Incidence Of Diabetic Foot Research Articles

Internet Health Resources for Diabetic Foot Search: The Content, Quality, and Readability of Information on Web Sites.

As the incidence of diabetes mellitus increases, the incidence of diabetic foot also increases. This situation, which may lead to devastating complications and progress to limb loss for patients, exposes patients and their social environments to a big crisis. Thus, patients may seek secondary opinions from online sources about information they initially obtained from health institutions. We aimed to evaluate the information content related to diabetic foot on the Internet that is probably used by patients for Internet searching. After software optimization and reset, related queries with the keyword diabetic foot were determined on Google Trends. Selected keywords were searched in three search engines, and the results were examined. Web sites were classified into five subcategories (nongovernmental health institution, governmental institution, academic, blog, and university) and evaluated with an information content scale (ICS) based on the literature, Journal of the American Medical Association benchmark criteria, the Flesch-Kincaid readability test, and presence of the Health On the Net Foundation Code of Conduct certificate. The search engines, keywords, and Web site subcategories were investigated with the evaluation criteria. In terms of finding Web sites eligible for assessment, the Google search engine listed more eligible Web sites than did Bing and Yahoo. Concerning the ICS, there was no significant difference between search engines for total scores (P > .05). Concerning ICS diagnosis and evaluation and ICS total score, academic Web sites scored significantly higher than other subcategories. Results that can be obtained with an Internet search for diabetic foot depend on the proper keyword selection, Web site type, and search engine to help patients reach more appropriate content.

Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing.

Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.

Development of a prediction model for incidence of diabetic foot in patients with type 2 diabetes and its application based on a local health data platform

Objective: To construct a diabetes foot prediction model for adult patients with type 2 diabetes based on retrospective cohort study using data from a regional health data platform. Methods: Using Yinzhou Health Information Platform of Ningbo, adult patients with newly diagnosed type 2 diabetes from January 1, 2015 to December 31, 2022 were included in this study and divided randomly the train and test sets according to the ratio of 7∶3. LASSO regression model and bidirectional stepwise regression model were used to identify risk factors, and model comparisons were conducted with net reclassification index, integrated discrimination improvement and concordance index. Univariate and multivariate Cox proportional hazard regression models were constructed, and a nomogram plot was drawn. Area under the curve (AUC) was calculated as a discriminant evaluation indicator for model validation test its calibration ability, and calibration curves were drawn to test its calibration ability. Results: No significant difference existed between LASSO regression model and bidirectional stepwise regression model, but the better bidirectional stepwise regression model was selected as the final model. The risk factors included age of onset, gender, hemoglobin A1c, estimated glomerular filtration rate, taking angiotensin receptor blocker and smoking history. AUC values (95%CI) of risk outcome prediction at year 5 and 7 were 0.700 (0.650-0.749) and 0.715(0.668-0.762) for the train set and 0.738 (0.667-0.801) and 0.723 (0.663-0.783) for the test set, respectively. The calibration curves were close to the ideal curve, and the model discrimination and calibration powers were both good. Conclusions: This study established a convenient prediction model for diabetic foot and classified the risk levels. The model has strong interpretability, good discrimination power, and satisfactory calibration and can be used to predict the incidence of diabetes foot in adult patients with type 2 diabetes to provide a basis for self-assessment and clinical prediction of diabetic foot disease risk.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico

ABSTRACT Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people’s uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Abstract MP35: Long-Term Trajectories of Self-Rated Health Are Similar Following Incident Diabetic Foot Disease and Acute Myocardial Infarction Among Adults With Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Incident diabetic foot disease is associated with significant morbidity and mortality. However, data are lacking on long-term patient-reported outcomes. We aimed to evaluate trajectories of self-rated health among adults with diabetes before and after incident foot disease compared to incident acute myocardial infarction (MI), another major diabetes complication. Methods: We conducted a longitudinal analysis of participants in the ARIC Study with diabetes and incident diabetic foot disease (N=749 hospitalizations, N=73 outpatient encounters) or incident MI (N=703). Diagnosis and procedure codes from active hospitalization surveillance and Medicare claims were used to identify events; only MI events were adjudicated. Self-rated health was collected during annual telephone calls and rated from 1 (poor) to 4 (excellent); a score of 0 was assigned to deaths. We used linear regression to examine changes in self-rated health from 1 year pre-event (baseline). Relative effects of index event type over time were estimated by repeated-measures ANOVA. Results: Self-rated health was similar between groups at baseline ( Figure ). Participants with MI had sharper declines from baseline at 1 year post-event than those with diabetic foot disease (-0.93 vs -0.50 points, P<0.01), largely due to higher mortality (29.4% after MI vs 15.9% after diabetic foot disease). Self-rated health stabilized in the outpatient diabetic foot group after 2 years post-event, whereas it continued to decline over 10 years following both MI and inpatient diabetic foot disease ( Figure ). Conclusions: Our findings suggest outpatient diabetic foot disease is primarily associated with a short-term drop in self-rated health, but inpatient diabetic foot disease is associated with long-term declines in self-rated health similar to those experienced after MI. These results reinforce the importance of early diagnosis and treatment of foot disease and of including patient-reported outcomes to measure sequelae of diabetes complications.

