Incidence Of Diabetic Foot Ulcers Research Articles

The effect of long-term glycemic burden on the incidence of diabetic foot ulcers: A retrospective study

BackgroundThis study aimed to examine the association between mean cumulative glycemic burden (MCGB) and variability cumulative glycemic burden (VCGB) with diabetic foot ulcers (DFUs). MethodsParticipants were followed up at least 4 times with 4 recorded glycosylated hemoglobin (HbA1c) measurements. Glycemic burden during follow-up period was defined as the trapezoidal areas enclosed by the HbA1c measurements taken during two consecutive visits and the responding time interval. MCGB was calculated by dividing sum of total trapezoidal areas by the period of follow-up. VCGB was defined as the standard deviation of the trapezoidal areas divided to the mean of trapezoidal areas. To identify the association between MCGB and VCGB with DFUs, a Cox regression analysis was conducted. ResultsAmong 1876 diabetic patients, 138 (7.4 %) developed foot ulcers. As MCGB increased across quartiles, DFUs incidence also rose significantly (3.2 % to 16.0 %, P < 0.001). Similarly, the prevalence of DFUs increases with increasing quartiles of mean HbA1c level (3.2 % to 16.2 %; P < 0.001). When assessing VCGB, ulcer incidence gradually increased with the quartiles increased (P = 0.040), but HbA1c variability did not follow a similar trend (P = 0.133).Multivariable Cox regression analysis indicates that compared to the first quartile, both MCGB and VCGB in the fourth quartile significantly increase the risk of DFUs (HR = 2.99 and 5.29, respectively). ConclusionsElevated MCGB and VCGB correlate positively with DFUs. In clinical practice, lowering blood glucose levels and reducing glycemic variability are both crucial for reducing the occurrence of diabetic foot ulcers.

Walking On Thin Ice: Understanding and Preventing Diabetic Foot Ulcers

Diabetic foot ulcers (DFU) are a serious side effect of diabetes that frequently results in amputations, extended hospital stays, and infections. Peripheral artery disease (PAD), neuropathy, smoking, long-term diabetes, foot abnormalities, and a history of ulcers or amputations all raise the chance of developing DFUs. Usually, a combination of Gram-positive and Gram-negative bacteria, anaerobes, and fungi cause the infections in DFUs. Comprehensive care, such as blood glucose management, lifestyle modifications, routine foot assessments, appropriate footwear, and patient education, is the focus of prevention initiatives. For people who are at risk of DFUs, wearing shoes that fit properly, abstinence of smoking, and managing blood pressure and cholesterol are important preventive measures. the use of multiple treatments is needed for patients who already have foot ulcers. This includes debridement, pressure unloading, wound dressings, and maybe surgery. To remove necrotic tissue and to promote healing, debridement techniques include surgery, enzymatic, autolytic, and biological debridement (such as maggot therapy) are crucial. For the treatment of neuropathic ulcers, pressure modulation using methods such as total contact casts (TCC) is potential. Numerous cutting-edge wound dressings, such as hydrogels, hydrocolloids, and dressings infused with silver, help control wound moisture, enhance autolysis, and fight against infection. Revascularization, nonvascular foot surgery for abnormalities, or amputation in extreme circumstances are all possible surgical therapeutic options. strategies are required for long-term prevention and care for treating both the ulcer and the underlying causes of DFU. Ultimately, lowering the incidence of DFU and enhancing patient outcomes require a mix of efficient communication, patient education, and coordinated treatment among healthcare providers

Identifying Predictors and Its Relationship with Developing of Diabetic Foot Ulcer (DFU)

Diabetic foot Ulcer is one of the severe complication of diabetes mellitus that leading to increasing serious problem. Early detection was an appropriate effort to prevent deteriorate condition. The aims of this study was to Identifying predictors of diabetic foot ulcer among type 2 diabetic patients through a scoping review. This study design is a scoping review using journal database with entering keyword predictors, diabetic foot ulcer, diabetic patient. Articles selected were met its inclusion criteria. The result showed that 17 articles included from 170 articles, from which 8 articles are cross-sectional studies, 7 articles are retro-spective studies, as well as 2 articles are systematic review. The incidence of diabetic foot ulcer reached more than 11,6%, from which dominated by grade 1 and grade 2 DFU, The significant predictors of diabetic foot ulcer classified into three categories including diabetes complications, demografic characteristic, and self-care behavior. Peripheral arterial disease (PAD) as the dominant predictor of diabetes complication, duration of diabetes &gt;10 years as the dominant predictor of demografic characteristic, and low diabetic foot-care practice as the dominant predictor of self-care behavior. Reducing impact of DFU could be achieved by optimizing self-care behavior through appropriate diabetic-care and foot-care management based on patients characteristic and diabetes complications.

