Abstract
Aim To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p = 0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p = 0.6), 14% were amputated (p = 0.2), and 12.8% were dead within one year in 2011/2012 (p < 0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. Conclusion The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.
Highlights
Diabetic foot ulcers (DFU) are severe complications to diabetes mellitus and are associated with a higher mortality [1], a lower quality of life [2], and life-threatening amputations [3]
Included Patients. 651 patients with diabetic foot ulcers treated at Copenhagen Wound Healing Center (CWHC) in the years 1999, 2000, 2011, and/or 2012 were included in the study. 74% were men and 26% women. 80% had type 2 diabetes (T2D), 10% had type 1 diabetes (T1D), and 10% was categorized as IDDM. 27% were current smokers, 61% were nonsmokers, and 12% had unknown tobacco habits. 19% drank more alcohol than the amounts recommended by the Danish National Board of Health
The duration of diabetes at DFU debut was higher for patients with T1D (32.7 and 36.3 years, respectively) than for patients with T2D (12.3 and 13.0 years, respectively) in 1999 and in 2012. 48% had ulcer(s) before, 81% had detectable neuropathy, and 59% had arterial insufficiency
Summary
Diabetic foot ulcers (DFU) are severe complications to diabetes mellitus and are associated with a higher mortality [1], a lower quality of life [2], and life-threatening amputations [3]. Several studies have investigated factors related to the healing time of DFU (diabetic foot ulcer). A recent study presented a linear relationship between HbA1c and the healing rate of diabetic foot ulcers (every 1% increase in baseline HbA1c resulted in a decrease of wound area healed per day by 0.028 cm, p = 0 02) [4]. The aim of this current study is to examine such possible predictors of diabetic foot ulcer healing time, for example, diabetic retinopathy and nephropathy, Journal of Diabetes Research
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