Burden Of Diabetic Foot Ulcers Research Articles

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review.

Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates. A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

Economic burden of diabetic foot ulcer: a case of Iran

BackgroundDiabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran.MethodsIn this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19).ResultsThe economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60–69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs).ConclusionsDFU represents a heavy burden to patients, Iran’s health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.

Patterns of Pathogens and Antimicrobial Susceptibility Profiles in Diabetic Foot Ulcers’ Infections among Patients at Bugando Medical Centre in Mwanza, Tanzania

Background: Diabetic foot ulcer (DFU) is an open sore or wound on the foot of a person with diabetes, and is most commonly located on the plantar surface, or bottom of the foot. The defect is relatively common in adult and elders with diabetes mellitus. Infected lower extremities wound with multi-drug resistant bacteria usually are associated with increased morbidity, mortality and long-term disabilities among diabetic patients. Although the burden of DFU is known in Tanzania (and Mwanza in particular), there is limited information on the patterns of pathogens associated with DFU in our setting, on bacterial and fungal pathogens which in turn limit specific management options to these patients. Methodology: Analytical cross section hospital-based study was conducted among patients with DFU admitted or attending outpatient clinics at BMC from May to July 2022. A structured questionnaire was used to collect socio-demographic, clinical and laboratory data from patients with DFU. Tissue culture was obtained from the base of the ulcer after cleaning with normal saline followed by removing of cellular debris and normal flora over the lesion. Finally, the obtained samples were subjected to culture methods to identify the presence of pathogens (bacteria and fungi) and antimicrobial susceptibility profiles of bacteria. Result: During the study period and based on inclusion criteria, a total of 71 patients, with a mean age of 59.2 ± 13.0 years were recruited. The majority of the participants were male 47 (66.2%). A total of 60 (84.5%) samples were culture positive, resulting into a total of 92 microorganisms isolated. More than half of cultures 34 (56.7%) revealed the presence of single microorganisms. Pathogens isolated were both bacterial 70 (76.1%) and fungi species 22 (23.9%), all bacterial isolates were aerobic. P. aeruginosa and E. coli were most frequent isolated gram-negative bacteria 12(23.5%) and 9(17.6%) respectively. On other hand common isolated gram-positive strains were S. aureus 13 (68.4%) out of all 19 gram-positive culture isolates. A total of 22 fungi spp were isolated, among them 7 (31.8%) were yeast C. albicans 3 (42.8%), A. fumigatus were frequent isolated 13 (86.7%). Polymicrobial growth was observed in 43.3% samples against 56.7% of monomicrobial growth. Most prevalent gram-negative bacteria Pseudomonas aeruginosa showed low resistance to ciprofloxacin, meropenem, gentamicin, piperacillin tazobactam (7.1%, 21.4%, 21.4% and 21.4 respectively) but more resistant to cephalosporins. Staphylococcus aureus showed low resistance to ciprofloxacin, gentamicin and clindamycin (30.8%, 15.4%, and 38.5% respectively), Total MDR bacteria isolates were 64.3%, where methicillin resistance staphylococcus aureus (MRSA) were 76.9%. More than 85.7% of the patient with higher grade ulcer, stage 3 and 4 according to Wagner’s classification were positive to diabetic foot infection and 14.3% of patients with Wagner’s stage 3 and 4 were not infected on their ulcers. Conclusion: Gram negative bacteria were most commonly isolated than gram positive bacteria in causing DFU infections. For gram negative spp the most effective antibiotic were ciprofloxacin, gentamicin, piperaccilin tazobactam and meropenem. Third generation cephalosporins, amoxicillin clavulanate showed poor effectiveness. All cases of DFU infection should therefore be subjected to culture and antimicrobial sensitivity testing for targeted infection management. More studies involving anaerobic pathogens and antifungal susceptibility patterns

The mechanisms of exosomes in diabetic foot ulcers healing: a detailed review.

