Foot Ulcer Patients Research Articles

Analysis of Risk Factors for the Occurrence of Diabetic Foot Ulcers in Patients with Type II Diabetes Mellitus

Background: Diabetes Mellitus (DM) has become a prevalent disease, imposing a significant burden on public health due to its widespread occurrence and association with numerous disabilities and fatalities. Uncontrolled DM can lead to severe metabolic complications and long-term vascular issues, including microangiopathy and macroangiopathy. Additionally, individuals with DM are highly susceptible to foot infections, which can escalate into gangrene if not properly managed. Purpose: This study aimed to determine the risk factors for diabetic foot ulcers in patients with Type II Diabetes Mellitus at the Hospital Infatil e Maternidade Jardim Amalia Methods: The research employed an analytical survey method with a case-control study design. Purposive sampling was utilized to select a total of 134 participants, comprising 67 individuals in the case group (those with diabetic foot ulcers) and 67 in the control group (those without diabetic foot ulcers). Data collection was conducted using a structured questionnaire, and the results were analyzed using the Odds Ratio (OR) test to identify significant risk factors. Findings: The findings of the study indicated that age is a risk factor for developing diabetic foot ulcers in patients with Type II DM, with an OR of 3.15 (95% CI: 0.43-17.216). The duration of diabetes also emerged as a significant risk factor, with an OR of 3.13 (95% CI: 0.62-14.12). Furthermore, foot care practices were identified as a crucial risk factor, with an OR of 4.13 (95% CI: 0.72-12.45). Conclusion: this study demonstrates that age, the length of time a patient has had diabetes, and their foot care routines are significant risk factors for the development of diabetic foot ulcers in patients with Type II Diabetes Mellitus at Hospital Infatil e Maternidade Jardim Amalia. These findings underscore the importance of early intervention and targeted patient education to mitigate these risks and improve patient outcome

Delayed treatment of diabetic foot ulcer in patients with type 2 diabetes and its prediction model

BACKGROUND Diabetic foot (DF) is a serious complication of type 2 diabetes. This study aimed to investigate the factors associated with DF occurrence and the role of delayed medical care in a cohort of patients with type 2 diabetes. AIM To reveal the impact of delayed medical treatment on the development of DF in patients with type 2 diabetes and to establish a predictive model for DF. METHODS In this retrospective cohort study, 292 patients with type 2 diabetes who underwent examination at our hospital from January 2023 to December 2023 were selected and divided into the DF group (n = 82, DF) and nondiabetic foot group (n = 210, NDF). Differential and correlation analyses of demographic indicators, laboratory parameters, and delayed medical treatment were conducted for the two groups. Logistic regression was applied to determine influencing factors. Receiver operating characteristic (ROC) analysis was performed, and indicators with good predictive value were selected to establish a combined predictive model. RESULTS The DF group had significantly higher body mass index (BMI) (P < 0.001), disease duration (P = 0.012), plasma glucose levels (P < 0.001), and HbA1c (P < 0.001) than the NDF group. The NDF group had significantly higher Acute Thrombosis and Myocardial Infarction Health Service System (ATMHSS) scores (P < 0.001) and a significantly lower delayed medical treatment rate (72.38% vs 13.41%, P < 0.001). BMI, duration of diabetes, plasma glucose levels, HbA1c, diabetic peripheral neuropathy, and nephropathy were all positively correlated with DF occurrence. ATMHSS scores were negatively correlated with delayed time to seek medical treatment. The logistic regression model revealed that BMI, duration of diabetes, plasma glucose levels, HbA1c, presence of diabetic peripheral neuropathy and nephropathy, ATMHSS scores, and delayed time to seek medical treatment were influencing factors for DF. ROC analysis indicated that plasma glucose levels, HbA1c, and delayed medical treatment had good predictive value with an area under the curve of 0.933 for the combined predictive model. CONCLUSION Delayed medical treatment significantly affects the probability of DF occurrence in patients with diabetes. Plasma glucose levels, HbA1c levels, and the combined predictive model of delayed medical treatment demonstrate good predictive value.

