scholarly journals An Analysis of Guideline Consensus for the Prevention, Diagnosis and Management of Diabetic Foot Ulcers

Author(s):  
Anthony B Karabanow ◽  
Ina Zaimi ◽  
Luis B. Suarez ◽  
Mark D. Iafrati ◽  
Geneve M Allison

BACKGROUND: Multiple organizations have issued guidelines to address the prevention, diagnosis and management of diabetic foot ulcers. These guidelines are based on evidence review and expert opinion. <p>METHODS: Literature review was conducted and guidelines were reviewed to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations and the level of evidence.</p> <p>RESULTS: Most guidelines were not based on highest level of evidence (randomized controlled trials). A listing of recommendations for prevention, diagnosis and management was created with evidence basis for all recommendations.</p> <p>CONCLUSIONS: Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or in areas of clinical care without recommendations.</p>

2021 ◽  
Author(s):  
Jiasheng You ◽  
Chao Liu ◽  
Yixin Chen ◽  
Weifen Zhu ◽  
Shunwu Fan ◽  
...  

Abstract Background: Citation analysis is a bibliometric method for appraising the impact of academic publications in any given scientific discipline. There is a paucity of literature concerning influential works on diabetic foot ulcers (DFUs). Aims: To determine the top-cited articles in the field of DFU research.Methods: A bibliometric analysis of citations indexed in the Scopus and the Web of Science databases was conducted in January 2021 to determine all publications related to DFU. The 50 top-cited articles that met the inclusion criteria were ranked. Articles were evaluated for several characteristics including year of publication, country of origin, authorship, publishing journal, topic categories, publishing type and level of evidence.Results: The median number of citations per article in the list was 442 (interquartile range [IQR], 320-520), with a median of 21.8 citations (IQR, 16.5-34.5) per year since publication. The publication years ranged from 1986 to 2017, with 1998 accounting for the greatest number of studies (n = 7). The citation classics were published in 20 journals and originated from institutions in nine countries. The majority of the studies were clinical, of which expert-opinion/review with Level V evidence and clinical studies with Levels I and II evidence comprised the greater proportion in the list.Conclusions: This study identified the top-cited articles and provides useful insights into the history and development of DFU research. Our findings may serve as a quick reference for education curriculums and clinical practice, in addition to providing a foundation for further studies on this topic.


2020 ◽  
Vol 9 (12) ◽  
pp. 4032
Author(s):  
José Luis Lázaro-Martínez ◽  
Francisco Javier Álvaro-Afonso ◽  
David Sevillano-Fernández ◽  
Yolanda García-Álvarez ◽  
Irene Sanz-Corbalan ◽  
...  

We aimed to evaluate the effects of ultrasound-assisted wound (UAW) debridement on cellular proliferation and dermal repair in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical/sharp wound debridement. A randomized controlled trial was performed involving 51 outpatients with complicated diabetic foot ulcers that either received surgical debridement (n = 24) or UAW debridement (n = 27) every week during a six-week treatment period. Compared to patients receiving surgical debridement, patients treated with UAW debridement exhibited significantly improved cellular proliferation, as determined by CD31 staining, Masson’s trichrome staining, and actin staining. Bacterial loads were significantly reduced in the UAW debridement group compared to the surgical group (UAW group 4.27 ± 0.37 day 0 to 2.11 ± 0.8 versus surgical group 4.66 ± 1.21 day 0 to 4.39 ± 1.24 day 42; p = 0.01). Time to healing was also significantly lower (p = 0.04) in the UAW group (9.7 ± 3.8 weeks) compared to the surgical group (14.8 ± 12.3 weeks), but both groups had similar rates of patients that were healed after six months of follow-up (23 patients (85.1%) in the UAW group vs. 20 patients (83.3%) in the surgical group; p = 0.856). We propose that UAW debridement could be an effective alternative when surgical debridement is not available or is contraindicated for use on patients with complicated diabetic foot ulcers.


2020 ◽  
Vol 2020 ◽  
pp. 1-18 ◽  
Author(s):  
Elahe Mahdipour ◽  
Amirhossein Sahebkar

Background. Recombinant proteins and growth factors are emerging therapies for diabetic foot ulcers. Despite several clinical reports, there has been no comprehensive and systematic assessment of the totality of clinical evidence on the efficacy and safety of recombinant proteins and growth factors in diabetic foot ulcers. We tried to address this gap through an updated systematic review of randomized controlled trials (RCTs). Methods. PubMed, the Cochrane Library, Scopus, Embase, and Google Scholar databases were searched, and RCTs on the efficacy of recombinant proteins and growth factors in the treatment of cutaneous wounds in diabetic patients were selected. The literature search and assessment were performed by two independent reviewers. Methodological quality of studies was appraised using the Jadad scale. Results. We identified 26 RCTs involving diabetic patients with ulcer that evaluated the effectiveness of platelet-derived growth factor, epidermal growth factor, fibroblast growth factor, granulocyte colony-stimulating factor, vascular endothelial growth factor, erythropoietin, transforming growth factor, talactoferrin, and rusalatide acetate. The main primary outcome was complete healing though different indices were employed to define this such as wound closure, granulation tissue formation, or complete reepithelialization. Few studies had a follow-up period to report any recurrence and amputation rate. No adverse effect was reported due to the intervention. Conclusion. Overall, there is a greater agreement on the effectiveness of EGF to enhance the healing of diabetic ulcers. Nevertheless, extant evidence is lacking for other agents since few trials have been conducted for most of the growth factors and available studies are heterogeneous in their methodologies.


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