Effects of continuing nursing intervention on high‐risk patients with diabetic foot ulcers: A meta‐analysis

AbstractA comprehensive meta‐analysis was conducted to evaluate the impact of continuous nursing interventions on patients with high‐risk diabetic foot (DF). We systematically searched electronic databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang for randomized controlled trials (RCTs), from database inception to October 2023, pertaining to continuous nursing interventions in high‐risk DF patients. Independent literature screening, data extraction and quality assessment were performed by two researchers. Data analysis was executed using Stata 17.0 software. Overall, 18 RCTs involving 1450 high‐risk DF patients were included. The analysis revealed that continuous nursing interventions significantly reduced levels of fasting blood glucose (standardized mean difference [SMD] = −1.02, 95% confidence interval [CI]: −1.29 to −0.76, p < 0.001), 2‐h postprandial blood glucose (SMD = −1.76, 95%CI: −2.23 to −1.29, p < 0.001) and glycated haemoglobin levels (SMD = −1.05, 95%CI: −1.40 to −0.70, p < 0.001) in high‐risk DF patients. Furthermore, there was a significant reduction in the incidence of DF (odds ratio [OR] = 0.22, 95%CI: 0.14–0.33, p < 0.001). This study demonstrates that continuous nursing interventions are effective in controlling glycaemic indices (fasting blood glucose, 2‐h postprandial blood glucose and glycated haemoglobin) and reducing the incidence of DF in high‐risk patients. These interventions contribute to stabilizing the patients' condition and optimizing their prognosis.

Estimation of Serum Adenosine Deaminase Levels as a Marker for Risk Assessment and Immunomodulation in Patients with Diabetic Foot

Introduction: Diabetic foot ulcers are critical complications of uncontrolled diabetes, with peripheral neuropathy, peripheral arterial disease, and immune suppression as primary contributing factors. Adenosine Deaminase (ADA), an enzyme, has been identified as a promising marker for cell-mediated immunity. Its estimation may serve as a predictive marker for immunomodulation, which, in turn, leads to complications among individuals with diabetes. Aim: To estimate serum ADA levels in diabetic patients without diabetic foot and diabetic patients with diabetic foot. Additionally, the study aimed to investigate the association of ADA serum levels with glucose, Glycated Haemoglobin (HbA1c), and the severity of wounds. Materials and Methods: This cross-sectional study was conducted in the central laboratory Department of Biochemistry at Krishna Rajendra Hospital (KR Hospital), Mysuru Medical College and Research Institute, Mysuru, India, from August to September 2021. The study included diabetic foot cases (n=45) and Type 2 diabetes patients on regular follow-up in the Department of Medicine without diabetic foot and any other complications (n=45). Venous blood samples were analysed for ADA, glucose, HbA1c, and complete blood count. The data were statistically analysed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation test. Results: The present study observed a higher incidence of diabetic foot among males. It showed a statistically significant increase in serum ADA, HbA1C, and neutrophil count in patients with diabetic foot compared to patients with diabetes without diabetic foot ulcers, with mean Standard Deviation (SD) of 71.79±25.11, 11.53±3.11%, and 75.91±9.77%, respectively. Serum ADA exhibited a positive correlation with HbA1C and different grades of ulcers. Conclusion: The present study demonstrated a significantly increased serum ADA in diabetic ulcers and a positive correlation with different grades of ulcers. This finding contributes to a better understanding of the disease's pathogenesis at different stages. Furthermore, the positive correlation between ADA and HbA1C levels may play an important role in predicting the glycaemic and immunological status of these patients

Association between anemia and the risk and outcomes of diabetic foot in patients with type2 diabetes mellitus.

