Incidence Of Diabetic Foot Ulcers Research Articles

Foot thermometry with mHeath-based supplementation to prevent diabetic foot ulcers: A randomized controlled trial

Background: Novel approaches to reduce diabetic foot ulcers (DFU) in low- and middle-income countries are needed. Our objective was to compare incidence of DFUs in the thermometry plus mobile health (mHealth) reminders (intervention) vs. thermometry-only (control). Methods: We conducted a randomized trial enrolling adults with type 2 diabetes mellitus at risk of foot ulcers (risk groups 2 or 3) but without foot ulcers at the time of recruitment, and allocating them to control (instruction to use a liquid crystal-based foot thermometer daily) or intervention (same instruction supplemented with text and voice messages with reminders to use the device and messages to promote foot care) groups, and followed for 18 months. The primary outcome was time to occurrence of DFU. A process evaluation was also conducted. Results: A total of 172 patients (63% women, mean age 61 years) were enrolled; 86 to each study group. More patients enrolled in the intervention arm had a history of previous DFU (66% vs. 48%). Follow-up for the primary endpoint was complete for 158 of 172 participants (92%). Adherence to ≥80% of daily temperature measurements was 87% (103 of 118) among the study participants who returned the logbook. DFU cumulative incidence was 24% (19 of 79) in the intervention arm and 11% (9 of 79) in the control arm. After adjusting for history of foot ulceration and study site, the hazard ratio (HR) for DFU was 1.44 (95% CI 0.65, 3.22). Conclusions: In our study, conducted in a low-income setting, the addition of mHealth to foot thermometry was not effective in reducing foot ulceration. Importantly, there was a higher rate of previous DFU in the intervention group, the adherence to thermometry was high, and the expected rates of DFU used in our sample size calculations were not met. Trial registration: ClinicalTrials.gov NCT02373592 (27/02/2015).

Foot practices in patients with type 2 diabetes: Where do we stand?

Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored <50% had poor knowledge and practices of foot care. Results: A total of 358 patients were included in the study. Out of which 243 were male and 115 were female. The average age was 54.43 ± 11.4 years, and the mean duration of diabetes was 13.35 ± 8.30 years, and the mean HbA1c was 9.60 ± 2.30. All the patients included were of type 2 diabetes mellitus. Out of the total respondents, 153 (43.2%) respondents had never received any foot care education from any healthcare professional prior to the development of ulcer and presenting to this institute, ten (0.8%) had received some information of foot care from print or electronic media or through family and friends, whereas 191 (54%) received foot care education formally by a health care professional. Only 148 (41.6%) got their feet examined by some healthcare professional before developing foot ulcer, while 196 (55.1%) never got their feet examined before presenting to this institute. Overall, 7% of the study participants had good foot care knowledge and practices, 55.3% had average and 37.7% had poor foot care knowledge and practices. Conclusion: Knowledge and practices of foot care were found to be unsatisfactory in most of the patients. This is of utmost importance to introduce foot care education programs at primary as well as tertiary care level with regular periodic physician reinforcement to reduce the incidence of diabetic foot ulceration and amputations.

Diyabetik Ayağın İyileşmesinde Beslenme Tedavisinin Rolü Var mı?

