Incidence Of Diabetic Foot Ulcers Research Articles

Development and Validation of a Risk Prediction Model for Foot Ulcers in Diabetic Patients.

The current study analyzed the status and the factors of foot ulcers in diabetic patients and developed a nomogram and web calculator for the risk prediction model of diabetic foot ulcers. This was a prospective cohort study that used cluster sampling to enroll diabetic patients in the Department of Endocrinology and Metabolism in a tertiary hospital in Chengdu from July 2015 to February 2020. The risk factors for diabetic foot ulcers were obtained by logistic regression analysis. Nomogram and web calculator for the risk prediction model were constructed by R software. The incidence of foot ulcers was 12.4% (302/2432). Logistic stepwise regression analysis showed that BMI (OR: 1.059; 95% CI 1.021-1.099), abnormal foot skin color (OR: 1.450; 95% CI 1.011-2.080), foot arterial pulse (OR: 1.488; 95% CI: 1.242-1.778), callus (OR: 2.924; 95%: CI 2.133-4.001), and history of ulcer (OR: 3.648; 95% CI: 2.133-5.191) were risk factors for foot ulcers. The nomogram and web calculator model were developed according to risk predictors. The performance of the model was tested, and the testing data were as follows: AUC (area under curve) of the primary cohort was 0.741 (95% CI: 0.7022-0.7799), and AUC of the validation cohort was 0.787 (95% CI: 0.7342-0.8407); the Brier score of the primary cohort was 0.098, and the Brier score of the validation cohort was 0.087. The incidence of diabetic foot ulcers was high, especially in diabetic patients with a history of foot ulcers. This study presented a nomogram and web calculator that incorporates BMI, abnormal foot skin color, foot arterial pulse, callus, and history of foot ulcers, which can be conveniently used to facilitate the individualized prediction of diabetic foot ulcers.

A clinicopathological study on management of diabetic foot ulcer in tertiary care centre

IntroductionDiabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. India being the Diabetes Capital of the World has a Prevalence of 65.1 million suffering from DM of the Entire Indian Population being 1.33 billion of Worlds 6 billion people. This states that almost half of the Indian Population will sometime in their life be detected with Diabetes Almost 15–20 % of the population suffering from Diabetes are seen to have Diabetic Foot Ulcer at least once in their lifetime. It is also been noted that 10–15 % of patients suffering from Diabetic Foot Ulcer require Expert Management or Multi Disciplinary Approach. Diabetic foot ulcers have many pathogenic mechanisms, These risk factors are as follows: gender (male), duration of diabetes longer than 10 years, advanced age of patients, high Body Mass Index and other co-morbidities such as retinopathy, diabetic peripheral neuropathy, peripheral vascular disease, high glycated haemoglobin level (HbA1C), foot deformity, high plantar pressure, infections and inappropriate foot selfcare habits. Rough estimates are at about 1,00,000 lower limbs are amputated in India every year, of which at least seventy-five percent are neuropathic feet with secondary infections and are potentially preventable. Aims and objectives1)To study the Incidence of Diabetic Foot Ulcer among the Diabetics Admitted in Surgical Wards and follow up.2)To evaluate the scoring and characteristics of Wound according to Wagner Staging and Improvement or Deterioration of Wound after Follow up of 3 months Duration.3)To establish prognosis and Healing Status of Wounds as per the Treatment option Given and accepted by the patient.4)To Identify the Basis of OPD level Dressings and Early Discharge versus In hospital Stay and Wound Healing.

A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration.

The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters. This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC). The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies. The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.

