Abstract
Background and Objective:Hand ulcers are seen in a small percentage of patients with diabetes. The predisposing factors of diabetic hand varies between different countries. However, the effects of predisposing factors on prognosis are not clear in diabetic hand infections. In this study, our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus.Methods:Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, end-stage renal disease (ESRD), and trauma. Death and minor/major amputation cases during treatment were defined as poor prognosis.Results:Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates.Conclusions:Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment.
Highlights
Diabetes mellitus is a multisystemic disease that affects multiple organs
Hospitalization time was significantly longer in patients who were admitted to hospital seven or more days after the onset of symptoms; had diabetes mellitus for more than 10 years; had neuropathy, end-stage renal disease, or an HbA1c level greater than 10%; or were 65 years or older (p ≤ 0.05)
We observed that end-stage renal disease, peripheral neuropathy, and an HbA1c level greater than 10% were significantly associated with poor prognosis in diabetic hand infections
Summary
Diabetes mellitus is a multisystemic disease that affects multiple organs. Hyperglycemia associated with diabetes represses cellular immunity, causes microangiopathy, and prevents chemotaxis and phagocytosis, so infection and poor wound healing occurs.[1,2,3,4] Peripheral neuropathy and circulatory disorders facilitate wound formation and make the healing process difficult.[5]Foot ulcers are seen in 9.7% of patients with diabetes mellitus, while hand ulcers are seen in a small percentage (0.37%) of patients.[6]. The effects of predisposing factors on prognosis are not clear in diabetic hand infections. Our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus. Methods: Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, endstage renal disease (ESRD), and trauma. Results: Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates. Conclusions: Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment
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