Tüm dünyada diyabetli hasta sayısı giderek artmakta ve buna eşlik eden komplikasyonların özellikle de diyabetik ayak ülseri (DAÜ) insidansı artmaktadır ki diyabet ile ilişkili ayak komplikasyonları en yaygın morbidite sebebidir. DAÜ’ye bağlı komplikasyonların yıllık insidansı %2’dir. DAÜ’nin tedavisi ve izlemi, hastanın yaşam kalitesinin arttırılması, infeksiyonun kontrol edilmesi, ampütasyon riskinin azaltılması ve ülkede ekonomik yükünün azaltması gibi sebeplerden dolayı önemlidir. Etkin diyabet yönetimi ile DAÜ komplikasyonlarını geciktirmek veya önlemek mümkündür. Tedavi ve önlemde ki hedefler; hasta eğitimi, iyi metabolik kontrol, risk faktörleri olan hastaların saptanması ve tedavisidir. Diyabetli bireyde yara iyileşmesi bozulmuştur. DAÜ, inflamatuvar cevabın uzaması, matriks yenilenmesinin gecikmesi ile karakterizedir. DAÜ’nün iyileşmesinin gecikmesi, tekrarlayan infeksiyonların varlığı, hastaneye yatış sıklığının artması morbidite ile ilişkilidir. Bu başarısızlığı önlemek için tedavide multidisipliner yaklaşım önemlidir. DAÜ’de yara iyileşmesinde glisemik kontrolü sağlamak için medikal tedavilerle birlikte tıbbı beslenme tedavisi gerekmektedir. Beslenme tedavisindeki önceliğin ve beslenme desteği gereksiniminin belirlenmesinde beslenme durumunun değerlendirilmesi önem taşımaktadır. Besin ögelerinin alımının yetersiz olması inflamatuvar sürecin uzamasına, fibroblast proliferasyonunun azalmasına ve kollajen sentezinin bozulmasına neden olarak yara iyileşmesini geciktirmektedir. Malnutrisyon varlığı da yara iyileşmesini olumsuz etkiler. DAÜ’lü hastaların %84.8’inde beslenme durumunun bozulmuş olduğu gösterilmiştir. DAÜ’nün şiddeti ve bununla ilişkili inflamatuvar yanıt, besin ögesi eksikliklerini şiddetlendiren negatif protein metabolizmasıyla ilişkilidir. Optimal beslenmedeki amaç yara iyileşmesinin sağlanmasıdır. Beslenme durumunun düzeltilmesinde enerji, makro ve mikro besin ögeleri eksiğinin tamamlanması yara iyileşme sürecini olumlu etkilemektedir. Besin ögesi takviyesi tamamlayıcı terapötik bir önlem olabilir. DAÜ’leri tedavi etmek için kanıta dayalı bir kılavuz bulunmamaktadır. Bağışıklık fonksiyonunu etkileyen, yetersiz beslenme ve kötü glisemik kontrole neden olan risk faktörleri beslenme tedavisi ile iyileştirilebilir. Sonuç olarak, yeterli enerji, protein, vitamin ve mineral alımı sağlayan beslenme tedavisi, bağışıklık fonksiyonunu en üst düzeye çıkarmaya yardımcı olabilir. DAÜ’lü hastalar sağlıklı beslenmeye teşvik edilmelidir.

Relationship of visual impairment and peripheral artery disease with the occurrence of diabetic foot ulcers in Dr. Moewardi Hospital

Abstract Objective One of the diabetes mellitus (DM) complications is foot ulcers. Foot ulcers are influenced by many factors. DM puts patients at risk of injury because of visual impairment. Hyperglycemia can damage blood vessels, which results in peripheral artery disease (PAD). The purpose of this study was to find the relationship of visual impairment and PAD with diabetic foot ulcers. Methods This research used observational analytic study with case–control methods. It used purposive sampling in 34 DM patients with foot ulcers and 34 DM patients without foot ulcers. The research instruments were an interview guide to assess visual impairment, physical examination to assess PAD, and documentation study, which was used to know the incidence of diabetic ulcers. Results The results showed that the respondents who experienced ulcers with visual impairment were 44.1% and the respondents who had foot ulcers with PAD were 73.5%. The results of statistical tests showed that there was no relationship between visual impairment and the incidence of ulcers (P = 0.166). The respondents with PAD will have a chance to suffer from foot ulcers 5.808 times higher than those who do not have PAD. Conclusions There is no relationship between visual impairment and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital, but there is relationship between PAD and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital. Suggestions of this study are to do foot screening and educate about the importance of foot care to prevent the occurrence of diabetic ulcers.