Immunological profile of diabetic foot ulcers: update review

The most frequent consequence of diabetes mellitus, diabetic foot ulcers frequently do not heal and necessitate lower limb amputation. According to estimates, DFU accounts for 50% to 70% of all lower limb amputations, and 50% of patients with DFU have peripheral artery disease (PAD), which is occasionally brought on by atherosclerosis. Deformity of foot, peripheral artery disease (PAD), loss protective sensation (LOPS), and a history of foot ulcers. Global prevalence for DFUs varies by region. One of the frequent complications of diabetes in poor nations, such as Iraq, is diabetic foot; approximately two-thirds of the patients with diabetes have Diabetic Foot disorder (DFD) in Iraq and this health issue had significant negative social and economic effects. The Saudi Arabia and Bahrain have the highest prevalence rates of DFU; the reported yearly incidence of diabetic foot ulcers ranges from "2.1% to 7.4%". There are three types of diabetic foot ulcers: neuropathic, neuroischaemic, and ischemic. An infected DFU often contains three to five different types of bacteria, including gram-positive aerobes, such as "Staphylococcus sp.", gram-positive anaerobes, gram negative aerobes, gram negative anaerobes, and fungi (Candida spp.). Numerous studies have demonstrated that effective management of DFU can significantly decrease, postpone, or even completely avoid consequences like infection, gangrene, amputation, and death.

Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews

BackgroundIn adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality.PurposeIdentify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible.MethodsWe searched for systematic reviews (SRs) of tools predicting DFU or amputation published in multiple databases from initiation to January, 2023. We assessed risk of bias (ROB) and provided a narrative review of reviews describing performance characteristics (calibration and discrimination) of prognostically accurate tools. For such tools, we additionally reviewed original studies to ascertain clinical applicability and usability (variables included, score calculation, and risk categorization).ResultsWe identified 3 eligible SRs predicting DFU or amputation risk. Two recent SRs (2020 and 2021) were rated as moderate and low ROB respectively. Four risk prediction models – Boyko, Martins-Mendes (simplified), Martins-Mendes (original), and PODUS 2020 had good prognostic accuracy for predicting DFU or amputation over time horizons ranging from 1- to 5-years. PODUS 2020 predicts absolute average risk (e.g., 6% risk of DFU at 2 years) and consists of 3-binary variables with a simple, summative scoring (0–4) making it feasible for clinic use. The other 3 models categorize risk subjectively (e.g., high-risk for DFU at 3 years), include 2–7 variables, and require a calculation device. No data exist to inform rescreening intervals. Furthermore, the effectiveness of targeted interventions in decreasing incidence of DFU or amputation in response to prediction scores is unknown.ConclusionsIn this review of reviews, we identified 4 prognostically accurate models that predict DFU or amputation in persons with diabetes. The PODUS 2020 model, predicting absolute average DFU risk at 2 years, has the most favorable prognostic accuracy and is clinically feasible. Rescreening intervals and effectiveness of intervention based on prediction score are uncertain.

Non-coding RNAs: Role in diabetic foot and wound healing.

Diabetic foot ulcer (DFU) and poor wound healing are chronic complications in patients with diabetes. The increasing incidence of DFU has resulted in huge pressure worldwide. Diagnosing and treating this condition are therefore of great importance to control morbidity and improve prognosis. Finding new markers with potential diagnostic and therapeutic utility in DFU has gathered increasing interest. Wound healing is a process divided into three stages: Inflammation, proliferation, and regeneration. Non-coding RNAs (ncRNAs), which are small protected molecules transcribed from the genome without protein translation function, have emerged as important regulators of diabetes complications. The deregulation of ncRNAs may be linked to accelerated DFU development and delayed wound healing. Moreover, ncRNAs can be used for therapeutic purposes in diabetic wound healing. Herein, we summarize the role of microRNAs, long ncRNAs, and circular RNAs in diverse stages of DFU wound healing and their potential use as novel therapeutic targets.

Incidence and predictor of diabetic foot ulcer and its association with change in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia, 2021.