Multifactorial analysis of risk factors for foot ulcers in patients with neurovascular complications of diabetes.

Diabetic foot ulcers (DFU) are a major complication associated with significant morbidity and mortality. While numerous studies have investigated risk factors for these ulcers in general, few have focused specifically on patients with Neurovascular Complications of Diabetes. This study aimed to evaluate the prevalence and risk factors for DFU in this specific population. We analyzed data from the National Institutes of Health (NIS) database for the years 2017-2019, involving a cohort of 161,834 patients aged over 18 who were diagnosed with neurovascular complications of diabetes. Demographic characteristics (age, gender, ethnicity), hospital characteristics, comorbidities, and other relevant data were included for analysis. A binary logistic regression model was generated to identify independent risk factors for DFU. The prevalence of DFU among patients with neurovascular complications of diabetes was 29.4% during the period from 2017 to 2019. Compared to patients without DFU, those with DFU had longer hospitalization times and higher costs. The multiple regression analysis revealed that Iron-deficiency anemia (OR, 1.10; 95% CI, 1.01-1.11; P=0.019), Hypertension (OR, 1.07; 95% CI, 1.03-1.11; P=0.001), Obesity (OR, 1.08; 95% CI, 1.06-1.11; P<0.001), Peripheral vascular disorders (PVD) (OR, 1.69; 95% CI, 1.65-1.74; P<0.001), Osteomyelitis (OR, 7.10; 95% CI, 6.89-7.31; P<0.001), Tinea pedis (OR, 1.89; 95% CI, 1.59-2.26; P<0.001), Sepsis (OR, 1.24; 95% CI, 1.20-1.28; P<0.001), and onychomycosis (OR, 1.26; 95% CI, 1.13-1.42; P<0.001) were independent predictors for DFU in this population. The study found a high prevalence of DFU in patients with neurovascular complications of diabetes. Identifying and addressing risk factors such as deficiency anemia, hypertension, obesity, PVD, infections, and foot conditions may contribute to reducing the prevalence of DFU in this vulnerable population.

Factors associated with quality of life of diabetic foot ulceration in patients with type 2 diabetes in Depok West Java, Indonesia

Factors associated with quality of life of diabetic foot ulceration in patients with type 2 diabetes in Depok West Java, Indonesia

Onychomycosis: Prevalence, Fungal Pathogens, Risk Factors, and Antifungal Susceptibility Profile among People Living with Diabetes Mellitus in Kano, Northwestern Nigeria

Abstract Context: Onychomycosis is a fungal infection of the nail unit that over time results in dystrophy and disfigurement. It affects the quality of life and increases the prevalence and severity of foot ulcers in patients with diabetes. Aim: The study investigated the prevalence of onychomycosis, the associated fungal pathogens, and their antifungal susceptibility profile in a cohort of people living with diabetes (PLWDM) in Kano, Nigeria. Settings and Designs: This cross-sectional hospital-based study recruited and enrolled 300 PLWDM from two major diabetes treatment centers in Kano. Materials and Methods: Participants were screened for thickened, brittle, crumbly, or ragged nails, and 30 met the inclusion criteria. Sociodemographic data, clinical history, and other risk factors for onychomycosis were also evaluated. Toenail and fingernail, nail clippings, and scrapings were collected and cultured on Sabouraud dextrose agar (SDA). The identification of yeasts and mold isolates was performed using gram stain, germ tube test, CHROMagar, lactophenol cotton blue (LPCB) mount, and slide cultures. Antifungal susceptibility testing was achieved by the agar well-diffusion method. Statistical Analysis Used: The data generated were analyzed using descriptive statistics and associations between variables checked by the chi-square test or Fisher’s exact test. Results: The prevalence of onychomycosis was 63.3% (19/30), and fingernails were mostly affected. Fungal pathogens recovered include dermatophytes, yeasts, and non-dermatophyte molds, with a predominance of Aspergillus spps. (7/19 (36.8%)), Trichophytonmentagrophytes (4/19 (21.1%)), Trichophytonrubrum (4/19 (21.1%)), and Candidaalbicans (2/19 (10.5%)). A preponderance of the isolates shows a good susceptibility profile to itraconazole, ketoconazole, and clotrimazole, but demonstrated high resistance to fluconazole. Age and use of oral hypoglycemic agents were some of the risk factors identified. Conclusion: The study shows a high prevalence of onychomycosis among PLWDM in Kano and calls for routine screening to minimize or eliminate all possible complications.

