 5 were excluded from the study. Final data analysis of 160 patients was done using SPSS version 20. The prevalence of Grade 2 and 3 ulcers were observed 54.37% and 31.8 % while Grade 1 ulcer was observed 13.75%. No risk factors were found to be significantly associated with diabetic foot ulcer. Wound was healed well in 50 % and partially healed in 21 % of the participants. Wound remains unchanged in 3 % of study participants, while 8% of participants underwent toe amputation. Foot ulceration is a preventable in many diabetic patients with adequate education, routine foot care and attention to foot wear.

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Glycaemic Control Impact on Renal Endpoints in Diabetic Patients on Haemodialysis

International Journal of Nephrology ◽

10.1155/2015/523521 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Danielle Creme ◽

Kieran McCafferty

Keyword(s):

Glycaemic Control ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Cross Sectional ◽

Poor Glycaemic Control ◽

Number Of Patients ◽

Weight Gains ◽

Before And After ◽

Patients With Diabetes ◽

The Impact

Objective. To identify the number of haemodialysis patients with diabetes in a large NHS Trust, their current glycaemic control, and the impact on other renal specific outcomes.Design. Retrospective, observational, cross-sectional study.Methods. Data was collected from an electronic patient management system. Glycaemic control was assessed from HbA1c results that were then further adjusted for albumin (Alb) and haemoglobin (Hb). Interdialytic weight gains were analysed from weights recorded before and after dialysis, 2 weeks before and after the most recent HbA1c date. Amputations were identified from electronic records.Results. 39% of patients had poor glycaemic control (HbA1c > 8%). Adjusted HbA1c resulted in a greater number of patients with poor control (55%). Significant correlations were found with interdialytic weight gains (P<0.02,r=0.14), predialysis sodium (P<0.0001,r=-1.9), and predialysis bicarbonate (P<0.02,r=0.12). Trends were observed with albumin and C-reactive protein. Patients with diabetes had more amputations (24 versus 2).Conclusion. Large number of diabetic patients on haemdialysis have poor glycaemic control. This may lead to higher interdialytic weight gains, larger sodium and bicarbonate shifts, increased number of amputations, and possibly increased inflammation and decreased nutritional status. Comprehensive guidelines and more accurate long-term tests for glycaemic control are needed.

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Diabetic Foot and Self-awareness of This Entity

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v29i930121 ◽

2019 ◽

pp. 1-5

Author(s):

Irma Aide Barranco-Cuevas ◽

Alexa Itaí Bello-Mora ◽

Juvencio Reyes-Bello ◽

Miguel Ángel Jacinto-López ◽

Álvaro José Montiel-Jarquín ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Self Care ◽

Cross Sectional Study ◽

The Self ◽

Diabetic Patients ◽

Self Awareness ◽

Cross Sectional ◽

A Value ◽

Level Of Knowledge

Aims: To determine the relationship between the diabetic foot stages and the self-awareness about self-care of the feet in patients attending first level medical facility. Study Design: This is a descriptive, cross sectional study. Place and Duration of Study: This study was conducted in Unit Number 57 of the Family Medicine in the Mexican Institute of Social Security in Puebla, Mexico between January and June of 2017. Methodology: We included 360 patients whom we surveyed to correlate between the level of knowledge about self-care of the feet in diabetic patients and its stages. We used a questionnaire in which the variables included gender, age, level of education, occupation, marital status, number of years since they were diagnosed with diabetes mellitus type 2, stage of the diabetic foot and level of knowledge related to this entity. Descriptive statistics and X2 were used. Results: We included 360 patients who met the inclusion criteria. Their average age was 55.75 years, the average number of years with the diagnosis of diabetes mellitus was 6.07. There was a significant statistic association between the level of knowledge and the stage of the diabetic foot P = .049 a value of P= .05 was considered statistically significant. Conclusion: There is an association between the stage of the diabetic foot and the knowledge about the self-care of the feet among patients.