BackgroundDiabetes mellitus is one of the global public health problems and fasting blood sugar is an important indicator of diabetes management. Uncontrolled diabetes can lead to diabetic foot ulcers, which is a common and disabling complication. The association between fasting blood glucose level and the incidence of diabetic foot ulcers is rarely considered, and knowing its predictors is good for clinical decision-making. Therefore, the aim of this study was to determine the incidence and predictors of diabetic foot ulcers and its association with changes in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia.MethodsA multicenter retrospective follow-up study was conducted at a referral hospital in Northwest Ethiopia. A total of 539 newly diagnosed DM patients who had follow-up from 2010 to 2020 were selected using a computer-generated simple random sampling technique. Data was entered using Epi-Data 4.6 and analyzed in R software version 4.1. A Cox proportional hazard with a linear mixed effect model was jointly modeled and 95% Cl was used to select significant variables. AIC and BIC were used for model comparison.ResultA total of 539 diabetes patients were followed for a total of 28727.53 person-month observations. Overall, 65 (12.1%) patients developed diabetic foot ulcers with incidence rate of 2.26/1000-person month observation with a 95% CI of [1.77, 2.88]. Being rural (AHR = 2.30, 95%CI: [1.23, 4.29]), being a DM patient with Diabetic Neuropathy (AHR = 2.61, 95%CI: [1.12, 6.06]), and having peripheral arterial disease(PAD) (AHR = 2.96, 95%CI: [1.37, 6.40]) were significant predictors of DFU. The time-dependent lagged value of fasting blood sugar change was significantly associated to the incident of DFU (α = 1.85, AHR = 6.35, 95%CI [2.40, 16.79]).Conclusion and recommendationIn this study, the incidence of DFU was higher than in previous studies and was influenced by multiple factors like rural residence, having neuropathy, and PAD were significant predictors of the incidence of DFU. In addition, longitudinal changes in fasting blood sugar were associated with an increased risk of DFU. Health professionals and DM patients should give greater attention to the identified risk factors for DFU were recommended.

The Relationship of Obesity to Diabetic Foot Ulcer in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is a group of metabolic diseases, the common finding of which is elevated blood glucose levels, known as hyperglycemia. Severe hyperglycemia causes classic symptoms such as polyuria, polydipsia, and polyphagia and unexplained weight loss. This study used an observational descriptive analytic method with a cross sectional design to 42 respondents of type 2 Diabetes mellitus patients at PKU Muhammadiyah Gamping Hospital. The blood sugar levels, HbA1C, height, weight and incidence of diabetic foot ulcers were recorded. Data analysis used the Chi-Square test to see the relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus. The results of the study on 42 respondents showed that there were 31 Diabetes mellitus patients with diabetic foot ulcers (73.8%) while 11 people (26.2%). There were 21 male patients (50%) and 21 female patients (50%). A total of study subjects with normal Body Mass Index had type 2 diabetes mellitus with complications of diabetic foot ulcers (77.8%.), 13 study subjects with overweight Body Mass Index experienced type 2 diabetes mellitus with complications of diabetic foot ulcers (61.9%.), 11 study subjects with Body Mass Index obese class 1 had type 2 diabetes mellitus with complications of diabetic foot ulcers (91.7%). In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with normal Body Mass Index, there were 2 people (22.8%.) In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index overweight, there were 8 people (38.1%). Then in patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index obesity class 1 obtained 1 person (8.3%). The Chi-Square test was performed and the p value = 0.166. There is no significant relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus.

The Prognosis of Diabetic Foot Ulcer is Independent of age? A Comparative Analysis of the Characteristics of Patients with Diabetic Foot Ulcer in Different age Groups: A Cross-Sectional Study from China.