Management of Diabetic Foot Ulcer in a Tertiary Level Hospital-Faridpur

A descriptive type of cross sectional study among 210 diabetic patients with foot ulcer was carried out in Diabetic Association Medical College during the period of May 2016 to April 2017 and were categorized based on Meggitt-Wagner system to find out the complications, management, below knee amputation rate and mortality rate. The aim of this study was to practise a profile of diabetic foot ulcer (DFU), complications and its management to assess the outcome of the surgical interventions. Majority of the patients were male 112(53%), and most of them 116 patients (55.23%) presented within Wegner grade - 2 and grade-3 diabetic foot ulcers. The duration of diabetes more than 10 years was 116 (55%). 99 (47%) patients out of 210 patients developed diabetic neuropathy. 76 (36%) patients presented with CKD. Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center, associated habit of smoking are all factors which lead to incidence of DFU at an earlier age than that seen in other studies. After admission of diabetic foot ulcer patients, diabetic foot ulcer is classified according to Wagner grading and treated the diabetic foot ulcer patients as the using protocol ’!1.Assesment whether it was conservative or surgical. 2. Optimal blood sugar control. 3. Systemic antibiotic. 4. Moist wound environment. 5. Offloading such as total contact casting. 6. Improves peripheral arterial circulation due to lack of vascularity. 7. Surgical debridement or minor amputation or major amputation. In case of G-4 or G-5 patients, ischemia was treated before debridement or amputation so that vascular circulation improved in the ulcer area and then healing potential was fastened.&#x0D; Bangladesh Heart Journal 2019; 34(1) : 52-57

Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study.

AimsTo ascertain the effects of improvements in diabetic foot services over 18 years on incidence of diabetic foot ulceration. We also compared survival time from first ulcer development with presence of neuropathy, peripheral vascular disease, age and healing.MethodsPersons with new ulceration and those at high risk of ulcer development were referred to community podiatry from 1998. Their details were recorded, with verbal consent, on a central database. The effects of neuropathy, peripheral vascular disease, healing and age on survival were analysed by Cox proportional hazards ratios.ResultsThe incidence of first ulcer presentation decreased from 11.1 to 6.1 per 1000 persons between 2003 to 2017 (P <0.0001). Recurrent ulceration incidence remained stable. Prevalence of chronic and new foot ulceration combined increased from 20.7 to 33.1 per 1000 persons (P <0.0001). Ten‐year survival was 85% for persons presenting with first ulcer and aged < 65 years, 50% for those aged 65–74 years and 25% for those aged 75–81 years (P < 0.0001). In those with peripheral vascular disease 5‐year survival was 35% (P <0.001).ConclusionsIntegrated care for the diabetic foot in one National Health Service (NHS) health service area over 18 years was associated with a reduction in first presentations of diabetic foot ulceration, but failed to reduce recurrent ulceration. Cumulative prevalence of all ulcers continues to increase. Monitoring ulceration incidence can inform audit and planning of diabetic foot care services. Survival is better than reported previously in persons < 65 years and in the absence of peripheral vascular disease.

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.

The effect of transitional care on the prevention of diabetic foot ulcers in patients at high risk for diabetic foot

To study the effect of transitional care on the prevention of diabetic foot ulcers (DFU) in patients at high risk for diabetic foot. A total of 284 diabetic patients at high risk for DFU were randomly divided into case and control groups (142 cases in each group). The control group was provided with conventional care in hospital. The case group received the transitional care intervention, including individualized education about diabetes mellitus and DFU, instruction in foot care, and the assistant management of calluses and the evaluation on quality of life. Both groups were followed up for 2 years. The levels of blood glucose, blood pressure and serum lipids, and foot dorsal artery pulse, 10-g monofilament nylon fiber probe test, knowledge of foot care, and diabetes quality of life (DQOL) in two groups were compared before and after transitional care intervention. There were statistically significant improvements in the case group compared with the control group in plasma glucose and blood pressure levels, and in foot dorsal artery pulse, 10-g monofilament nylon fiber probe test, knowledge of foot care, and DQOL. The incidence of DFU was lower, and the ulcers also were milder in the case group than in the control group. Transitional care was beneficial to the prevention of DFU and could reduce the development of DFU and improve the patients’ quality of life.