Differences in characteristics between first-ever foot ulcer and recurrent foot ulcer in patients with diabetes: Prospective observational study.

More effective preventive care can potentially be provided if the characteristics of both the first ever and the recurrent foot ulcers can be clarified. The purpose of this study was to characterize first ever and recurrent foot ulcers in diabetic patients. This study was conducted as a secondary analysis of a prospective study that was entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers." In 73 diabetes-related foot ulcer patients who visited one wound clinic in Indonesia between August 2020 and February 2021, we investigated characteristics of the patients and wounds, healing period, and cost. Trauma was shown to be the primary cause of the diabetic foot ulcer in both the first ever foot ulcer (n = 48) and recurrent foot ulcer (n = 25) patient groups (95.8% and 100.0%, respectively). The DMIST score for the first ever foot ulcer patients was significantly higher than the DMIST score for the recurrent foot ulcers. This was found to be especially the case in the first ever foot ulcer patients, as not only were there signs of inflammation (45.8%), but there were also signs of local infection (35.4%), or osteomyelitis and signs of local infection (14.6%) present. In the eightfirst ever foot ulcer patients and in the ninerecurrent ulcer patients who were able to be followed through complete healing, the costs found for the first ever foot ulcer patients were significantly higher as compared to the costs for the recurrent foot ulcer patients. To avoid diabetes-related foot ulcers, specialized educational programs on trauma prevention need to be established. Moreover, patients without diabetes-related foot ulcer histories should be educated regarding the need to undergo early consultations before developing any infections.

Risk Factors and Frequency of Foot Ulceration in Patients Receiving Chronic Hemodialysis Treatment.

To determine the prevalence and risk factors of foot ulceration in patients receiving hemodialysis treatment. A total of 180 patients who received hemodialysis treatment in two state hospitals and a private health center between April 2017 and September 2017 were included in the study. The researchers collected data using a patient information form and by conducting physical evaluation of the lower extremities. They used the diabetic foot risk assessment algorithm to classify risk according to the data obtained. Of the patients receiving hemodialysis treatment, 6.7% had foot ulceration, 19.4% had a history of foot ulceration, and 8.3% had a history of hospitalization associated with ulceration in a lower extremity. Infected foot ulceration was the most common (6.1%) cause of hospitalizations. In the group with current or past foot ulceration, diabetic nephropathy was the most common etiologic factor of end-stage kidney disease (48.6%); there was a significant between-group difference in diabetic nephropathy (P < .05). Etiologic factors had a significant effect on foot ulcerations: As determined by univariate logistic regression, diabetes (odds ratio [OR], 2.727; P < .05), presence of neuropathy (OR, 4.208; P < .05), low-density lipoprotein cholesterol (OR, 1.013; P < .05), and serum albumin (OR, 0.302; P < .036) all had a statistically significant effect on the presence of foot ulcerations. Patients receiving hemodialysis treatment are at high risk for foot ulceration. Therefore, patient awareness strategies should be expanded to include individuals with end-stage renal disease regardless of diabetes status. Clinical and dialysis nurses should educate these patients about foot ulcerations and foot health to prevent ulcer development.