Background: With younger onset age of type 2 diabetes mellitus (T2DM), the incidence of diabetic foot ulcer (DFU) in young and middle-aged adults is also increasing. Elucidating the distinctive characteristics of DFU in different ages and exploring the influence of age on the prognosis of DFU are crucial to the improvement of DFU treatments. Methods: 684 patients hospitalized for DFU in the department of endocrinology were recruited and assigned into the young and middle-aged group (age <65 years old) and the elderly group (age ≥65 years old). Demographic data and clinical features were compared between two groups. Results: Compared with the elderly group, the young and middle-aged group had higher proportion of males (72.3% vs 49.6%, P < .01) and smokers (52.5% vs 35.8%, P < .01), shorter duration of diabetes mellitus (155 months vs 196 months, P < .01), higher levels of glycosylated hemoglobin (9.3% vs 8.7%, P < .01), lower ratio of ankle-brachial index <0.9 (25.8% vs 51.1%, P < .01) and higher levels of c-reactive protein and erythrocyte sedimentation rate (14 mg/L vs 10 mg/L, P < .05; 36 mm/h vs 30 mm/h, P < .05). The prevalence of diabetic peripheral neuropathy and Wagner Grade were similar in two groups. Of note, the prognosis was similar in different age groups, as there were no significant differences in the healing rate (59.7% vs 60.1%, P > .05), healing time (30 days vs 22 days, P > .05) and minor amputation rate (11.9% vs 8.7%, P > .05). Conclusions: We found that no evidence to suggest a better prognosis with younger DFU patients. Compared with elderly ones, young and middle-aged patients were characterized by a higher proportion of smoking, worse glycemic control, higher inflammatory biomarkers but less severe lower limb ischemia, indicating that smoking cessation, strict blood glucose control and early detection of infection were crucial for improving the prognosis of young and middle-aged diabetic DFU patients.

Effects of Special Therapeutic Footwear on the Prevention of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective To reduce diabetic foot ulcer (DFU) occurrence or recurrence, diabetic therapeutic footwear is widely recommended in clinical practice for at-risk patients. However, the effectiveness of therapeutic footwear is controversial. Thus, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine whether special therapeutic footwear could reduce the incidence of DFU. Method We systematically searched multiple electronic databases (Medline, EMBASE, and EMB databases) to identify eligible studies published from inception to June 11, 2021. The database search, quality assessment, and data extraction were independently performed by two reviewers. Efficacy (i.e., incidence of DFU) was explored using the R'meta' package (version 4.15-1). To obtain more robust results, the random-effects model and the Hartung-Knapp-Sidik-Jonkman method were selected to assess pooled data. Metaregression analysis and sensitivity analysis were performed to explore heterogeneity, and publication bias was assessed by a visual inspection of funnel plots and the AS-Thompson test. Results Eight RCTs with a total of 1,587 participants were identified from the search strategy. Compared with conventional footwear, special therapeutic footwear significantly reduced the incidence of DFU (RR 0.49; 95% CI, 0.28-0.84), with no evidence of publication bias (P = 0.69). Unexpectedly, the effectiveness of special therapeutic footwear had a reverse correlation with the intervention time (coefficient = 0.085, P < 0.05) in the metaregression analysis. Conclusion Special therapeutic footwear with offloading properties is effective in reducing the incidence of DFU. However, the effect may decrease gradually over time. Despite undefined reasons, the optimal utility time and renewal frequency of special therapeutic footwear should be considered.

Evaluation of foot ulcer incidence in diabetic patients at a diabetic foot ulcer prevention clinic over a 10-year period.

The present study aimed to evaluate diabetes patients over a 10-year period that visited our outpatient clinic for prevention of diabetic foot ulcers and then investigate the incidence and aetiology of diabetic foot ulcers. The Department of Diabetes and Metabolic Diseases of a university hospital was in charge of the clinic that provided diabetes patients with individual education via the use of visualisation techniques. In this prospective cohort study, a total of 942 diabetes patients who visited the clinic were evaluated for neuropathy, angiopathy and medical history between November 2006 and March 2017. Using the patients' medical records, diabetic foot ulcer development was evaluated between the day of the first visit and December 31, 2018, with 20 out of 942 participants developing these ulcers. Over a period of 12, 60 and 120 months, the diabetic foot ulcer cumulative incidence was 0.2%, 2.4% and 5.8%, respectively. A history of diabetic foot ulcers and the male sex were shown by a Cox regression analysis to be correlated with diabetic foot ulcer development (Hazard Ratio [HR] 11.55, 95%CI 4.600-29.004, p < 0.001; and HR 3.55, 95%CI 1.031-12.196, p=0.045, respectively). However, only five out of 20 participants with ulceration returned to the clinic for re-examination. In conclusion, a 12-month evaluation showed there was a low incidence of diabetic foot ulcers. These results might suggest that patients with a diabetic foot ulcer history need to undergo at least an annual follow-up in order to further reduce diabetic foot ulcer incidence, although studies involving control groups needs to be conducted, in presenting these as evidence.