Accuracy of Daily Foot Temperature Monitoring for Patients with Recently Healed Diabetic Foot Ulcers or History of Amputation

Diabetic foot ulcers (DFU) result in significant morbidity, mortality, and healthcare costs. Fortunately, recent data suggest as many as 75% of DFU and 60% of lower extremity amputations (LEA) may be preventable. Clinical practice guidelines recommend evidence-based foot temperature monitoring (thermometry) for preventing DFU and its complications in high-risk patients. Despite this, several authors have noted that thermometry is not commonly practiced. This is potentially due to lack of evidence on the accuracy of thermometry in some of the highest-risk cohorts, including those with a recently-healed DFU or with history of LEA. The former may present with ipsilateral inflammation as part of normal healing, while the latter may lack the anatomy required for direct contralateral comparison of temperatures. Whether these concerns affect the accuracy of thermometry needs to be assessed. A recent study suggests that a novel thermometric mat may address some barriers to adoption. The mat was found to predict as many as 97% of non-traumatic plantar DFU with an average lead time of five weeks in a cohort with history of DFU. In the current investigation, we hypothesized no difference in the predictive accuracy of thermometry in two subgroups: those who healed from a DFU fewer than three months before enrolling, and those with a history of partial LEA (Syme amputation or more distal). Of the 129 subjects studied, 31% had recently-healed DFU and 56% had history of LEA. Although no difference in DFU incidence was found in the LEA subgroup, we found significantly higher incidence in those with recently-healed DFU (0.88 vs. 0.63 DFU/subject/year). Importantly, we found no differences in accuracy or lead time in either cohort. These data suggest thermometry is appropriate for monitoring both recently-healed DFU or partial LEA patients. Utilization of thermometry in these high-risk patients may significantly reduce morbidity, mortality, and resource utilization. Disclosure I.L. Gordon: None. A. Nouvong: None. B. Najafi: None. G.M. Rothenberg: Consultant; Self; Podimetrics. B. Petersen: Employee; Self; Podimetrics, Inc.. Stock/Shareholder; Self; Podimetrics, Inc. J.D. Bloom: Employee; Self; Podimetrics, Inc. Board Member; Self; Podimetrics, Inc. Stock/Shareholder; Self; Podimetrics, Inc. R. Frykberg: None.

A study of aerobic bacterial culture and antibiotic susceptibility pattern of diabetic foot ulcer

Background: Diabetes mellitus is a chronic disorder that affects large segments of the population in the whole world.Aim: The aim of the study was to isolate and identify aerobic bacteria from diabetic foot ulcers (DFU) and to determine their antibiotic susceptibility pattern. The reason for the increased incidence of DFU involves the interaction of several pathogenic factors such as neuropathy, abnormal foot ulcer, and peripheral arterial diseases.Materials and Methods: A prospective study was conducted for a period of 6 months in Sir Sayajirao General Hospital and Medical College, Vadodara, Gujarat. 175 DFU patients attending the surgery ward were included in the study. Two swabs were taken from each patient and processed by standard techniques to isolate and identify various bacterial species. Antibiotic susceptibility testing was done by Kirby-Bauer’s disc diffusion method for all the aerobic bacterial isolates.Results: It was observed from the result that common pathogens isolated from the DFU were Klebsiella species and acinetobacter followed by Pseudomonas and Proteus species, as well as Escherichia coli. Pseudomonas species, isolates were highly resistant to most tested antibiotics except piperacillin-tazobactam, levofloxacin, and meropenem. Cefoperazone-sulbactam and levofloxacin are more active against E. coli followed by gentamycin. Ofloxacin is more active against Staphylococcus aureus followed by gentamycin and cefoxitin. Cefoperazone-sulbactam is active against Proteus mirabilis followed by piperacillin-tazobactam.Conclusion: This study concludes that DFU infection is mostly polymicrobial in nature and appropriate antibiotic therapy is required for treatment of DFU.