The aim of the present study was to explore the association between anemia and the risks and outcomes of diabetic foot (DF) in patients with type 2 diabetes mellitus (T2DM). A total of 145 patients with T2DM were recruited between January and December 2021 and divided into the DF and non-DF groups according to whether they were diagnosed with DF. Individual patient data were extracted and blood samples were evaluated in a biochemical center for routine biochemical and blood-related indicators. The patients' survival rates were followed up until December 2022. An independent-samples t-test and χ2 test were used to compare the differences between the two groups. The association between the various clinical indicators for the DF and non-DF groups was evaluated using single-factor binary logistic regression analysis. Multi-factor binary logistic regression analysis was used to analyze the association between hemoglobin (Hb) and the risk for DF. A Kaplan-Meier survival curve was used to analyze the impact of anemia and DF on the 1-year survival rate. The diabetes duration, number of patients who smoked and consumed alcohol, and serum creatinine and C-reactive protein levels in the DF group were significantly higher than those in the non-DF group (P<0.05). By contrast, the estimated glomerular filtration rate (eGFR) and Hb, albumin (Alb) and total cholesterol levels, were lower in the DF group when compared with those in the non-DF group (P<0.05). All of the study participants were divided into two groups, according to their baseline eGFR [eGFR ≥90 or <90 ml/(min x 1.73 m²)]. It was found that, independently of renal function, lower Hb and Alb levels were associated with a higher incidence of DF. The 1-year survival rate for DF with anemia was significantly lower when compared with that in patients with DF without anemia (P<0.05). In conclusion, the Hb level in patients with T2DM is a protective factor against DF and anemia is an independent risk factor for DF. The present study suggested that anemia is associated with a decrease in the survival rate of patients with DF. This finding provided a theoretical basis for the clinical correction of anemia and improvement of DF prognosis (clinical trial no. 20220003).

Abstract MP29: High-Sensitivity Troponin-T is Associated With Incident Diabetic Foot Infections in the Atherosclerosis Risk in Communities Study

Background: Diabetic foot infections (DFI) are associated with substantial morbidity and mortality. Glycemic control and prevalent cardiovascular disease have been associated with DFI risk, but the association of subclinical cardiovascular disease with incident DFI has not been explored. Hypothesis: We hypothesized that high-sensitivity troponin-T (hs-cTnT, a marker of microvascular disease) and N-terminal-pro hormone BNP (NT-proBNP, a marker of cardiac wall stress) would be associated with incident DFI in adults without prevalent cardiovascular disease. Methods: We conducted a prospective cohort analysis of 1733 Black and White participants in the Atherosclerosis Risk in Communities (ARIC) study who had diabetes without prevalent cardiovascular disease at visit 2 (1990-1992, mean age 57.7 yrs). We estimated the cumulative incidence of incident DFI through 2019 using hospitalization discharge codes. We used Cox models to assess the associations of categories of cardiac biomarkers (using clinical cut-points) with DFI after adjusting for traditional risk factors. Results: During a median follow-up of 25 years, there were 417 incident DFI events. The 25-year cumulative incidence of DFI was higher among participants with elevated hs-cTnT (≥14 ng/L) vs not elevated (35% vs. 21%; P&lt;0.001), but not among participants with elevated NT-proBNP (≥125 pg/mL) (23% vs. 23%; P=0.73). In adjusted models, elevated hs-cTnT was associated with incident DFI (HR 1.98, 95%CI 1.46, 2.68). Elevated NT-proBNP was not significantly associated with incident DFI (HR 1.04, 95%CI 0.78, 1.41). Our results were similar when the biomarkers were modeled more flexibly using splines: we observed a robust association of hs-cTnT, but not NT-proBNP, with incident DFI ( Figure ). Conclusions: Elevated hs-cTnT was associated with incident DFI among middle-aged adults without prevalent cardiovascular disease. This suggests subclinical cardiovascular disease, possibly in the form of microvascular ischemia, may play a role in the etiology of DFI.

Ulcus Diabetica Hallucis Pedis: The Importance of Timely Treatment.