127-OR: Diabetic Foot Ulcers in Remission: Cyclical-Pressure Topical Wound Oxygen Therapy Significantly Reduces DFU Related Hospitalizations and Amputations over a 12-Month Period

Purpose: The purpose of this real-world evidence (RWE) cohort study was to evaluate whether utilization of Cyclical-Pressure Topical Wound Oxygen (TWO2) therapy had any impact on the incidence of Diabetic Foot Ulcer (DFU) related hospitalizations and amputations over a 12-month period in patients with hard to heal Diabetic Foot Ulcers (DFU) Methods: An IRB approved retrospective review of deidentified DFU patient medical records was conducted at 2 US Veterans Affairs Medical Centers in Illinois and Virginia, which included demographic information on wound characteristics, clinical characteristics, neuropathy, cardiovascular disease (CVD) , peripheral vascular disease (PVD) , pain level and kidney disease etc. Results: Within the unmatched cohorts of 202 DFU patients (91 TWO2, 1NO TWO2) there was an 88% reduction in hospitalizations and 71% reduction in amputations over the 12-month period for the patients treated with TWO2 therapy compared to those that did not receive TWO2 therapy. After propensity score matching was conducted, which minimizes the effects of confounding by achieving more balanced covariates in the absence of a randomized study, resulting in matched cohorts of 140 DFU patients (70 TWO2, 70 NO TWO2) , 82% fewer TWO2 patients were hospitalized) and 73% fewer TWO2 patients had amputations, compared to those who did not receive TWO2 therapy (p &amp;lt; 0.0001, p = 0.00 respectively) . Conclusions: This large RWE study demonstrates that TWO2 therapy positively impacts patient’s quality-of-life and the costs associated with treating their DFU by forcing them into remission, resulting in significantly reduced rates of amputations and hospitalizations. Disclosure M.G.Garoufalis: None.

IDF21-0257 The Feasibility of a Social Media-based Diabetic Foot Ulcer Prevention Program during the COVID-19 Pandemic in Canada

Background: Diabetic foot ulcer (DFU) is a costly complication associated with excessive disability and mortality. Due to the COVID-19 pandemic impact on the healthcare system, recent studies have anticipated an increased DFU incidence among people with diabetes (PWD). Therefore, continuous education and support are necessary to promote PWD adherence to foot self-care recommendations. However, available community and health facility-based DFU prevention programs for PWD are mostly face-to-face and restricted regarding access and its impact on sustaining foot self-care adherence. With the adaption of telehealth to improve healthcare access and support self-management, social media offers some benefits that healthcare professionals could explore to empower patients to prevent DFU, but evidence on its feasibility is limited. Aim: This study aims to determine the feasibility of social media as an alternative method to engage PWD in DFU prevention. Method: This feasibility study utilized a partially randomized preference trial design to explore PWD acceptance of a social media-based DFU prevention program and its efficacy on foot care adherence, self-efficacy, foot health status, and quality of life. The participants in the experimental group received self-management education and support via a private Facebook group platform alongside their routine health care. In contrast, the control received only routine health care. The study intervention was based on Social Cognitive theory with the education content adapted from the Wounds Canada Diabetes, Healthy Feet and You module. Two to three posts are scheduled daily in formats such as text, videos, photos, polls, and web links for three months. Data collection involves a validated questionnaire administered through QualtricsXM survey software at baseline, one, and three-month post-intervention with an interview. The data were analyzed using SPSS-27 and NVivo-12. The cut-off point for all study outcomes was > 70% except for the quality of life (50%). Results: A total of 32 participants were enrolled in the study (intervention [n=23] and control group [n=9]). The intervention implementation and data collection are still ongoing. The participants in the intervention and control group baseline characteristics were not statistically different. Most participants had a moderate to high DFU risk level, 62.5% and 28.1%, respectively. At baseline, 62.5% of the participants have poor adherence to foot self-management recommendations. Nineteen participants have completed the study (intervention [n=12] and control group [n=7]). The intervention acceptance mean-score was 83.08 ± 9.93 (range, 71 – 99%). The intervention led to significant improvement in participants' adherence to foot self-care recommendations (p=0.01). Participants accepted the intervention because it enhanced their awareness of DFU as a debilitating health condition. Also, the intervention resulted in a non-significant increase in participants' communication with healthcare professionals about foot problems, awareness of community resources, foot health status, and physical functioning. Discussion: Preliminary data revealed that social media is a feasible platform to engage PWD in DFU prevention. In addition, the intervention improved participants' foot self-care adherence, communication with healthcare professionals, community resources awareness, foot health status, and physical functioning. The overall study findings would inform recommendations for integrating social media into DFU prevention programs during and beyond the COVID-19 pandemic.

