scholarly journals Toward Machine-Learning-Based Decision Support in Diabetes Care: A Risk Stratification Study on Diabetic Foot Ulcer and Amputation

2021 ◽  
Vol 7 ◽  
Author(s):  
Zeinab Schäfer ◽  
Andreas Mathisen ◽  
Katrine Svendsen ◽  
Susanne Engberg ◽  
Trine Rolighed Thomsen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Diabetic Foot ◽  
National Registry ◽  
Registry Data ◽  
Data Sources ◽  
Machine Learning Techniques ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Diabetes mellitus is associated with serious complications, with foot ulcers and amputation of limbs among the most debilitating consequences of late diagnosis and treatment of foot ulcers. Thus, prediction and on-time treatment of diabetic foot ulcers (DFU) are of great importance for improving and maintaining patients' quality of life and avoiding the consequent socio-economical burden of amputation. In this study, we use Danish national registry data to understand the risk factors of developing diabetic foot ulcers and amputation among patients with diabetes. We analyze the data of 246,705 patients with diabetes to assess some of the main risk factors for developing DFU/amputation. We study the socioeconomic information and past medical history of the patients. Factors, such as low family disposable income, cardiovascular disorders, peripheral artery, neuropathy, and chronic renal complications are among the important risk factors. Mental disorders and depression, albeit not as pronounced, still pose higher risks in comparison to the group of people without these complications. We further use machine learning techniques to assess the practical usefulness of such risk factors for predicting foot ulcers and amputation. Finally, we outline the limitations of working with registry data sources and explain potentials for combining additional public and private data sources in future applications of artificial intelligence (AI) to improve the prediction of diabetic foot ulcers and amputation.

Plantar Pressures, Plantar Forces, and Their Influence on the Pathogenesis of Diabetic Foot Ulcers

2013 ◽  
Vol 103 (4) ◽  
pp. 322-332 ◽  
Author(s):  
Jérôme Patry ◽  
Richard Belley ◽  
Mario Côté ◽  
Marie-Ludivine Chateau-Degat
Keyword(s):  
Shear Stress ◽  
Mechanical Stress ◽  
Diabetic Foot ◽  
Threshold Value ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Plantar Pressures ◽  
Manual Search ◽  
Patients With Diabetes ◽  
Full Text Review

Background: Clinical recommendations for the prevention and healing of diabetic foot ulcers (DFUs) are somewhat clear. However, assessment and quantification of the mechanical stress responsible for DFU remain complex. Different pressure variables have been described in the literature to better understand plantar tissue stress exposure. This article reviews the role of pressure and shear forces in the pathogenesis of plantar DFU. Methods: We performed systematic searches of the PubMed and Embase databases, completed by a manual search of the selected studies. From 535 potentially relevant references, 70 studies were included in the full-text review. Results: Variables of plantar mechanical stress relate to vertical pressure, shear stress, and temporality of loading. At this time, in-shoe peak plantar pressure (PPP) is the only reliable variable that can be used to prevent DFU. Although it is a poor predictor of in-shoe PPP, barefoot PPP seems complementary and may be more suitable when evaluating patients with diabetes mellitus and peripheral neuropathy who seem noncompliant with footwear. An in-shoe PPP threshold value of 200 kPa has been suggested to prevent DFU. Other variables, such as peak pressure gradient and peak maximal subsurface shear stress and its depth, seem to be of additional utility. Conclusions: To better assess the at-risk foot and to prevent ulceration, the practitioner should integrate quantitative models of dynamic foot plantar pressures, such as in-shoe and barefoot PPPs, with the regular clinical screening examination. Prospective studies are needed to evaluate causality between other variables of mechanical stress and DFUs. (J Am Podiatr Med Assoc 103(4): 322–332, 2013)

scholarly journals Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance

2020 ◽  
Vol 8 (10) ◽  
pp. 1580
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Sophie Schuldiner ◽  
Albert Sotto ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Infection ◽  
Current Knowledge ◽  
Bacterial Species ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Main Role ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

scholarly journals Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

2014 ◽  
Vol 55 (5) ◽  
pp. 1373 ◽  
Author(s):  
Sung Hun Won ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Taeseung Lee ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Free Survival ◽  
Factors Associated

The Physical Characteristics of Materials Used in the Manufacture of Orthoses for Patients with Diabetes

2007 ◽  
Vol 28 (10) ◽  
pp. 1057-1063 ◽  
Author(s):  
Joanne Paton ◽  
Ray B. Jones ◽  
Elizabeth Stenhouse ◽  
Graham Bruce
Keyword(s):  
Physical Properties ◽  
Diabetic Foot ◽  
Performance Indicator ◽  
Practical Method ◽  
Relevant Information ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes ◽  
Properties Of Materials ◽  
Materials Used

Background: Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues can be modified. Orthotic therapy is one practical method commonly used to maintain tissue integrity. Orthotic design must consider the materials chosen for use in fabrication and profile of the device because both aspects influence the performance and durability of the device. Published research evaluating the physical properties of materials commonly used in the manufacture of orthoses for patients with diabetes is limited. This study investigated the physical properties of materials used to fabricate orthoses designed for the prevention of neuropathic diabetic foot ulcers. Methods: Fifteen commonly used orthotic materials were selected for testing: four specifications of 6.4-mm Poron® (Rogers Corp., Gent, Belgium), 3.2-mm Poron®, three densities of 12-mm Ethylene Vinyl Acetate (EVA), 12-mm low-density plastazote, two depths (6.4-mm, 3.2-mm) of Cleron™ (Algeo Ltd., Liverpool, UK), Professional Protective Technology (PPT), and MaxaCane (Algeo Ltd, Liverpool, UK). The density, resilience, stiffness, static coefficient of friction, durability, and compression set of each material were tested, ranked, and allocated a performance indicator score. Results: The most clinically desirable dampening materials tested were Poron® 96 (6-mm) and Poron® 4000 (6-mm). High density EVA (Algeo Ltd., Liverpool, UK) and Lunacell Nora® EVA (Freudenberg, Weinhein, Germany) possessed the properties most suitable to achieve motion control. The data present a simple and useful comparison and classification of the selected materials. Conclusions: Although this information should not be used as a single indicator for assessing the suitability of an orthotic material, the results provide clinically relevant information relating to the physical properties of orthotic materials commonly used in the prevention of neuropathic diabetic foot ulcers.