Introduction. Diabetes mellitus represent a global problem in public health, and the incidence of diabetic foot is constantly increasing Patients with diabetes have a tendency to infections, due to previously present neuropathy, vascular insufficiency, as well as neutrophil dysfunction. The most important risk factor is the existence of peripheral neuropathy, and it is present in 30% to 50% of patients with diabetes. The foot becomes sensitive to trauma as a result of sensory, motor and autonomic dysfunction, and there is excessive pressure in the deformed foot, also the development of ischemia.&#x0D; Case report. A 59-year-ol male patient sought medical help at the Clinic of Emergency Medicine of the Clinical Center in Sarajevo. He had edematous ulcers on the foot of his right leg. On the first day of therapy, the antibiotic amoxicillin + clavulanic acid, 875/125 mf film-coated tablets were included. Ulcerative formation on the injured finger healed relatively slowly in the first five days of therapy, so from the sixth day of therapy, another broad-spectrum antibiotic per os was included, for synergistic effects: metronidazole 500 mg tablets. On the tenth day of the therapy, visible progress was observed in the healing of the injured finger. Ultimately, the treatment of the injured finger was completed routinely and successfully.&#x0D; Conclusion. Identification of risk factors as well as patients’ education is an important prerequisite for the prevention of complications arising from the chronic course of diabetes.&#x0D; Early initiation of treatment, with an adequate multidisciplinary approach, can cure ulcerative, inflammatory diabetic foot, which in our case corresponded to the Wagner-Meggitt classification, superficial ulcer, with a corresponding gradation 1.

Gender Differences in the Risk of Adverse Outcomes After Incident Diabetic Foot Hospitalization: A Population Cohort Study.

Diabetic Foot Disease (DFD) is more prevalent among males and is associated with an excess risk of cardiovascular events or mortality. This study aimed at exploring the risk of cardiovascular events, renal failure, and all-cause mortality after incident DFD hospitalizations, separately in males and females, to detect any gender difference in a cohort of 322,140 people with diabetes retrospectively followed up through administrative data sources in Tuscany, Italy, over the years 2011-2018. The Hazard Ratio (HR) for incident adverse outcomes after first hospitalizations for DFD, categorized as major/minor amputations (No.=449;3.89%), lower limbs' revascularizations (LLR: No.=2854;24.75%), and lower-extremity-arterial-disease (LEAD) with no procedures (LEAD-no proc: No.=6282;54.49%), was compared to the risk of patients having a background of DFD (ulcers, infections, Charcot-neuroarthropathy: No.=1,944;16.86%). DFD incidence rate was higher among males compared to females (1.57(95% CI:1.54-1.61) vs. 0.97(0.94-1.00)/100,000p-years]. After DFD, the overall risk of coronary artery disease was significantly associated with the male gender and of stroke with the female gender. LEAD-no proc and LLR were associated with the risk of stroke only in females, whereas they were found to be associated with the risk of coronary artery disease among females to a significantly greater extent compared to males. The incident of renal failure was not associated with any DFD category. Amputations and LEAD-no proc significantly predicted high mortality risk only in females, while LLR showed reduced risk in both genders. Moreover, females had a greater risk of composite outcomes (death or cardiovascular events). Compared to the background of DFD, the risk was found to be 34% higher after amputations (HR: 1.34(1.04-1.72)) and 10% higher after LEAD-no proc (HR:1.10(1.03-1.18)), confirming that after incident DFD associated with vascular pathogenesis, females are at an increased risk of adverse events. After incident DFD hospitalizations, females with DFD associated with amputations or arterial disease are at a greater risk of subsequent adverse cardiovascular events than those with a DFD background.

Knowledge, Attitudes, and Practices Associated With Diabetic Foot Prevention Among Rural Adults With Diabetes in North China.

BackgroundThe diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China.MethodThis cross-sectional survey included 1,080 rural adults from North China, cluster sampled 12 villages and surveyed diabetic patients without diabetic foot who participated in community diabetes management. The self-administered knowledge and attitude questionnaire and the Chinese version of the Nottingham Assessment of Functional Foot-care Questionnaire were used.ResultOf the 1,080 subjects, 51.6% received moderate knowledge scores, 63.9% had a positive attitude and 71.4% received poor practice scores. In terms of knowledge, parameters of knowledge about foot examinations and treatment of foot problems showed the lowest scores. In terms of practice, in line with the results of the low knowledge score, parameters of the pursuit of medical treatment for foot problems and routine foot examinations were associated with the lowest scores. Multiple regression analysis revealed that participants who were current smokers (β: −0.049, 95% CI: −0.088 to −0.011) had lower knowledge scores than those who never smoke; participants who were current smokers (β: −0.818, 95% CI: −1.067 to −0.569) and past smokers (β: −0.299, 95% CI: −0.485 to −0.112) had lower attitude scores than those who had never smoked; participants who had higher knowledge scores (β: 1.964, 95% CI: 1.572–2.356) achieved higher scores on attitudes; women had better practice scores than men (β: 0.180, 95% CI: 0.122–0.239); patients with a long diabetes duration (6–10 years) had better practice scores than those who had a short diabetes duration (<2 years; β: 0.072, 95% CI: 0.012–0.131). Knowledge (β: 0.130, 95% CI: 0.001–0.258) and attitudes (β: 0.268, 95% CI: 0.249–0.287) were significantly associated with good practices.ConclusionsIncreasing knowledge regarding diabetic foot would help instill positive attitudes and cultivate better practices toward diabetic foot prevention. The results of this study may help guide future promotional resources to those groups most in need, which may help lower the incidence of diabetic foot among adults in North China.