As time goes by, the morbidity of diabetes mellitus continues to rise, and the economic burden of diabetic foot ulcers as a common and serious complication of diabetes is increasing. However, currently there is no unified clinical treatment strategy for this complication, and the therapeutic efficacy is unsatisfactory. Recent studies have revealed that biological effects of exosomes involved in multiple stages of the process of wound closure are similar to source cells. Compared with source cells, exosomes possess lowly immunogenicity, highly stability and easily stored, etc. Accumulating evidence confirmed that exosomes promote diabetic wound healing through various pathways such as promoting angiogenesis, collagen fiber deposition, and inhibiting inflammation. The superior therapeutic efficacy of exosomes in accelerating diabetic cutaneous wound healing has attracted an increasing attention. Notably, the molecular mechanisms of exosomes vary among different sources in the chronic wound closure of diabetes. This review focuses on the specific roles and mechanisms of different cell- or tissue-derived exosomes relevant to wound healing. Additionally, the paper provides an overview of the current pre-clinical and clinical applications of exosomes, illustrates their special advantages in wound repair. Furthermore, we discuss the potential obstacles and various solutions for future research on exosomes in the management of diabetic foot ulcer. The aim is to offer novel insights and approaches for the treatment of diabetic foot ulcer.

The Burden of Diabetic Foot Ulcers in Urban India: A Community Healthcare Setup-Based Study.

Foot ulcer is the most common cause of hospitalisation among people with diabetes (PWD). The objective of the study is to determine the incidence of diabetic foot ulcers (DFUs) in the urban community in India and its relationship with glycemic level and demographic parameters like age and sex among diabetic patients. A retrospective observational study was performed from January 2016 to December 2018 at an urban community set up in Mumbai. The study was conducted in a healthcare setting, providing lifelong contributory healthcare to beneficiaries of an employees' universal healthcare scheme. PWD from the community was identified using prescriptions of anti-diabetic medications. We identified patients with DFUs from electronic medical records from the hospital information system (HIS). The yearly incidence rate of DFU among PWD was estimated for the study period. The association between glycemic control and the demographic profile of patients with DFU was studied using binary logistic regression. The study documents the average incidence of 66 DFU patients among 10,000 PWD per year in the community. Logistic regression analysis showed higher odds for the elderly age group (OR 2.863) compared to lower age for developing DFU. Similarly, poor control (HbA1c >7%) over glycemic level has a higher chance (OR 1.713) of DFU than that of optimum glycemic control (HbA1c ≤7%). Among the DFU, 15.29% of patients required amputation during the study period. The study documents the community-level incidence of DFUs among patients with diabetes. High glycemic levels and elderly age groups (≥60) are the associated risk factors for DFU.

Study to Evaluate the Pharmacoeconomics in Diabetic Foot Ulcer Management

Background: Diabetic foot ulceration (DFU) is one of the macrovascular complications of diabetes, its prevalence was estimated to be about 8-11% of individuals with uncontrolled diabetes experience for long time. The pathogenic cascade of DFU is a combination of vascular complications of peripheral arteries, Peripheral neuropathy and the raised blood glucose makes it as a non-healing ulcer followed by secondary infection which will progress to end with leg Amputation. The recurrent nature of Diabetic foot ulcer can impact on the health status as well as the economical stability of the affected patients and are associated with the major health care consumption with high cost. Methodology: It was a Mono centered prospective observational comparative study conducted in the department of general surgery for 6 months duration. Results: Total samples of 100 diabetic foot ulcer patients were enrolled into the study, 74 (74%) were males and 26 (26%) were females. The age group between51-60 and 61-70 years was observed as the highest percentage 27% (27). Highest percentage 42% (42) of patients were none (without any comorbidities) followed by 32(32%) patients are with combined (more than one comorbidity like HTN, CKD, CAD…etc.) with utmost percentage of 43% was peripheral neuropathy. 23 patients were diagnosed with gangrene and23 patients underwent major amputation, The economic burden of diabetic foot ulcer for conservative treatment was slightly more when compared to amputated patients. Conclusion: Study concludes that, economic burden on diabetic foot ulcer in conservative patients was slightly more while compared to amputated patients by descriptive statistics even the statistical analysis shown less significant difference. Because the necessity rate for extra hospitalization and medical services was more for conservative treatment (Debridement, Fasciotomy, Incision and Drainage) when compared to amputation patients with diabetic foot ulcer. whereas in the pharmaco-economics there was not much significant difference among both amputated and conservative patients.

A single arm prospective feasibility study evaluating wound closure with a unique wearable device that provides intermittent plantar compression and offloading in the treatment of non-healing diabetic foot ulcers.

