Cognitive Impairment in People with Diabetes-Related Foot Ulceration.

Ranita Siru,David Bruce,Jens Ritter,Paul Norman,Laurens Manning,Melanie Burkhardt,Ashley Makepeace,Wendy Davis,Peter Fegan,Jonathan Hiew,Timothy Davis,Emma Hamilton

doi:10.3390/jcm10132808

Abstract

Aims: To determine whether there is an excess of cognitive impairment in patients with type 2 diabetes and foot ulceration. Methods: 55 patients with type 2 diabetes and foot ulcers attending Multidisciplinary Diabetes Foot Ulcer clinics (MDFU cohort) were compared with 56 patients with type 2 diabetes attending Complex Diabetes clinics (CDC cohort) using commonly used screening tests for cognitive impairment (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA)), as well as foot self-care, mood and health literacy. MMSE was also compared between the MDFU cohort and a historical community-based cohort of patients with type 2 diabetes (FDS2 cohort). Results: Median MMSE scores were the same in all three groups (28/30). Median MOCA scores did not differ between the MDFU and CDC cohorts (25/30). There were no significant differences in the percentages of patients with MMSE ≤ 24 or MOCA ≤ 25 between MDFU and CDC cohorts (3.6% versus 10.7%, p = 0.27 and 56.4% versus 51.8%, p = 0.71, respectively), findings that did not change after adjustment for age, sex, education, diabetes duration, and random blood glucose. Conclusions: Using conventionally applied instruments, patients with type 2 diabetes and foot ulceration have similar cognition compared with patients without, from either hospital-based clinic or community settings.

Highlights

An individual with diabetes is estimated to have a 15–34% lifetime risk of developing a foot ulcer [1,2,3]
55 participants with type 2 diabetes with a diabetes-related foot ulcer (DFU) attending the multidisciplinary diabetes foot ulcer clinic (MDFU) clinic recruited to the study
The groups were similar in terms of potentially confounding comorbid conditions, including hypertension and prior cardiovascular disease, but the MDFU participants had significantly better glycemic control than those from complex diabetes clinic (CDC), reported less depression, and had greater adherence to foot self-care

Summary

Introduction

An individual with diabetes is estimated to have a 15–34% lifetime risk of developing a foot ulcer [1,2,3]. The potential consequences of a persistent diabetes-related foot ulcer (DFU). Non-adherence to these measures is common [8,9,10] with patients reporting that they find management of DFUs disruptive and difficult [10,11,12]. International guidelines recommend proven preventive and self-management practices, optimal adherence to which should be achieved through patient education and participation in an integrated foot care program [13]. It is possible that both cognitive dysfunction and DFU in people with diabetes share common mechanisms underlying vascular and neurological degeneration, including hyperglycaemia, altered insulin signalling, effects of advanced glycation, and chronic inflammation [22]

Methods

Results

Conclusion