IJCM_121A: Assessment of risk of foot ulcer in patients with diabetes according to the risk classification consensus of International Working Group on Diabetic Foot (IWGDF) in Ernakulam District, Kerala; a community based cross sectional study

Background: The International Diabetes Federation states that India accounts for 1 in 7 of all adults living with diabetes worldwide. Diabetic foot disease is among the most serious complications of diabetes mellitus as it is a source of major suffering and financial burden for the patient, healthcare professionals and the society in general. The leading cause of lower-limb amputations is diabetes and 40%–85% of these are preventable Objective: Assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: A community based cross-sectional study was done in Ernakulam district involving 600 individuals with diabetes mellitus. The study gathered information on sociodemographic factors, anthropometric details and a detailed foot examination was performed with a IWGDF checklist. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: Mean age of patients in the study was 61.48 yrs±10.24 years.371 patients (61.83%) were females and 229(38.17%) were males.108 patients (18%) had disturbed sense of vibration (128 Hz). 90 patients (15%) had decreased sensitivity to 10-gram monofilaments. Peripheral arterial disease was present in 47 patients (7.83). 20 patients (3.33%) had history of previous ulcer. 11(1.83%) patients had lower extremity amputation. Patients were classified into four risk groups according to IWGDF criteria. Four hundred and fifty-five patients (75.83%) were in group 0, fifty-five patients (9.1%) in group 1, sixty-six patients (11%) in group 2 and twenty-four patients (4%) in group 3 of IWGDF criteria Conclusion: Routine foot examination in patients with diabetes as per IWGDF guidelines for each risk category will help in prevention of diabetic foot ulcers.

Podiatrist intervention could reduce the incidence of foot ulcers in patients with diabetes: a hospital survey in China.

This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: -0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.

Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome. The present MA includes randomized controlled studies (duration > 12weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing. A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%). Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.

Hubungan Perilaku Perawatan Kaki Dengan Terjadinya Komplikasi Diabetic Foot Ulcer Pada Pasien DM Tipe 2 Di RSUD Pagelaran Cianjur Tahun 2023

Diabetes Mellitus is a chronic disease characterized by an increase in blood sugar levels, the cause of which is unhealthy lifestyle behavior, lack of physical activity and stress, which can cause various chronic complications. A complication that is often found in sufferes with type 2 diabetes melilitus is diabetic foot ulcers which are open wounds on the surface of the skin of the feet. A further impact of diabetic foot ulcers is amputation. Prevention that can be done for these complications is to have good foot care behavior. Objective: Tis study was to determine the relationship between foot care behavior and the event of complications of diabetic foot ulcers in RSUD Pagelaran Cianjur. Methods: This study used analytic descriptive quantitative method with Cross-sectional technique with 30 respondents. Results: Based on the results of the analysis using the Chi-square statistical test obtained p = 0,000 &lt; α = 0,05 then Ha is accepted, which means there is a relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur . Conclusion: That there are is a significant relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur. Suggestion: It is hoped that good foot care behavioe will be maintained by patients with type 2 diabetes mellitus so that complications of diabetic foot ulcesr can be prevented

IDF23-0392 Study of predisposing factors for development of diabetic foot ulcers in patients with type 2 diabetes mellitus

IDF23-0392 Study of predisposing factors for development of diabetic foot ulcers in patients with type 2 diabetes mellitus

Self-care of chronic illness prevents the risk of diabetic foot ulcers in patients with diabetes: a cross-sectional study