Incidence of diabetic foot ulcer in Japanese patients with type 2 diabetes mellitus: The Fukuoka diabetes registry

AimsAlthough diabetic foot ulcer (DFU) is a serious diabetic complication, there have been no large-scale epidemiological studies of DFU in Japan. We prospectively investigated the incidences of DFU and limb amputation, the risk for developing DFU, and mortality in Japanese patients with type 2 diabetes. MethodsWe followed 4870 participants (mean age, 65 years) with type 2 diabetes attending an outpatient diabetes clinic for a median of 5.3 years (follow-up rate, 97.7%). The primary outcome was the development of DFU. ResultsDuring the follow-up period, DFU occurred in 74 participants (incidence rate, 2.9/1000 person-years) and limb amputation in 12 (incidence rate, 0.47/1000 person-years). DFU recurrence was observed in 21.4% of participants with history of DFU. History of DFU, chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2), depressive symptoms, and poor glycemic control were significant risk factors for developing DFU. Survival was significantly lower in participants with DFU and/or history of DFU compared with those without (5-year survival rates: with DFU, 87.7%, without DFU, 95.3%; P < .0001). The hazard ratio for death was 1.80 (95% confidence interval, 1.13–2.73, P = .014) in those with DFU and/or history of DFU in a multi-adjusted model. The most common cause of death was cardiovascular disease among participants with DFU, whereas it was malignant neoplasm among those without. ConclusionsIncidences of DFU and limb amputation were 0.3% and 0.05% per year in this Japanese cohort, respectively. Mortality significantly increased approximately 2-fold in those with DFU and/or history of DFU compared with those without.

Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study

Aim/Introduction This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89–8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13–43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37–14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33–7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40–8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10–8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait.

ABSTRACT Objective: This single-centred study aims to evaluate the incidence, risk factors and treatment outcomes of a podiatry led, evidence-based diabetic foot ulcer (DFU) clinic. Research design and methods: Data from the DFU database and patient electronic health records were retrospectively collected from patients with new DFUs who were referred for treatment to the Department of Podiatry, Dasman Diabetes Institute, Kuwait, from 1 October 2014, to 31 December 2016. Patients were followed-up until healing occurred or until 6 months after the study end date, whichever came first. Results: All data were analysed using IBM SPSS version 24 software. Data were collected from 230 patients with 335 DFUs. Most DFUs (67%) were present for <3 months from the time of the first podiatry appointment. A total of 56% of DFUs were classified as neuropathic. Most (72%) DFUs healed, with a median healing time of 52.0 days. Chronic kidney disease (p = 0.001), retinopathy (p = 0.03), smoking (p = 0.02), ulcer location (p = 0.03), peripheral arterial disease (PAD) (p = 0.004) and osteomyelitis (p = 0.05) were found to have a meaningful association with DFU outcome. The number of days to heal was associated with ulcer classification (p = 0.005), bacterial infection (p = 0.002), osteomyelitis (p = < 0.001) and PAD (p = < 0.001). Conclusions: The incidence of new DFUs in our tertiary clinic is 3.4%. The incidence of diabetic foot ulceration, days to heal, healing rate and the risk factors influencing healing are in accordance with other multidisciplinary facilities with podiatry input.

The prevalence and incidence of diabetic foot ulcers among five countries in the Arab world: a systematic review.

There is a rising incidence of diabetes worldwide; however there seems to be a higher incidence and prevalence rates in the Arab world when compared with the global average. 1 Out of the top 10 countries with the highest prevalence rates, six are Arab countries and almost 20.5 million people in that part of the world live with diabetes. Despite this, published scientific research from the 22 Arab countries is limited and seems to be of lower quality when compared with the rest of the developed world. 2 Therefore, our aim was to explore the contribution of the different Arab countries in the world literature, to identify the diabetic foot ulcer (DFU) prevalence and incidence rates and to quality appraise these studies. A systematic review, following PRISMA guidelines, was undertaken to identify the incidence and prevalence of DFUs in the Arab world. The following databases were searched: PubMed, Embase CINAHL, Web of Science (Scopus), Global Health and EBSCO Results: A total of nine papers were identified. The mean prevalence of DFU in Saudi Arabia was 11.85% (4.7-19%), in Egypt was 4.2% (1-7.4%), in Jordan was 4.65% (4-5.3%), in Bahrain was 5.9% and in Iraq was 2.7%. A single study identified DFU incidence in Saudi Arabia as 1.8% between 2009-2010. The mean prevalence rates of DFU were highest in Saudi Arabia and Bahrain and lowest in Iraq. Saudi Arabia had the only reported incidence study, thus findings could not be compared to other countries of the Arab world. There were no studies identified during our search reporting prevalence rates of DFU in 17 of the 22 Arab countries. It is clear that further research is required to determine the incidence and prevalance of DFUs in the Arab world and that progress is needed in order to improve the quality of research conducted in those countries.