6909 Mortality and Readmission Rates for Inpatients with Diabetic Foot Ulcer in a Tertiary, Urban Medical Center: A Five-Year Retrospective Review

Abstract Disclosure: A. Herrera Chancay: None. R. Lopez Fanas: None. H. Tabassum: None. J. Daily: None. A. Myers: None. Background: Diabetic Foot Ulcer (DFU) is a severe complication of diabetes mellitus and is associated with high rates of morbidity and mortality. The incidence of DFUs and amputation disproportionately impact Black and Hispanic populations. DFU is also associated with a high rate of hospital readmissions and prolonged length of stay (LOS). The goal of this study was to examine 1-year mortality data, LOS and readmission rate. Methods: This study was a retrospective chart review of 1348 patients admitted to three hospitals in our system in the Bronx from 6/1/16 to 5/31/21. Data was extracted from the EPIC® electronic health records, based on the diagnoses ICD 10 codes, E10.621 and E11.622. Inclusion criteria was patients admitted with an active DFU regardless of other admission diagnosis, age 18 years or above. The index admission was defined as the first admission in our medical records within the date range. Patients were excluded if their index admission was not accessible through our EMR. Simple logistic regression and multiple logistic regression were used to analyze the association between variables of interest and mortality at index admission and at 1-year, LOS and re admissions. Results: Of the 650 eligible patients, the mean age was 59 + 13 years, 70% of patients were male, and majority were non-White (88%). Mortality was 1% during the index admission and the risk increased to 6% at 1 year after the index admission. Readmission with an active DFU from the index admission occurred in 15% of patients within 30-days, 32% of patients within 90 days, and 55% of patients within 1 year. The mean length of stay was 9 +7.5 days. Discussion: Our study in an urban region has identified high rates of mortality and costs associated with DFU, which has been reported in many settings. This patient population is high risk for poor outcomes and targeted programs are needed to reduce mortality and provide care to reduce readmissions. Future studies that explore the challenges of DFU health care and that test interventions are needed to improve DFU related health outcomes. Presentation: 6/2/2024

Performance of risk prediction models for diabetic foot ulcer: a meta-analysis.

The number of prediction models for diabetic foot ulcer (DFU) risk is increasing, but their methodological quality and clinical applicability are uncertain. We conducted a systematic review to assess their performance. We searched PubMed, Cochrane Library, and Embase databases up to 10 February 2024 and extracted relevant information from selected prediction models. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) checklist was used to assess bias risk and applicability. All statistical analyses were conducted in Stata 14.0. Initially, 13,562 studies were retrieved, leading to the inclusion of five development and five validation models from eight studies. DFU incidence ranged from 6% to 16.8%, with age and hemoglobin A1C (HbA1c) commonly used as predictive factors. All included studies had a high risk of bias, mainly due to disparities in population characteristics and methodology. In the meta-analysis, we observed area under the curve (AUC) values of 0.78 (95% CI [0.69-0.89]) for development models and 0.84 (95% CI [0.79-0.90]) for validation models. DFU risk prediction models show good overall accuracy, but there is a risk of bias. Adherence to the PROBAST checklist is crucial for improving their clinical applicability.

Incidence and predictors of diabetic foot ulcer among patients with diabetes mellitus in a diabetic follow-up clinic in Central Ethiopia: a retrospective follow-up study

BackgroundDiabetic foot ulcer is a major medical, social, and economic problem, and a leading cause of hospitalisations, increased morbidity, and mortality. Despite a rising occurrence, there is a dearth of...

Penerapan Terapi Hiperbarik Oksigen Terhadap Penyembuhan Luka Pada Pasien Ulkus Kaki Diabetik: Studi Literatur

Background: Diabetic foot ulcers are advanced complications experienced by people with diabetes mellitus that have a negative impact and must be treated immediately. One method that can be done to overcome the incidence of diabetic foot ulcers is hyperbaric oxygen therapy. This therapy is known to facilitate wound healing by improving wound tissue perfusion, increasing fibroblast replication and collagen production and increasing phagocytic ability. Purpose: The purpose of this study was to determine the application of hyperbaric oxygen therapy to wound healing in diabetic foot ulcer patients. Methods: The method used in this writing is literature review, with secondary data obtained from previous research with empirical studies of the last 10 years, data sources are accessed through the google scholar database, by taking journals that are relevant to the research topic. Results: This study shows that the results that have been carried out on the administration of hyperbaric oxygen therapy to diabetic foot ulcers, show the ability to heal wounds in a fast time and more effective results. Conclusion: Based on the results of literature review research by collecting several journals, it is concluded that the management of hyperbaric oxygen therapy in diabetic foot ulcer patients is more effective, cost-effective, and increases the prevalence of wound healing.

