Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers.

Marco Meloni,José Luis Lázaro-Martínez,Valentina Izzo,Luigi Uccioli,Laura Giurato

doi:10.3390/jcm9061780

Abstract

This study aims to evaluate clinical and ulcer characteristics as well the outcomes of patients with diabetic foot ulcers (DFUs). The study group was composed of DFUs patients managed by a limb salvage protocol according to guidance. Clinical and ulcers findings were described, and 1-year outcomes defined as limb salvage, healing, healing time, major amputation and death were compared between neuropathic and ischemic DFUs. One thousand, one hundred and ninety-eight subjects were included; 386 (32.2%) neuropathic and 812 (67.8%) ischemic DFUs. Neuropathic patients were younger (69.5 ± 11.5 vs. 74.5 ± 11.5, p < 0.0001) and reported less cases of nephropathy (22.8 vs. 39.6%, p < 0.0001), ischemic heart disease (22.8 vs. 36.9, p = 0.0004), cerebrovascular disease (8.3 vs. 17.2%, p = 0.002), heart failure (10.1 vs. 24.7%, p = 0.0002) and end-stage-renal-disease (ESRD) (5.4 vs. 27%, p = 0.0001) than ischemic patients; they also showed less cases of large (>5 cm2) (10.3 vs. 22.9%, p = 0.0007), infected (40.4 vs. 55.7%, p = 0.0005) and deep to the bone (22.3 vs. 39.2, p = 0.0002) ulcers, as well less multiple ulcerations (21.8 vs. 32.8%, p = 0.006) than patients with ischemic DFUs. The outcomes for neuropathic and ischemic DFUs were limb salvage (98.4 vs. 82.3%, p < 0.0001), healing (97.3 vs. 79.6%, p < 0.0001), healing time (34.9 vs. 35.6 weeks, p = 0.8), major amputation (0.5 vs. 6.6%, p = 0.0001), death (1.1 vs. 11%, p < 0.0001) respectively. Revascularization failure and ESRD were independent predictors of major amputation, while heart failure and number of co-morbidities (≥5) were independent predictors of death. Ischemic DFUs patients showed more severe clinical and ulcers features as well worse outcomes than neuropathic DFUs patients.

Highlights

Diabetic foot disease (DFD) is the most severe consequence of two diabetes related long-term complications: peripheral neuropathy (PN) and peripheral arterial disease (PAD)
They were characterized by the high presence of long-term diabetes-related complications, mainly peripheral neuropathy (92%), retinopathy (51%), nephropathy (34%), PAD (68%) and ischemic heart disease (32%)
Our data illustrate that among current patients affected by DFD, there is a prevalence of ischemic Diabetic foot ulcers (DFUs) in comparison to neuropathic DFUs, and there seems to have been an increase in ischemic subjects over the last years

Summary

Introduction

Diabetic foot disease (DFD) is the most severe consequence of two diabetes related long-term complications: peripheral neuropathy (PN) and peripheral arterial disease (PAD). Diabetic foot ulcers (DFUs) affect up to 15% of the diabetic population at some time in their life and they represent the first cause of hospitalization, minor and major amputation among diabetic subjects [2,3]. Patients with DFD are often very fragile and foot ulceration may be just a part of an extremely complex clinical condition in which specific long-term complications (PN and PAD) and concomitant co-diseases affect the general health of patients. Diabetic foot (DF) patients have reported a complex interplay of several inflammatory markers which can affect cardio-vascular system and DF influence a faster progression of cardio-vascular damage and morbidity [6,7]. Does DFD require early management of foot ulceration and the assessment of all comorbidities that may influence the outcomes

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