The incidence and economic burden of diabetic foot ulcers continues to rise throughout the world. In this prospective study, a unique device designed to offload the wound, enhance circulation and monitor patient compliance was evaluated for safety and efficacy. The device provides offloading and intermittent plantar compression to improve the pedal flow of oxygenated blood and support wound healing while recording patient use. Ten patients with non-healing diabetic foot ulcers UTgrade 1A/Wagner grade 1 were treated weekly for up to 12 weeks. The primary endpoint was complete wound closure at 12 weeks, and secondary endpoints included healing time, percent area reduction and changes in pain using the visual analogue pain scale. Eight out of ten wounds healed within 12 weeks(80%), and the mean healing time was 41 days(95% CI:24.3-58.3). The percent area reduction was 75(SD:53.9). The baseline visual analogue pain scale was 4.5(2.9) as compared with 3.3(3.4) at end of study. No device-related or serious adverse events were reported. This unique intermediate plantar compression and offloading device may be considered as an alternative for safe and effective for treatment of non-healing diabetic foot ulcers. During treatment, wound healing was significantly accelerated, and pain was improved. Larger randomised controlled trials are underway to validate these early findings.

A scoping review protocol to map the evidence on the risks and benefits of population based diabetic foot screening.

Background: Diabetic foot ulcers are one of the most common lower extremity complications of diabetes, with the lifetime risk of a person developing a DFU estimated to be as high as 34%. It is recommended that those with diabetes receive an annual review of their feet, by a trained healthcare professional, to identify risk factors for ulceration and allow for subsequent risk stratification, patient education and provision of appropriate care to prevent ulceration and amputation. Internationally, while many countries have a diabetic foot care pathway, it is not a structured population health screening programme unlike other areas of preventive care for people with diabetes such as retinopathy screening. A structured diabetic foot screening pathway could allow for earlier identification of the at-risk foot. However, the introduction of any population screening programme should meet the Wilson and Jungner principles of screening. This paper presents a protocol for a scoping review of existing evidence on screening for the at-risk-foot against the Wilson and Junger principles. Methods:The scoping review will be conducted in line with the six-stage methodological framework by Arksey & O'Mally and the Joanna Briggs Institute (JBI) scoping review methodology. Medline (EBSCO), Scopus, ScienceDirect and EMBASE databases will be searched. Studies relating to the burden of diabetic foot ulcers, their pathophysiology and screening tests for peripheral neuropathy and peripheral artery disease, and screening programmes will be included. A data extraction tool will be used to facilitate a chronological narrative synthesis of results. Results: These will bereported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Conclusion: This scoping review will evaluate and map the evidence surrounding diabetic foot ulcers using the Wilson and Jungner principles of screening as a framework.

Attitude and Practice on Foot Care among Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Centre in Southern Part of Tamilnadu, India

Introduction : Diabetic foot has got a high prevalence of 52% among diabetics. The duration of hospital stay and physical disability are likely to cause depression and affects overall quality of life. So it is important for general population, to know about Self Care activities which include foot care practice to avert long term complications and improve quality of life which is likely to be effective in reducing the burden of diabetic foot ulcer. Objective: To assess the knowledge, attitude and practice about foot care among Type 2 DM patients in a Tertiary health care center, Tamil Nadu. Method: A cross-sectional study was done during August and September 2021 among diabetic patients after obtaining consent at a Tertiary Hospital in southern district of Tamil Nadu. Results: The mean age of the study participants was 47.56 ± 9.718 years with 55.9% being male and 44.1% female and the majority (65.6%)of subjects was residing in rural areas. Among the participants, 103 (92.8%) were found to have good attitude towards self-care activities whereas69 (62.2%) respondents practiced proper footcare. Age, gender and education were found to have significant association with the practice of proper foot care. Female gender was found to be an independent predictor for practice of adequate foot care. Conclusion: Regardless of good attitude towards diabetic foot care there is considerable resistance in practising it.

Clinical Profile and Outcome of Diabetic Foot Ulcer in Teritary Care Hospital

Background: The goal of this study was to estimate the disease burden of diabetic foot ulcer (DFU) admissions in a tertiary care hospital in a developing country in terms of clinical profile and outcome.
 Method: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Saveetha medical college and hospital between the period of February to November 2020. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed.
 Results: There were 180 admissions with diabetic foot problems involving 100 patients. All of the patients had type 2 diabetes, and there was no gender bias. The average age was 50, and diabetes control was poor. The majority of patients had no knowledge what had caused their symptoms. In 56 % of cases, ulcers were neuropathic, 25% were neuro ischemic, and a smaller fraction were pure ischemia. More than 70% of ulcers were Wagner grade 3 or higher, with infection occurring in nearly every patient. Gram-negative bacteria were the most prevalent isolates from culture. A total of 30 lower extremity amputations (LEAs) were performed at various levels of the foot.
 Conclusion: Diabetic foot problems are a source of morbidity, a reason for LEA surgery, and a cause of death in people who have diabetes mellitus.