Exploring the influence of dietary habits on foot risk in type 2 diabetes patients: An observational study

Background & AimTo date, there are no studies demonstrating the impact of the Mediterranean diet on the risk of diabetic foot ulcer. The aim of this research was to examine the connection between adherence to the Mediterranean diet and the level of risk of diabetic foot ulcers in individuals with type 2 diabetes. MethodsObservational pilot study collecting sociodemographic, anthropometric, lifestyle, and type 2 diabetes-related data. Loss of protective sensation was assessed using the Semmes Weinstein 5.07-10g monofilament, considered altered when not perceived in four points. Vascular status was assessed by palpating pulses and ankle-brachial index, indicating peripheral arterial disease if ankle-brachial index was less than 0.9 or if both pulses were absent. Foot deformities were recorded. The risk of diabetic foot ulcers was stratified into two categories: no risk and risk of diabetic foot ulcers. Adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener-14 questionnaire (good adherence with score > 7). ResultsOf the 174 patients with type 2 diabetes mellitus who participated (61.5% men and 38.5% women) with a mean age of 69.56 ± 8.86 years and a mean duration of type 2 diabetes of 15.34 ± 9.83 years. Non-adherent patients to the Mediterranean diet exhibited a higher association of diabetic foot ulcers (p=0.030) and a lower average score on the Mediterranean Diet Adherence Screener-14 (p=0.011). Additionally, a lower incidence of diabetic foot ulcers was observed in those who consumed nuts three or more times a week (p=0.003) and sautéed foods two or more times a week (p=0.003). Multivariate analysis highlighted the importance of physical activity (OR=0.25, 95% CI 0.11-0.54; p<0.001), podiatric treatment (OR=2.59, 95% CI 1.21-5.56; p=0.014), and duration of type 2 diabetes (OR=3.25, 95% CI 1.76-5.99; p<0.001) as significantly associated factors related to the risk of diabetic foot ulcers. ConclusionsAdhering to the Mediterranean diet correlates with a lower incidence of diabetic foot ulcers in individuals diagnosed with type 2 diabetes mellitus. Furthermore, factors such as regular physical activity, podiatric treatment, and the duration of type 2 diabetes mellitus emerge as pivotal in preventing diabetic foot ulcers.

Two-year incidence and risk factors of diabetic foot ulcer: second phase report of Ahvaz diabetic foot cohort (ADFC) study

Aim/IntroductionThis study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU).Materials and methodsThe study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression.ResultsWe followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066].ConclusionOverall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity.

Hubungan Perawatan Kaki Dengan Resiko Kajadian Ulkus Kaki Diabetik Pada Penderita Diabetes Melitus Di Wilayah Kerja Puskesmas Sukabumi

Background: Diabetes Mellitus (DM) is a chronic, progressive disease characterized by the body's inability to metabolize carbohydrates, fats and proteins, leading to hyperglycemia (high blood sugar levels). Diabetes Mellitus can be associated with serious complications such as kidney damage, eye problems, cardiovascular disease, nerve damage and skin and foot problems, so DM sufferers need to take precautions to avoid complications. There are several ways to prevent diabetic ulcers, several things that families and patients can do independently, checking the condition of the feet every day for Diabetes Mellitus sufferers needs to be done once a day to detect abnormalities such as redness, blisters, cracked skin, swelling and pain. Objective: To determine the relationship between foot care and the incidence of diabetic foot ulcers in diabetes mellitus sufferers in the Sukabumi Health Center Working Area. Method: The method used in this research is the Descriptive Analytical method with a cross-sectional approach. The samples used were 69 patients suffering from diabetes who were at risk of diabetic foot ulcers in the Sukabumi Community Health Center Working Area. Results: Based on the results of statistical tests with chi-square, the resulting P value was 0.000 &lt; 0.05, which can be concluded that there is a relationship between foot care behavior and the incidence of diabetic ulcers in diabetes mellitus sufferers in the Sukabumi Community Health Center Working Area. Conclusion: it can be concluded that there is a relationship between foot care behavior and the incidence of diabetic ulcers in diabetes mellitus sufferers in the Sukabumi Health Center Work Area. Suggestion: DM sufferers are expected to be disciplined in caring for their feet even though diabetic foot ulcers have not yet occurred and families with diabetes are able to get involved and help if the patient has a serious ulcer, without having to visit health personnel.

