Abstract
ABSTRACT Objective: This single-centred study aims to evaluate the incidence, risk factors and treatment outcomes of a podiatry led, evidence-based diabetic foot ulcer (DFU) clinic. Research design and methods: Data from the DFU database and patient electronic health records were retrospectively collected from patients with new DFUs who were referred for treatment to the Department of Podiatry, Dasman Diabetes Institute, Kuwait, from 1 October 2014, to 31 December 2016. Patients were followed-up until healing occurred or until 6 months after the study end date, whichever came first. Results: All data were analysed using IBM SPSS version 24 software. Data were collected from 230 patients with 335 DFUs. Most DFUs (67%) were present for <3 months from the time of the first podiatry appointment. A total of 56% of DFUs were classified as neuropathic. Most (72%) DFUs healed, with a median healing time of 52.0 days. Chronic kidney disease (p = 0.001), retinopathy (p = 0.03), smoking (p = 0.02), ulcer location (p = 0.03), peripheral arterial disease (PAD) (p = 0.004) and osteomyelitis (p = 0.05) were found to have a meaningful association with DFU outcome. The number of days to heal was associated with ulcer classification (p = 0.005), bacterial infection (p = 0.002), osteomyelitis (p = < 0.001) and PAD (p = < 0.001). Conclusions: The incidence of new DFUs in our tertiary clinic is 3.4%. The incidence of diabetic foot ulceration, days to heal, healing rate and the risk factors influencing healing are in accordance with other multidisciplinary facilities with podiatry input.
Highlights
Diabetic foot ulcers (DFUs) continue to be a leading cause of non-traumatic lower limb amputation [1], with an estimated lifetime risk of 12–25% [2,3,4]
Two hundred and thirty (230) patients with one or more DFU attended during the study period, with a total of 335 new DFUs documented
A total of 68% of patients were male, 95% were diagnosed with Type 2 diabetes and 59% gave a history of diabetes for greater than 21 years
Summary
Diabetic foot ulcers (DFUs) continue to be a leading cause of non-traumatic lower limb amputation [1], with an estimated lifetime risk of 12–25% [2,3,4]. PAD is associated with poor DFU outcome. PAD and DFI have been associated with some of the most adverse outcomes of DFU and can lead to major amputation [9]. DFUs are categorized into three groups: neuropathic, neuroischaemic and ischemic [10]. Neuropathic DFUs are the largest group accounting for 54% of cases [11]. There has been a recent shift, with neuro-ischemic classification overtaking neuropathic to become the largest group (50% vs 35%, respectively), most cases (85%) are complicated by neuropathy [12]
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