Introduction: Diabetic foot ulcer (DFU) is a serious and chronic complication of diabetes mellitus (DM). This study aims to explain a model of self-care of chronic illness on the prevention of DFU risk in patients with DM, including foot self-care of maintenance, monitoring, and management. Methods: This study was an analytical study with a cross-sectional approach, with 300 patients randomly selected from six Public Health Centers in Surabaya, Indonesia, from June to August 2022. The inclusion criteria were individuals with DM and aged more than 26 years. Exclusion criteria were reading disabilities or having cognitive impairments Data were collected using a questionnaire. The correlation between variables was analyzed using the statistical method of Partial Least Squares. Results: The risk of DFU in patients with DM was 40% with low risk, 38% with moderate risk, 8% with high risk, 5% remission, and 10% with DFU. This research shows that there is a significant correlation between foot self-care management and the risk of DFU, where the p-value = 0.000, while the indicators of foot self-care maintenance and self-care monitoring do not have a significant correlation with the risk of DFU, where the p-value is respectively equal to 0.350 and 0.844. Conclusions: Foot self-care management was a factor that directly correlates with the risk of DFU. Autonomous self-care management behaviors still needed to be improved, because most patients still had these inadequate behaviors. Further research is needed to improve the behavior quality of patients with DM in managing foot care independently.

Matrix Metalloproteinase-9 Testing of Golden Rice Cookies With Piper Crocatum Active Extract for Preventing Foot Ulcers in Patients With Diabetes: Protocol for a Randomized Controlled Trial.

Diabetic foot ulcers (DFUs) present a formidable challenge to both patients and health care systems. DFUs significantly reduce the quality of life for patients, prolong hospital stays, and are the cause of approximately 70,000 lower limb amputations across the globe annually. Prevention of DFUs primarily involves the optimization of blood sugar levels and the effective management of complications, particularly peripheral neuropathy. Golden Rice has been proven to lower blood sugar levels due to its beta-carotene content, and Piper crocatum (P. crocatum) has been found to be effective in reducing the risk factors of DFUs through biomolecular regulation because of its polyphenol content. The principal objective of this study is to identify the efficacy of P. crocatum-enriched cookies, with Golden Rice as their primary ingredient, in preventing DFUs. The evaluation will center on their impact on the expression of matrix metalloproteinase-9 (MMP-9), a pivotal factor in the development of DFUs. This study is an experimental clinical research that follows the randomized controlled trial method and uses a single-blind design. The participants in the study are outpatients from primary health centers in Makassar, Indonesia, who have been diagnosed with diabetes mellitus. The sample for the study will be randomly selected and subsequently categorized into 2 groups: the intervention group and the control group. The intervention group consumes P. crocatum-enriched Golden Rice cookies, while the control group receives cookies without these additives. The participants from both groups will consume their respective cookies (packaged identically) twice a day for 14 days. The cookies will be prepared according to a modified recipe with an emphasis on low glucose content, resulting in 51 calories per cookie, comprising 1% carbohydrates, 6% fat, 4% cholesterol, and 4% fiber, excluding gluten, sugar, and salt. They will be baked at 158°C for 20 minutes. The process involves the addition of 20% Golden Rice and 10% P. crocatum ethanol extract, both prepared via maceration with 96% ethanol. The dependent variable in this study is the expression of gelatinases matrix metalloproteinase, to be assessed at 2 distinct time points-preintervention (pretest) and postintervention (posttest)-with the evaluation conducted through the western blotting method. The recruitment and testing phase started in January 2024. The study is scheduled to be completed by the end of March 2024. Data analysis will commence in April 2024, and the publication of the results is anticipated in the same year (2024). The study will report on the changes in primary data, encompassing gelatinases matrix metalloproteinase, as well as secondary data, including the ankle-brachial index, neuropathy score, and random blood glucose level. The findings of this trial are expected to significantly impact the selection of strategies by health care practitioners to enhance diabetes self-management, particularly in the domain of therapeutic snacking, for patients diagnosed with diabetes mellitus. Thai Clinical Trials Registry TCTR20230502001; https://www.thaiclinicaltrials.org/show/TCTR20230502001. PRR1-10.2196/49940.