Facilitating Healing in Diabetic Foot Ulcers Using Homeopathy in a Multi-Disciplinary Integrative Approach: Two Evidence-Based Case Reports.

A rising incidence of diabetic foot ulcers (DFUs) in India has escalated the rate of lower limb amputations in the country. The present study aims to evaluate the potential healing properties of homeopathic medicines as a part of the integrative management of DFUs through two evidence-based case reports. Two patients with DFUs, identified as Wagner grade 2, having had diabetes for 12 years, were treated with individualized homeopathic medicine within a multi-disciplinary approach. Both cases were on oral hypoglycemic agents for managing blood sugar, continued their diabetic medication, and were advised to use regular wound dressings. The DFUs were assessed using the Pressure Ulcer Scale for Healing (PUSH) score at baseline and every 4 weeks until complete wound healing. Neuropathic changes were evaluated by the 10g monofilament tactile test, and the Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory (MONARCH) tool was used to assess the likelihood of there being a causal relationship between clinical improvement and the homeopathic intervention. The DFUs showed healing within 12 weeks, with a significant improvement in the PUSH score, though there was no change in tactile sensation as assessed by the monofilament test. The MONARCH tool yielded +9 in both cases, indicating the likelihood of a causal relationship between the clinical outcome and homeopathic intervention. The homeopathic medicines Arsenicum album and Lachesis respectively were found useful by each patient. Homeopathy appeared beneficial in facilitating the early healing of DFUs within a multi-disciplinary integrative approach.

A promising method for reducing the incidence of diabetic foot ulcers: Regulating foot temperature during walking

Diabetic foot ulcers (DFUs) pose a significant challenge in the medical field, particularly with the rising prevalence of diabetes. Consequently, there’s a growing emphasis on devising effective prevention strategies to combat the high recurrence rate of these ulcers. Daily walking, while essential for maintaining a normal lifestyle and social interaction is also the primary source of external mechanical stress applied to the foot. Preserving the integrity of foot tissues during daily walking is critical for preventing foot ulcers. An increase in foot tissue temperature, a significant environmental factor induced by walking, can diminish the foot tissue’s resistance to external mechanical stimuli by affecting tissue metabolism and biomechanical properties (tensile and compressive properties) during walking. This could be a key factor contributing to the high recurrence rate of foot ulcers, despite the advancement in clinical unloading protection technology. We propose a hypothesis that managing foot temperature and preventing a continuous temperature rise caused by walking could help protect the integrity of diabetic foot tissue. Long-term adherence to this approach could potentially reduce the incidence of DFUs. A clinical randomized controlled trial has been designed to evaluate this hypothesis from the aspects of tissue metabolism and biomechanical properties. This study aims to offer a novel method for protecting against DFUs and guide the design of foot aids.

Association Between Lipid Profile and Diabetic Foot Ulcer

Diabetic foot ulcer is a serious disabling consequence of Diabetes Mellitus. They are characterized by the breakdown of skin and underlying tissues in the feet, and are a major cause of lower limb amputations. Various risk factors have been identified for the development of diabetic foot ulcers, including poor glycemic control, peripheral neuropathy, peripheral arterial disease, and impaired wound healing. it is considered that the lipid profile is one of many factors that contribute to the formation and progression of diabetic foot ulcers. To stratify the incidence of diabetic foot ulcers (DFUs), biomarkers are required. The aim of this review is to assess the relationship between the risk of DFU and lipid profile in diabetic patients.