scholarly journals Impact of diabetic (diabetes mellitus) patients immune factors on the skin cell viability in vitro

2020 ◽  
Vol 17 (3) ◽  
pp. 263-274
Author(s):  
M. A. Mashkova ◽  
T. V. Mokhort ◽  
V. A. Goranov
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Culture System ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Skin Culture ◽  
Patients With Diabetes ◽  
Immune Factors ◽  
3D Skin

At the moment, a lot of scientific research focused on the role of immune mechanisms in diabetic foot ulcers development and impaired healing. A 3D skin culture system as a relevant skin model may prove valuable in investigating these mechanisms and may be a useful tool to study interactions between different cell types such as keratinocytes, fibroblasts, and immune cells. The aim of our research was to study keratinocytes and fibroblasts viability in co-culture with immune factors of patients with diabetes mellitus type 2 (DM2) and patients with diabetes and chronic foot ulcers in a 3D skin culture system. In this study, the multilayer 3D immunocompetent model of human skin comprising keratinocytes, fibroblasts, and mononuclears in an agarose-fibronectin gel was used. The human immortalized keratinocyte cell line, HaCaT, and primary fibroblast cell culture isolated from skin samples of healthy man in abdominal surgery were used for the 3D system. For the experiment 20 % serum of 9 patients with chronic diabetic foot ulcers (without active inflammation signs), 9 diabetic type 2 patients and 9 healthy people, and mononuclears of the same groups of patients were used. 9 experimental series with 3 repeats were carried out. Mononuclears of patients with DM2 and DM2 and diabetic foot syndrome (DFS) had a greater inhibitory effect on fibroblasts, significantly inhibiting their proliferation to a level of 83.78 [79.03; 89.53] % vs 70.18 [66.38; 72.10] % vs 95.40 [91.75; 99.05] %, H = 21.259, p <0.001 – DM2, DFS, and the control group, respectively. There was no significant difference in the cytoinhibitory effect of mononuclears on keratinocytes between different groups: 96.40 [92.82; 100.50] % vs 93.61 [86.80; 97.10] % vs 92.87 [85.15; 95.25] %, H = 4.459, p = 0.108 – control, DM2 and DFS group, respectively. Adding serum to the culture system influenced significantly the viability of neither keratynocytes – 99.40 [95.35; 102.05]  % vs 98.60 [90.55; 100.40] % vs 94.79 [91.65; 98.16] %, H = 3.030, p = 0.220 nor of fibroblasts – 95.61 [92.39; 100.19] % vs 95.80 [88.99; 102.15] % vs 96.20 [99.69; 88.70] %, H = 0.353, p = 0.838, control, DM2 and DFS group, respectively. It was determined that the fibroblasts vialability significantly decreases after introducing mononuclears of patients with DM and patients with DM and chronic diabetic foot ulcers to the co-culture system. Adding serum of these patient groups to the culture system doesn’t influence significantly the viability of skin cells.

scholarly journals Preulcerous Risk Situation in Diabetic Foot Syndrome: Proposal for a Simple Ulcer Prevention Score

2020 ◽  
pp. 193229682092259
Author(s):  
Stephan Kress ◽  
Helmut Anderten ◽  
Anja Borck ◽  
Guido Freckmann ◽  
Lutz Heinemann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Screening Tools ◽  
Diabetic Foot Syndrome ◽  
Foot Ulcers ◽  
Individual Risk ◽  
Diabetic Foot Ulcers ◽  
Prevention Measures

Background: Preulcerous risk situations in patients with diabetes are often undiagnosed and care administered too late. Even with regular medical check-ups and status documentation, foot examinations have not been given enough attention. Diagnosing an individual patients’ risk of developing diabetic foot ulcers may increase vigilance for diabetic foot syndrome (DFS), and the appropriate prevention measures matching the risk involved may prevent the emergence of diabetic ulcers. The classical DFS risk factors are well established and have been extensively covered in the literature; however, there is a lack of efficient screening tools that could be used for a rapid assessment of diabetic foot ulcer risk. Methods: A methodical literature search was conducted to assess relevant publications for the preparation of a simple risk score for amputation related to diabetic foot ulcer. We then analyzed the risk factors for predictive value as odds ratios in foot ulcers and/or amputation. We used the available data to deduce a mean value to reflect the authors’ consensus. Results: In view of the current literature on the matter, we have developed a semi-quantitative scoring system using just a few items to allow rapid and visual risk assessment for diabetic foot ulcers alongside recommendations for prevention and a sensible follow-up strategy to match the risk. Conclusion: This relatively simple score enables rapid risk classification for patients that can ease the way for both physicians and patients in gaining an insight into individual risk situations. The score provides more effective preventative measures for high-risk patients against future complications.

Effect of Exercise on Risk Factors of Diabetic Foot Ulcers

2019 ◽  
Vol 98 (2) ◽  
pp. 103-116 ◽  
Author(s):  
Fuyuan Liao ◽  
Ruopeng An ◽  
Fang Pu ◽  
Stephanie Burns ◽  
Sa Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers
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