Clinical and economic burden of diabetic foot ulcers: A 5-year longitudinal multi-ethnic cohort study from the tropics.

Diabetic foot ulcers (DFUs) present a substantial clinical and economic burden to healthcare systems around the world, with significant reductions in quality of life for those affected. We aimed to analyse the clinical and economic burden of DFU via a 5‐year longitudinal multi‐ethnic cohort study. A longitudinal analysis of inpatient and outpatient DFUs data over 5 years from a university tertiary hospital in Singapore was performed. Data included baseline characteristics, clinical outcomes, hospitalisation, and outpatient details. Descriptive statistics, Kaplan–Meier survival analyses, and Cox proportional hazard models were performed. Patients treated for DFUs (n = 1729, mean patient age of 63·4 years) were assessed. The cohort consists of Chinese (61.4%), Malay (13.5%), and Indian (18.4%) patients. Common comorbidities included peripheral arterial disease (74.8%), peripheral neuropathy (14.5%), and a median haemoglobin A1c of 9.9%. Patients underwent toe(s) amputation (36.4%), transmetatarsal amputations (16.9%), or major amputations (6·5%). The mean length of inpatient stay for ulcer‐only, minor amputation, and major amputation was 13.3, 20.5, and 59.6 days, respectively. Mean cost per patient‐year was US $3368 (ulcer‐only), US $10468 (minor amputation), and US $30131 (major amputation). Minor amputation‐free survival was 80.9% at 1 year and 56.9% at 5 years, while major amputation‐free survival was 97.4% at 1 year and 91.0% at 5 years. In conclusion, within our multi‐ethnic cohort of patients from the tropics, there was significant clinical and economic burden of DFUs, with a high wound per patient ratio and escalating healthcare costs corresponding to more proximal amputation levels.

PDB50 Clinical and Economic Burden of Diabetic Foot Ulcers: A 5-Year Longitudinal Institutional Population Health Review

Diabetic foot ulcers present a substantial clinical and economic burden to health systems globally. We analysed their burden in a 5-year longitudinal population health review. A retrospective observational study of inpatient and outpatient data from a university tertiary hospital in Singapore. Data included baseline characteristics, clinical outcomes, resource use and costs. Descriptive statistics, Kaplan-Meier survival analysis and Cox-proportional hazards regression models were performed. 1,729 patients were treated for diabetic foot ulcers, with mean age 63.4 years and 64.4% males. 61.4% of patients were Chinese, 13.5% Malay and 18.4% Indian. 74.8% had underlying peripheral arterial disease (PAD) and 14.5% had peripheral neuropathy, with median HbA1c 9.9%. More than a third had toe(s) amputation, 16.9% transmetatarsal and 6.5% major amputations. The mean inpatient length of stay for ulcer-only, minor amputation and major amputation was 13.3, 20.5 and 59.6 days respectively. Mean cost per patient-year was USD$3,368 (ulcer-only), USD$10,468 (minor amputation) and USD$30,131 (major amputation). Minor amputation-free survival was 80.9% at 1-year and 56.9% at 5-years while major amputation-free survival was 97.4% at 1-year and 91.0% at 5-years. Independent predictors for all-cause mortality were age (Hazard Ratio [HR] 1.1, p<0.001), major amputation (HR 1.8, p<0.001), PAD (HR 1.4, p=0.015), ischaemic heart disease (IHD) (HR 10.8, p<0.001), previous stroke (HR 1.2, p=0.041) and end-stage renal failure (ESRF) (HR 1.4, p=0.002). Independent predictors for major amputation were age (HR 1.0, p=0.002), PAD (HR 27.9, p<0.001), IHD (HR 12.3, p=0.033) and ESRF (HR 1.9, p=0.002). For minor amputation, independent predictors were male (HR 1.3, p<0.001) and PAD (HR 7.4, p<0.001). Within our study cohort, there is a significant clinical and economic burden of diabetic foot ulcers. These patients have poor glycaemic control, hence resulting in high wounds per patient ratio with escalating healthcare costs corresponding to more proximal amputation levels.