Assessment the Role of Phagocytic Neutrophil Cells among Different Wagner’s Grades of Diabetic Foot Ulcers Infection

Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems. This study aimed to assessment the role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection in diabetic patients. A case-control analytical study was conducted on 60 DM, DFU patients and healthy control group. Blood samples were collected for phagocytic activity testing and swabs samples of DFU were collected and processed for culture and antibiotics susceptibility testing after the ulcers classified according to Wagner’s grades system. Findings revealed that Gram-positive bacteria were the most prevalent in the DFU 57.1% with statistically significant relationship between the bacterial species and grades of Wagner’s classification. Wagner’s ulcers grade I and II were the most prevalence in DFU patients 30% for both. There was a weak negative correlation between phagocytic activity and grade ulcers classified. Amikacin and ciprofloxacin were the most effective antibiotics against bacterial isolates, whereas ampicillin, cefepime and cefadroxil were the most common resistance antibiotics of bacterial isolates. In conclusion, this is the first study carried out in Hadhramout, Yemen to assessment the phagocytic neutrophil cells and its role to fight the bacterial infection of diabetic foot ulcers. When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalence of Gram-negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

Care Giver Competency in Prevention Risk of Diabetic Foot Ulcer in Diabetes Mellitus Patients

Increasing in the incidence of diabetic foot ulcer (DFU) among diabetes mellitus patients (DM), which then access to health services is so far, as well as the lack of knowledge of the local community in preventing and caring for DFU made researchers try to initiate training related to prevention and basic wound care for village health cadres, community leaders, and families family members with DM and at risk for UKD. The activity, which carried out in March 2021, involved the puskesmas in Sui District. Raya, Kab. Kubu Raya. After obtained a permit to carry out activities, the Team briefly contacted the community with the assistance of the Head of RT and RW. Participants who toke part in this activity were those who lived or have a family with diabetes mellitus. Participants were given training related to prevention and treatment of basic wounds, which in the end evaluation followed by publication.

Assessment the Role of Phagocytic Neutrophil Cells among Different Wagner’s Grades of Diabetic Foot Ulcers Infection

Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems. This study aimed to assessment the role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection in diabetic patients. A case-control analytical study was conducted on 60 DM, DFU patients and healthy control group. Blood samples were collected for phagocytic activity testing and swabs samples of DFU were collected and processed for culture and antibiotics susceptibility testing after the ulcers classified according to Wagner’s grades system. Findings revealed that Gram-positive bacteria were the most prevalent in the DFU 57.1% with statistically significant relationship between the bacterial species and grades of Wagner’s classification. Wagner’s ulcers grade I and II were the most prevalence in DFU patients 30% for both. There was a weak negative correlation between phagocytic activity and grade ulcers classified. Amikacin and ciprofloxacin were the most effective antibiotics against bacterial isolates, whereas ampicillin, cefepime and cefadroxil were the most common resistance antibiotics of bacterial isolates. In conclusion, this is the first study carried out in Hadhramout, Yemen to assessment the phagocytic neutrophil cells and its role to fight the bacterial infection of diabetic foot ulcers. When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalence of Gram-negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis.

to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.