THU260 Development Of Plantar Thermography For Screening Of Diabetic Neuropathy

Abstract Disclosure: V. Panamonta: None. R. Jerawatana: None. P. Ariyaprayoon: None. P. Looareesuwan: None. B. Ongphiphadhanakul: None. C. Sriphrapradang: None. B. Ongphiphadhanakul: None. Background: Diabetic foot ulcers are a major complication of diabetes. They are also the leading cause of nontraumatic lower extremity amputation. The incidence of diabetic foot ulcers is highest in those patients with poor glycemic control and neuropathy. In people with diabetic neuropathy, the feet temperature may change due to decreased blood flow and nerve damage. Thermography has been proposed as a noninvasive modality to identify patients at risk for diabetic foot ulcers. In this study, we used thermography and deep learning to stratify patients with diabetes at risk for developing a foot ulcer. Methods: We prospectively record clinical data and plantar thermogram in adult diabetic patients underwent diabetic foot screening at outpatient clinics at Ramathibodi hospital, Bangkok, Thailand during September to December 2022. Altogether, there were 245 thermal images were analyzed using a deep learning algorithm to determine the risk for diabetic foot ulcers by transfer learning using the pre-trained VGG16 model which is a convolutional neural network for image recognition. Twenty percent of the images were set aside for testing purposes while 20% of the images served as the validation set during training of the neural network. The neural network was trained and weighed more toward higher sensitivity of identifying at risk feet for screening purpose. Results: The study sample consisted of individuals with a mean age of 62.5±12.5 years, 57.1% who had diabetes for more than 10 years. The majority of the participants were females (57.1%). The average body mass index (BMI) was 27.8±9.6 (kg/m2). There were 186 thermal images classified as category 0 and 59 images classified as categories 1 to 3 according to the American Diabetes Association risk classification. The trained neural network achieved 75 % accuracy with 95 % sensitivity and 67 % specificity for classifying thermograms as higher than normal risk in the training dataset. For the testing dataset, the sensitivity and specificity was 75% and 41%, respectively. The accuracy, however, decreased to 50% due mainly to the misclassification of normal thermograms from abnormal. Conclusions: These results suggest that thermography combined with deep learning could potentially be developed for screening purpose to stratify patients at risk of developing diabetic foot ulcers. Further research is needed to validate the results in larger datasets and to explore alternative algorithms for predicting diabetic foot ulcers. Presentation: Thursday, June 15, 2023

ANALYSIS OF RISK FACTORS OF DIABETIC FOOT ULCER IN DIABETES MELLITUS PATIENTS

Diabetes Mellitus (DM) is a chronic metabolic disorder caused by the pancreas not using insulin effectively, if the management is not good, one of the risks of complications in DM patients is Diabetic Foot Ulcer. Behaviors at risk for causing Diabetic Foot Ulcer are smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The behavior of DM patients greatly influences the incidence of Diabetic Foot Ulcer, therefore it is very important to analyze the behavioral factors of DM patients who are at risk for Diabetic Foot Ulcer. The aim of this research is to analyze the behavioral factors that are at risk for the occurrence of Diabetic Foot Ulcer and to look for the most dominant factors that are at risk of causing Diabetic Foot Ulcer. The research was conducted using a descriptive method on 30 respondents using a total sampling technique. The data collection process used questionnaires about smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The results obtained for risk behaviors for Diabetic foot ulcers were 70% normal BMI, 93.7% had non-smoking habits, 50% did physical activity, 66.67% used footwear, 66.67% went on a diet and 100% did glycemic control . The behavior of DM patients who are at risk of developing Diabetic Foot Ulcer are all indicators only if sorted from the most dominant, namely Physical Activity, Diet and Use of Footwear, BMI, Smoking Habits and Glycemic Control. Suggestions for the pronalis program to provide education that emphasizes behavior that is at risk of developing diabetic foot ulcers. Key Word : Behavioral, Diabetes Mellitus, Diabetic Foot Ulcer,

Association between diabetic retinopathy and diabetic foot ulcer in patients with diabetes: A meta-analysis.

This study aimed to explore the relationship between diabetic retinopathy (DR) and diabetic foot ulcers (DFUs) to provide evidence for the prevention of diabetic complications. PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data databases were searched from their inception until March 2023 for studies on the relationship between DR and DFU. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The meta-analysis was performed using the RevMan 5.3 software. Eleven articles referring to 10 208 patients were included, of whom 2191 patients had DFU and 8017 patients did not have DFU. The meta-analysis results showed that DR significantly increased the incidence of DFU (47.94% vs. 16.38%; OR, 4.13; 95% CI, 2.33-7.33; p < 0.001). The results of this study suggest that patients with DR have a higher risk of developing DFU, highlighting the importance of regular screening for these two complications to prevent serious adverse outcomes of diabetes. However, further high-quality studies are required to validate the conclusions of the present study.

Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria

Background: Diabetes mellitus (DM) and its complications, continues to pose enormous challenge to health and financial stability. Diabetes has remained a source of national and global economic burden. It has been observed lately that incidence of diabetic foot ulcer (DFU); one of the complications of DM, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among diabetic patients. This is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. The aim was to determine the magnitude of limb loss or lower extremity amputation attributable to DM over a period of 12 months in tertiary institution and to assess the clinical profile of the patients.&#x0D; Method: This is a retrospective study of the records of all patients that were consecutively booked for lower limb amputation and operated upon in the last 12 months at UNIOSUN Teaching Hospital, Osogbo, South-Western Nigeria. Out of these total, cases of DFU were extracted to form another study group and then studied in detail.&#x0D; Results: Atotal of 38 patients had lower limb amputation from July 2021 to May 2022. Twenty three of the total number of amputations had DFU with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) Of the 23 diabetic cases , females were 15 with M:F ratio of 1:1.9. Mean age was 63±11.18 years. Mean duration of DM was 8.06±5.64 years. 78.3% had no foot care education and Doppler USS confirmed atherosclerosis in 100% of the patients. The commonest bacteria isolated was Proteus 34.8%. Length of hospital stay ranged between 6 weeks to 16 weeks. Outcome of admission was largely successful with 95.7% discharged and 4.3% mortality. &#x0D; Conclusion: DFU contributes markedly to morbidity and mortality. Long duration of DM, presence of PAD and DPN as well as advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous DFU. However, larger studies are needed to establish these factors as predictors of amputation in patient with DFU. Outcome was majorly good as majority of the patients were discharged.

A qualitative-based evaluation of the impact of participating in a social media-based foot self-management program among people with diabetes

BackgroundThe rising prevalence of diabetes, along with continued challenges associated with diabetes self-management, including foot self-care activities critical to reducing the incidence of diabetic foot ulcers among people with diabetes (PWD), calls for an alternative approach to diabetes self-management education and support (SMES) programs. AimThis study aimed to explore PWD’s experience of participating in a social media-based foot SMES program tagged Diabetic Foot Care Group (DFCG) and their perspective on how the program changed their foot self-care practices. MethodsThis qualitative-based summative evaluation study involved content analysis of transcripts from telephone interviews about PWD’s current foot self-care practices, change process, likes/dislikes, preferences, and recommendations three months after participating in DFCG. FindingsThe participants had a positive experience in DFCG and reported improved foot self-care practices. Five themes emerged to describe how DFCG helped participants change their foot self-care practice — in-depth knowledge, perceived susceptibility, sense-making, informed decision, and self-motivation. Most participants preferred an online program like DFCG to an in-person program. Participants’ recommendations include increasing individual access to DFCG, integrating virtual group meetings, increasing participants’ engagement, framing posts more positively, and ensuring program continuity. DiscussionDFCG content and structure facilitated cognitive processes that activated PWD to discern the reality of their diabetic foot risks, take ownership of their health, and become committed to practicing the required foot self-care activities. ConclusionThe findings of this study indicate the potential of a social media-based SMES program in promoting healthy foot self-care practices among PWD.

CLINICAL STUDY OF DIABETIC FOOT, ITS RISK FACTORS, CLINICOPATHOGENESIS, INVESTIGATIONS AND MANAGEMENT

Objectives: The objectives of the study are to study epidemiology and clinicopathogenesis of diabetic foot ulcers and (2) to study investigations that correlate with diabetic foot recurrence and its management. Methods: This study was done among diabetic patients came to surgery outpatient department with complaints of ulcer, swelling, gangrene, over foot, toes/leg+foot/ankle and admitted in surgery ward of C.R. Gardi Hospital, Ujjain, Madhya Pradesh, in time period between October 2017 and November 2018. Detailed history and thorough clinical examination were done in all cases. A total of 85 cases of diabetic foot ulcers were analyzed. Results: Out of 85 patients involved in study, peak incidence of diabetic foot ulcer is seen in age group of 51–60 years and the lowest, i.e., 3.5% of incidence seen in age group of &lt;40 years. The most common cause of ulcer formation was trauma, i.e., 61.2% and rest 38.8% were spontaneous as patients were unaware of any injury that might have caused it. In this study, it is seen that patients with duration of diabetes 11–15 years were most consisting 40% of all patients and more than 15 years being the least with 7.2%. Conclusion: On the basis of our study findings, we found out that most common mode of ulcer formation was due to injury rather than spontaneous. It can be due to the fact that majority of population is from rural areas and less educated and mostly involved and open-field work such as farming and laborer.

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

Abstract Introduction: 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. Methods: 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. Results: 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 &gt;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. Conclusion: 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.