Decreasing incidence of foot ulcer among patients with type 1 and type 2 diabetes in the period 2001-2014.

Diabetic foot ulcer (DFU) is a serious complication to diabetes. The aim was to study the incidence of first DFU among patients with type 1 (T1DM) and type 2 diabetes (T2DM), stratified according to etiology: neuropathic, neuro-ischemic or ischemic, over a period of 14years (2001-2014). DFU incidence rates were calculated from electronic patient record data from patients with T1DM and complicated T2DM from a large specialized diabetes hospital with a multidisciplinary foot clinic in Denmark. Poisson regression was used to model incidence of first DFU according to calendar year, diabetes type and etiology. Among 5640 patients with T1DM 255 developed a DFU, corresponding to an incidence of 5.8 (95% confidence interval (95%CI) 5.1-6.5) per 1000 patient years; this incidence dropped from 8.1 (95%CI 5.4-11.9) per 1000 patient years in 2002 to 2.6 (95%CI 1.3-5.3) in 2014 (p=0.0059). Among 6953 patients with T2DM 310 developed a DFU, corresponding to an incidence of 11.3 (95%CI 10.1-12.6) per 1000 patient years; this incidence dropped from 17.0 (95%CI 12.2-23.8) per 1000 patient years in 2002 to 8.7 (95%CI 5.3-14.1) per 1000 patient year (p=0.0260) in 2014. The incidence of DFU has decreased substantially in T1DM as well as in T2DM. This change was driven by a decrease in incidence of neuropathic ulcers.

A medical thermal imaging device for the prevention of diabetic foot ulceration

In this paper a description is given of the development, characterisation and first results of a thermal imaging device aimed at significantly reducing the incidence of diabetic foot ulceration (DFU). These devices will be used in three clinical centres and in two preliminary clinical trials. The first will be on healthy volunteers to set a robust baseline for the overall research aims and the second on >100 patients at high risk of DFU. In the second phase of the project the objective is to demonstrate significant reduction in the incidence of DFU through a comparison of the results of standard care of high risk feet with standard care plus thermal imaging.

A retrospective study of management of diabetic foot ulcer in tertiary care hospital in North Karnataka

Background: Foot ulcers and amputations are a major cause of morbidity as well as emotional and physical disability for people with diabetes. A cumulative life time incidence of diabetic foot ulcer (DFU) is as high as fifteen percent making it a leading cause of non-traumatic amputations worldwide. The objective of the study was to assess the outcome of diabetic foot ulcer based on Meggitt-Wagner classification system.Methods: It was a retrospective review of 130 patients with diabetic foot ulcer managed at a tertiary care teaching hospital from January 2010-August 2016 in Bagalkot, North Karnataka, India.Results: In this study most of the patients were in the age group of 51-60 years, most of them being male 85%, 49.23% of patients with ulcers were over the plantar aspect of the foot and 40% of ulcers were Grade 2. 11.53% of patients required disarticulation of toes. 3.07% of patients required below knee amputation and 2.30% of patients require above knee amputations. 42.30% of the patients had peripheral neuropathy and 12.30% of the patients had associated peripheral arterial disease.Conclusions: Even though Meggitt-Wagner classification system is considered Gold Standard it has many disadvantages. The neuropathic changes, charcoats osteoarthropathy and associated vascular pathology has not taken into consideration, hence the outcome of the ulcer cannot be predicted.

A model to estimate cost-savings in diabetic foot ulcer prevention efforts

BackgroundSustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. MethodsA Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. ResultsPP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. ConclusionsLow-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential.

The diabetic foot

A comprehensive program focused on foot-specific patient education, skin and nail care, and protective footwear lowers the incidence of diabetic foot ulcers and lower extremity amputations. Orthopedic or podiatric consultations are warranted for those “at risk” or with foot ulcers.

National Diabetes Foot Care Audit results: initial steps identify areas of current need

National Diabetes Foot Care Audit results: initial steps identify areas of current need