Microbial Profile of Diabetic Foot Ulcers of Patients Attending the Regional Hospital Bamenda (Cameroon)

Microbial Profile of Diabetic Foot Ulcers of Patients Attending the Regional Hospital Bamenda (Cameroon)

Neddylation suppression by a macrophage membrane-coated nanoparticle promotes dual immunomodulatory repair of diabetic wounds

Oxidative stress, infection, and vasculopathy caused by hyperglycemia are the main barriers for the rapid repair of foot ulcers in patients with diabetes mellitus (DM). In recent times, the discovery of neddylation, a new type of post-translational modification, has been found to regulate various crucial biological processes including cell metabolism and the cell cycle. Nevertheless, its capacity to control the healing of wounds in diabetic patients remains unknown. This study shows that MLN49224, a compound that inhibits neddylation at low concentrations, enhances the healing of diabetic wounds by inhibiting the polarization of M1 macrophages and reducing the secretion of inflammatory factors. Moreover, it concurrently stimulates the growth, movement, and formation of blood vessel endothelial cells, leading to expedited healing of wounds in individuals with diabetes. The drug is loaded into biomimetic macrophage-membrane-coated PLGA nanoparticles (M-NPs/MLN4924). The membrane of macrophages shields nanoparticles from being eliminated in the reticuloendothelial system and counteracts the proinflammatory cytokines to alleviate inflammation in the surrounding area. The extended discharge of MLN4924 from M-NPs/MLN4924 stimulates the growth of endothelial cells and the formation of tubes, along with the polarization of macrophages towards the anti-inflammatory M2 phenotype. By loading M-NPs/MLN4924 into a hydrogel, the final formulation is able to meaningfully repair a diabetic wound, suggesting that M-NPs/MLN4924 is a promising engineered nanoplatform for tissue engineering.

Hemoglobin Levels and Diabetic Foot Ulcer in Patients With Type 2 Diabetes: A Cross-Sectional Study

Background. Anemia is prevalent among patients with T2DM with DFU. However, there is limited research on the relationship between Hb level and DFU. Objective. To investigate the characteristics and relationship between Hb level and prognosis in patients with DFU. Materials and Methods. A total of 212 patients with T2DM were included and grouped according to the presence (n = 105) or absence (n = 107) of DFU. The independent t test and multiple logistic regression analysis were used to analyze the effect of different factors on the occurrence of anemia in patients with DFU and whether Hb level could be used to predict prognosis. Results. There were significant differences in clinical indicators that directly or indirectly contributed to anemia in patients with DFU (P &lt; .05). Hb level was independently associated with DFU (OR, 0.899; P &lt; .05). Hb levels were significantly decreased in patients aged 65 years or older (P &lt; .05). Mild anemia was prevalent among most patients with DFU (59.62%). Hb level decreased with the severity of foot ulcer (P &lt; .05) and was correlated with the duration of diabetes (R2 = 0.653; P &lt; .05). The AUC value was 0.82, with a cutoff value of 122.5 g/L to identify patients with DFU at high risk of adverse outcomes. Conclusion. Anemia is common in patients with DFU. Anemia is a marker of DFU severity, and Hb level can predict poor prognosis in patients with DFU.

BUERGER ALLEN EXERCISE ON THE RISK OF INJURY IN THE FEET OF DIABETES MELLITUS TYPE 2

Diabetes Mellitus is a chronic metabolic disease that requires medical care and self-management to prevent complications of diabetic ulcers. The Buerger Allen Exercise is a specific exercise that aims to increase circulation to the legs by using changes in gravity and using muscle contraction through active movements of the legs to increase circulation of peripheral blood vessels. The Inlow's 60-second Diabetic Foot Screen Tool is an indicator for assessing the risk of foot injuries. This study aims to determine the effect of Buerger Allen Exercise on the risk of foot injuries in patients with diabetes mellitus type 2 at Masbagik Health Center. The research design used a pre-experimental design with a one group pretest-posttest design. The sampling technique was purposive sampling with a sample of 18 respondents who met the inclusion criteria. Data analysis used univariate and bivariate analysis. The mean value of the risk of foot ulcers in diabetes mellitus respondents before the intervention was 9.00 with a standard deviation of 1.328 and after the intervention the mean value was 8.54 with a standard deviation of 1.286. The results of the Wilcoxon test show a p value: 0.000 which means that there is an effect of Buerger Allen Exercise on the risk of foot injuries in patients with diabetes mellitus type 2 and is hoped that the Buerger Allen Exercise intervention can be applied as an effort to prevent complications of diabetic foot ulcers in patients with DM type 2.&#x0D; &#x0D; Keywords: Diabetes Mellitus; Buerger Allen Exercise; Foot Wound Risk