Epidemiology and Burden of Diabetic Foot Ulcer and Peripheral Arterial Disease in Korea.

Information about the epidemiology of diabetic foot ulcer (DFU) with peripheral arterial disease (PAD) is likely to be crucial for predicting future disease progression and establishing a health care budget. We investigated the incidence and prevalence of DFU and PAD in Korea. In addition, we examined costs of treatments for DFU and PAD. This study was conducted using data from Health Insurance Review and Assessment Service from 1 January 2011 to 31 December 2016. The incidence of DFU with PAD was 0.58% in 2012 and 0.49% in 2016. The prevalence of DFU with PAD was 1.7% in 2011 to 1.8% in 2016. The annual amputation rate of DFU with PAD was 0.95% in 2012 and 1.10% in 2016. Major amputation was decreased, while minor amputation was increased. The direct cost of each group was increased, especially the limb saving group. which was increased from 296 million dollars in 2011 to 441 million dollars in 2016. The overall incidence of DFU with PAD was about 0.5% of total population in Korea, from 2012 to 2016. Furthermore, costs for treatments of diabetic foot ulcer are increasing, especially those for the limb saving group.

Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria.

BACKGROUNDNigeria bears the greatest burden of diabetes prevalence in Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially life-threatening complication of diabetes. Significant improvements in diabetic foot incidence and outcomes have been recorded in many Western countries in the past decade. However, the current burden of DFU in Nigeria is largely unknown.AIMTo evaluate the patients’ profile, ulcer characteristics, associated co-morbidities and outcome of patients with DFU in Nigeria.METHODSMulticenter evaluation of diabetic foot ulcer in Nigeria was a one year multicenter observational study of patients hospitalized for DFU in six tertiary health institutions in Nigeria from March 2016 to March 2017. Demographic and diabetes information, ulcer characteristics and associated co-morbidities were assessed. Relevant laboratory and imaging studies were performed. All patients received appropriate multi-disciplinary care and were followed up until discharge or death. Outcome variables of interest were ulcer healing, lower extremity amputation (LEA), duration of hospitalization and mortality.RESULTSA total of 336 patients (55.1% male) with mean age of 55.9 ± 12.5 years were enrolled into this study. Majority (96.1%) had type 2 diabetes. Only 25.9% of the subjects had prior foot care knowledge. Most of the subjects presented late to the hospital and median (IQR) duration of ulcer at presentation was 39 (28-54) d. Ulcers were already advanced (Wagner grades ≥ 3) in 79.2% of the subjects while 76.8% of the ulcers were infected at the time of admission. The commonest co-morbidities were systemic hypertension, anemia and hyperglycemic emergencies. One hundred and nineteen subjects (35.4%) suffered LEA while 10.4% left against medical advice. The median (IQR) duration of hospitalization was 52.0 (29-66) d with case fatality rate of 20.5%.CONCLUSIONThe burden of DFU in Nigeria is very high. The major gaps include low level of foot care knowledge among diabetic patients, overdependence on self-medication and unorthodox medicine following development of foot ulceration, late hospital presentation, and high amputation and mortality rates. Extensive foot care education within the framework of a multi-disciplinary foot care team is highly desirable.

The BDFOOT- IDGDC study: Burden of diabetic foot ulcers and its determinants among type 2 diabetes patients attending an “Integrated Diabetes and Gestational Diabetes Clinic” of Eastern India

Background: Globally, about 425 million people are suffering from diabetes mellitus (DM) which will be about 629 million by 2045. India is popularly known as “World Diabetes Capital” and is presently home of about 72.9 million diabetes patients. Poorly managed DM will increase the burden of both microvascular and macrovascular complications. One of the most common complications among them is diabetic foot ulcer (DFU) which affects about 7%–24% of DM patients. Aims and Objectives: This study was planned to determine the burden of DFU and its determinants among Type 2 diabetes mellitus (T2DM) patients attending integrated diabetes and gestational diabetes clinic. Materials and Methods: An institution-based, observational, cross-sectional study was conducted from July to September 2018. A pre-designed, pre-tested, semi-structured schedule was used to collect clinicosocial data. Blood pressure of the study subjects was measured and classified as per Joint National Committee-8 guidelines. Peripheral vascular assessment of the feet was done by calculating “ankle-brachial index (ABI)” in both lower limbs using “Diabetik Foot Care India Pvt. Limited” vascular Doppler instrument having 8 MHz transducer. ABI ≤0.9 and absence of pulse in dorsalis pedis and/or posterior tibial arteries were considered as peripheral artery disease (PAD). Vibration perception threshold for peripheral sensory neuropathy was tested with the help of Diabetik Foot Care Pvt. Limited Digital Biothesiometer using 50 Hz frequency. Results: Data were collected from 338 study participants. The frequency of DFU was found to be 9.5%. Increasing age, longer duration of diabetes, poor educational status, overweight/obesity, poor glycemic control, treatment with insulin, PAD, diabetic peripheral neuropathy, hypertension, ischemic heart disease, and hypothyroidism were significantly associated with DFU. Conclusion: There is high frequency of DFU among T2DM patients. Most of the risk factors are modifiable and if taken care of the occurrence of DFU can be prevented and/or delayed.