Efeito da termometria na prevenção de úlceras de pé diabético: revisão sistemática com metanálise

Objective: to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. Method: a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. Results: of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. Conclusion: thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.

Nurse care for diabetic foot patient

Introduction: The diabetic foot also called by a multifaceted pathophysiological state is characterized by lesions that arise from the feet of the person with diabetes without adequate treatment and specific care. It is estimated that the incidence of diabetic foot ulcer reaches 6.3% of diabetic patients and its prevalence approaches 10%, and people with low socioeconomic status are the greatest victims. In view of this evidence, the work is based on the following problem: What care do nurses develop in patients with diabetic feet? General objective: To evidence the care of diabetic foot related to the practice of nurses. Methodology: An integrative review was conducted in the Specialized Bibliographic Database in nursing (BDENF), latin american and caribbean literature in health sciences (LILACS) and the Scientific Electronic Library Online (SCIELO) and which resulted in seven articles. Results: The studies showed how the care of nurses with diabetic foot health education, continuing and permanent education, evaluation techniques to diabetic foot that involve physical examinations and self-care of patients with diabetic feet. It is reinforced that this care should be performed as a priority by nurses, since nurses have specific and qualified care to the patient in their main attributions. Conclusion: It is concluded, therefore, that the study identified several forms of care provided by nurses and that all these forms are important for the continuity of treatment and the prevention of complications, however, it is up to the nurse to be a professional who values the quality of their care based on theoretical concepts that lead to frequent training.

Bacteriological Profile of Diabetic Foot Ulcers and Detection of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum β-Lactamase Producers in a Tertiary Care Hospital.

IntroductionDiabetic foot infection is the most dreaded complication of diabetes mellitus and the commonest cause of hospitalization and limb amputation. Identification of the causative agent responsible for diabetic foot infection and the earliest initiation of appropriate antimicrobial therapy are vital for the control and prevention of the complication of diabetic foot ulcers. Therefore, we conducted this study to determine the bacteriological profile of diabetic foot ulcers and to detect methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producers in our institute.MethodologyDuring the study period, samples were collected from the foot ulcers of 100 patients at the Diabetic Outpatient Department. The samples were processed according to the standard laboratory protocol, and bacterial isolates were identified. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion technique, and results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (CLSI 2016). A phenotypic test for MRSA detection was performed using cefoxitin (30 μg) disk. ResultsThe highest incidence of diabetic foot ulcers was observed in patients aged 41-50 years. There were 83 men and 17 women, with a male to female ratio of 4.882. Of the 100 collected samples, 73 were positive for microbial growth, and 27 samples showed no growth. Of the 73 positive cultures, monomicrobial infection was found in 48 patients, and polymicrobial infection was found in 25 patients. Gram-positive pathogens were isolated from 34 patients, and gram-negative microbes were isolated from 64 patients. Among all collected isolates (n=100), Staphylococcus aureus was the most predominant organism and Acinetobacter species was the least common (only two isolates). Among the gram-negative bacteria, Pseudomonas aeruginosa was predominant. All the isolated gram-positive bacteria were susceptible to vancomycin. Gram-negative bacteria were highly susceptible to colistin with the exception of Proteus species which is intrinsically resistant to colistin and it is not reported for Proteus species. ESBL producers were primarily found among Klebsiella species isolates (22.22%). Among 29 S. aureus isolates, 8 (27.5%) were found to be MRSA producers.ConclusionBased on the bacteriological profile of diabetic foot ulcers, S. aureus among the gram-positive isolates and P. aeruginosa among the gram-negative isolates were the predominant pathogens. Infections caused by multidrug-resistant bacteria such as MRSA and ESBL producers have been reported with increasing frequency. According to the antibiotic susceptibility pattern, treatment can be initiated, continued, or altered, thereby reducing morbidity in patients with diabetic foot ulcers.