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Pie risk, una herramienta para la prevención del pie diabético

Revista Colombiana de Endocrinología, Diabetes & Metabolismo ◽

10.53853/encr.3.1.21 ◽

2017 ◽

Vol 3 (1) ◽

pp. 25-34

Author(s):

Arturo Orduz ◽

Claudia Tique ◽

Ingrid Stetphens ◽

Andrés González ◽

Barengo Noel ◽

...

Keyword(s):

Diabetic Foot ◽

Glycosylated Hemoglobin ◽

Foot Ulcer ◽

Public Health Problem ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Clinical Expertise ◽

Medical Visit ◽

Cross Sectional ◽

Factores De Riesgo

Introducción: El pie diabético es un problema de salud pública debido a su elevada frecuencia, severidad y a su impacto económico. En la etapa prepatogénica, el pie presenta alteraciones funcionales y estructurales que de no detectarse a tiempo pueden progresar a la úlcera. Sin embargo, el examen de los pies no se realiza en la mayoría de las consultas. La prevención primaria y la detección oportuna deben tener lugar en el primer nivel de atención.Objetivo: Desarrollar y validar un instrumento simple y práctico para clasificar de manera temprana el pie del paciente diabético en riesgo por parte de la enfermera entrenada antes de la visita a su médico tratante, teniendo en cuenta todos los elementos patogénicos.Métodos: Estudio transversal. Se creó una escala a partir de la experiencia clínica en donde se califican ocho factores de riesgo para desarrollar ulceración: tiempo de diabetes desde el diagnóstico, control metabólico, presencia de síntomas de neuropatía diabética, diagnóstico de la neuropatía por monofi- lamento, presencia de claudicación intermitente y ausencia de pulsos periféricos, presencia de deformidades, presencia de infecciones locales e historia anterior de úlceras que sanaron, amputaciones menores o pie de Charcot. Los puntajes fueron asignados según gravedad. Esta herramienta fue aplicada a un grupo de 204 diabéticos con ulceración y 207 pacientes diabéticos sin ulceración.Resultados: El promedio de edad fue de 65 años, el 42,8% de los pacientes eran hombres. La edad y todos los ítems de la escala, excepto hemoglobina glucosilada, fueron asociados con la presencia de úlcera. Usando un punto de corte de 10 puntos, la herramienta tuvo una sensibilidad del 100% y una especificidad del 73,4% para el diagnóstico de úlcera, con un área bajo la curva ROC de 0,992(IC 95%, 0,986 A 0,998).Conclusión: La herramienta “pie risk” es útil para la calificación y valoración del riesgo de pie diabético.Abstract Background: The diabetic foot is a public health problem due to its frequency, severity and economic impact. In prepathogenic phases, the foot presents structural and functional alterations that, if not detected opportunely, will progress to an ulcer. However, a thorough examination of the diabetic patient’s feet is often eluded in routine health controls. Objective: To develop and validate a simple and practical instrument for early classification of the diabetic foot risk that can be easily applied by a trained nurse before the medical visit. Methods: Cross-sectional study. Based on clinical expertise, a scale with eight risk factors for foot ulcer was developed: time from diagnosis, glycosylated hemoglobin, neuropathy symptoms, monofilament test, absent pulses or claudication; deformities, local infection and history of either amputation, ulceration or Charcot foot. Item scores were assigned based on severity. The tool was tested in a group of 204 ulcerated diabetic patients and 207 of non-ulcerated diabetic patients. Results: Median age was 65 years, 42.8% of patients were male. Age and all scale items except glycosylated hemoglobin were statically associated with ulcer presence. Using the proposed cut point of 10 points, the scale has 100% sensitivity and73.4% specificity for ulcer diagnosis, with an area under the ROC curve of 0.992 (95% CI 0.986 to 0.998). Conclusions: ‘Pie risk’ is a useful tool for the evaluation and risk assessment of the diabetic patient.

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