MS02.8 Economic and Clinical Burden of Diabetic Foot Ulcers: A Multicentre Study

MS02.8 Economic and Clinical Burden of Diabetic Foot Ulcers: A Multicentre Study

Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always.

Diabetic foot complications are the most common occurring problems throughout the globe, resulting in devastating economic crises for the patients, families and society. Diabetic foot ulcers (DFUs) have a neuropathic origin with a progressive prevalence rate in developing countries compared with developed countries among diabetes mellitus patients. Diabetic patients that are of greatest risk of ulcers may easily be diagnosed with foot examination. Economic burden may be carefully examined. The budget costing must include both the clinical and social impact of the patients.

Burden of Diabetic Foot Ulcers in India: Evidence Landscape from Published Literature

Burden of Diabetic Foot Ulcers in India: Evidence Landscape from Published Literature

Evaluation of wound healing properties of bioactive aqueous fraction from Moringa oleifera Lam on experimentally induced diabetic animal model.

Diabetic foot ulcer is a serious complication of diabetes, which affects a significant percentage (15%) of diabetics and up to 15%–24% of those affected may require amputation. Therefore, the economic burden of diabetic foot ulcers is enormous and is associated with high cost of treatment and prolongs hospitalization. The present study was conducted to evaluate antibacterial and in vivo wound healing activities of an aqueous fraction of Moringa oleifera on a diabetic condition. Antibacterial activity testing was carried out using agar well and tube dilution techniques. The in vivo study was conducted using six groups of animals that comprise of one normal and diabetic control group each, three treatment groups of 0.5%, 1%, and 2% w/w aqueous fraction, and a positive control group (1% w/w silver sulfadiazine). Rats were induced with diabetes using a combination of streptozotocin 65 and 150 mg/kg nicotinamide daily for 2 days, and excision wounds were created and treated with various doses (0.5%, 1%, and 2% w/w aqueous fraction) daily for 21 days. Biophysical, histological, and biochemical parameters were investigated. The results of the study revealed that aqueous fraction possessed antibacterial activity through inhibition of growth of Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli organisms. The topical application of aqueous fraction revealed enhancement of wound healing under sustained hyperglycemic condition for the duration of the experiment. This enhancement was achieved through decreased wound size, improved wound contraction, and tissue regeneration, as well as downregulation of inflammatory mediators, such as tumor necrosis factor-α, interleukin-1β, interleukin-6, inducible nitric oxide synthase, and cyclooxygenase-2, and upregulation of an angiogenic marker vascular endothelial growth factor in wound tissue treated with various doses of aqueous fraction of M. oleifera. The findings suggest that aqueous fraction of M. oleifera containing Vicenin-2 active compound may accelerate wound healing in hyperglycemic condition.

Plasma Medicine: Novel Technique for Treatment of Chronic Wound

Therefore, the burden of diabetic foot ulcers is significantly increasing and it is now considered as a leading cause of infection, amputation, and hospitalization in patients with diabetes mellitus [3]. Management of foot ulcers remains a major health challenge and different treatment options are currently available for it. Therefore, it seems necessary that the effectiveness of different treatment options should be rigorously assessed. Currently, several different interventions for treatment of DFUs are available such as: wound debridement, antibiotics, different wound dressings, topical negative pressure, hyperbaric oxygen treatment, electrical interventions, electromagnetic options, laser, shockwave, and ultrasound therapies, growth and cell biology factors, cell products and tissue engineering, bioengineered skin and skin grafts, and adjuvant therapies [4]. As a result of interdisciplinary approaches in medicine, physics, chemistry, biology and microbiology, plasma medicine has emerged as an innovative and dynamic field of research in the recent years.