Burden Of Diabetic Foot Ulcers Research Articles

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.

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers. Diabetes Care 2014;37:651–658

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers. Diabetes Care 2014;37:651–658

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers

To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs). DFU patients and non-DFU patients with diabetes (controls) were selected using two de-identified databases: ages 65+ years from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, January 2007-December 2010) and ages 18-64 years from a privately insured population (OptumInsight, January 2007-September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts. Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having $11,710 in incremental annual health care costs for Medicare, and $16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of $3,259. These findings document that DFU imposes substantial burden on public and private payers, ranging from $9-13 billion in addition to the costs associated with diabetes itself.

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India

Background:The burden of diabetes and its foot complications is increasing in India. Prevention of these complications through foot care education should be explored. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients.Materials and Methods:A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. Individual and group health education focusing on foot care was performed. Foot care practice was reassessed after 2 weeks of education.Results:Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. Only 22% of the patients had their feet examined by a health worker or doctor. The patients with poor, satisfactory and good practice scores were 44.7%, 35.9% and 19.4% respectively. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. Average score for practice of foot care improved from 5.90 ± 1.82 to 8.0 ± 1.30 after 2 weeks of health education. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally.Conclusion:Foot care education for diabetics in a primary care setting improves their foot care practice and is likely to be effective in reducing the burden of diabetic foot ulcer.

The burden of diabetic foot ulcers

Lower extremity ulcers represent a major concern for patients with diabetes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown that patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majority of costs occur in the inpatient setting, (2) a lack of financial benefit when comparing primary amputation with an aggressive approach to limb salvaging including vascular reconstruction, and (3) private insurance provides greater reimbursement for inpatient care than does Medicare. Results of etiologic studies suggest that hyperglycemia induces diabetes-related complications through sorbitol accumulation and protein glycation, and the resultant nerve damage manifests as peripheral neuropathy, which predisposes to ulcer development. Patients with diabetes also have an increased incidence of peripheral vascular disease, impaired wound healing, and decreased ability to fight infection. In light of these factors, it is sometimes difficult to determine the optimal course for patient management. This review is aimed at helping healthcare providers make better decisions about treatment, resource use, and strategies for future foot ulcer prevention.

Evaluation and audit in a paediatric disability service.

Parental and professional responses to questionnaires evaluating a paediatric disability service are reported and the viability of auditing structural, process, and outcome aspects of clinical practice are discussed. Expectations of waiting time to first appointment (met for only 52% of consumers) illustrate structural issues. Process issues are reflected in consumer reactions to outreach work (for example, 94% of parents and 84% of professionals found this supportive). Outcome measures such as consumer satisfaction with the service (76% of consumers reported being 'very satisfied' and 20% 'fairly satisfied') suggest that service aims are being met. Good concurrence of service aims with consumer needs is indicated by parental reasons for referral (for example, 75% for diagnostic help, 73% for a better understanding of the disorder, 88% for practical help), referrers' reasons (for example, 55% for a second diagnostic opinion, 45% due to lack of local expertise), and reports from most other professionals involved with the case that a similar service was not provided locally.