Revisiting metformin therapy for the mitigation of diabetic foot ulcer in patients with diabetic kidney disease from real-world evidence.

Diabetic foot ulcer and diabetic kidney disease are diabetes-related chronic vascular complications that strongly correlate with high morbidity and mortality. Although metformin potentially confers a wound-healing advantage, no well-established clinical evidence supports the benefit of metformin for diabetic foot ulcer. Thus, this study investigated the effect of metformin on diabetic foot ulcer from a large diabetic kidney disease cohort for the first time. This retrospective cohort study enrolled 10 832 patients who visited the nephrology department more than twice at two South Korean tertiary-referral centers between 2001 and 2016. The primary outcome was diabetic foot ulcer events; secondary outcomes included hospitalization, amputation, a composite of amputation or vascular intervention, and Wagner Grade ≥ 3. Multivariate Cox analysis and propensity score matching (PSM) were used to balance baseline intergroup differences between metformin users and non-users. In total, 4748 patients were metformin users, and 6084 patients were metformin non-users. Over a follow-up period of 117.5 ± 66.9 months, the diabetic foot ulcer incidence was 5.2%. After PSM, metformin users showed a lower incidence of diabetic foot ulcer events than metformin non-users (adjusted hazard ratio 0.41; p < 0.001). In a sensitivity analysis of 563 patients with diabetic foot ulcer, metformin usage was associated with lower severity in all four secondary outcomes: hospitalization (adjusted hazard ratio 0.33; p < 0.001); amputation (adjusted hazard ratio 0.44; p = 0.001); composite of amputation or vascular intervention (adjusted hazard ratio 0.47; p < 0.001); and Wagner Grade ≥ 3 (adjusted hazard ratio 0.39; p < 0.001). In conclusion, metformin therapy in patients with diabetic kidney disease can lower diabetic foot ulcer incidence and progression.

Uji Validitas dan Reliabilitas Kuesioner Skrining Kaki Diabetik

Ulceration of the foot in diabetes is common and disabling. It frequently leads to leg amputation, and the risk for leg amputation increases 10 to 30 times higher among the general population. 85% of leg amputations are performed due to diabetic foot ulcers, which can affect the quality of life and be potentially life-threatening. Diabetic foot ulcers are preventable by performing foot screening. The study aims to determine the validity and reliability score of diabetic foot screening questionnaires. The study used an observational descriptive design with a cross-sectional approach to the samples of 35 out of 40 populations. Respondents are selected using simple random sampling techniques. The instrument used was the diabetic foot ulcer and blood sugar observation sheet. The data were tested using SPSS 26 using Pearson Product Moment and Cronbach's Alpha test. The majority of respondents were female, the age ratio of the respondents was 65 years, the blood sugar rate was 234 mg/dl, and the ankle-brachial index rate was 1.04. The Pearson Product Moment results showed that the rcounts &gt; rtable (0.334), while the reliability test using Cronbach’s Alpha value is &gt; 0.60. The diabetic foot screening questionnaire is declared valid, reliable, and appropriate to detect the risk of foot ulcers in patients with Type 2 Diabetes Mellitus. There are ten themes of questions: diabetic diet patterns, anti-diabetic medication consumption, monofilament tests, foot pulse, history of foot ulcers, a history of amputations, foot deformities, nails growing into tissue, callus, and cracks.