Incidence and Risk Factors of Diabetic Foot Syndrome in Patients Early After Pancreas or Kidney/Pancreas Transplantation and its Association with Preventive Measures.

Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.

Relations between Interlukin-6 and Some Biochemical Parameters in Diabetic Foot Syndrome

The aim of this study is to predict the incidence of diabetic foot syndrome in type 2 diabetic patients bymeasuring some parameters (IL-6, FBS, MDA, CP, BMI). Samples were obtained from (75) type II diabeticpatients with and without diabetic complications (diabetic foot and diabetic neuropathy), as well as (25)healthy controls as a control group. They were divided into four groups: Group A (the control group):-It included (25) healthy individuals aged between (35-70 years). Group B (Diabetics type II withoutcomplications):- Includes (25) patients, their ages range (35-70 years). Group C (diabetic patients withdiabetic neuropathy):- It included (25) patients whose ages ranged from (35-70 years). Group D (diabeticpatients with diabetic foot syndrome): - Included (25) patients whose ages ranged from (35-70 years). Theresults showed a significant increase in the levels of (IL-6, FBS, MDA, CP) in all groups of type II diabetespatients with and without complications compared to the control group (P? 0.05). There was a significantincrease in the parameters measured in the group of diabetic patients with type II diabetic foot syndrome(DF) compared to the group of diabetic patients with type II disease Diabetic neuropathy (DN), and theresults also showed a significant increase in group DN compared to group of type II diabetic patients (DM)(P? 0.05). Our study show Interleukin-6 values, as well as oxidative stress, could predict the future incidenceof diabetic foot syndrome.

An Epidemiologic Study on Type 2 Diabetic Foot Disorders in Indonesia -A Perspective from an Uncontrolled Blood Glucose Level until Amputation-

Introduction: The prevalence of diabetes mellitus is continuously increasing worldwide and expected to reach more than 500 million people in 10 to 15 years later. In Indonesia, neglected case for diabetic foot and uncontrolled blood glucose level make the amputation rate is higher. The aim of this study is to describe the diabetic foot disease among Indonesian population, underlying disease, and the all of the treatments in our hospital. Method: All conservative and operative procedures in diabetic foot during the period of January 2017 – December 2018 was collected in Wahidin Sudirohusodo Hospital. All demographic data, disease classifications, laboratory results, and treatments were collected from medical records retrospectively. Results: In total of 229 patients, were found 1.02:1 male-to-female ratio of patients, where most of patients were in the sixth decade as much as 41%. The most Wagner classification was in the Grade 4 (29.%), HbA1C &gt;6.5mg/dL was found in 68.6% patients with higher WBC counts in 71.2%. Of 44.1% patients were treated conservatively, whilst 127 (55.9%) patients were treated operatively, which were debridement and amputation procedures. We found mortality rate of 3.9% as an outcome. Conclusion: The incidence of diabetic foot is increasing. Uncontrolled blood glucose levels (HbA1C) become one of the causes. Proper handling on controlling blood glucose and podiatry treatment can decrease morbidity and mortality rates. Keywords: diabetic foot, Wagner, amputation, Indonesia

Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study: Epidemiology of diabetic foot complications study

AimsThis long-term prospective study evaluated limb amputation and mortality after the first neuropathic diabetic foot ulcer (DFU). MethodsA total of 2880 patients with neuropathic DFU (DFU group) and a similar number of patients of diabetes without DFU (nDFU) matched for age and diabetes duration were prospectively assessed at five referral-centers over 14 years. Pre-defined outcome was death during follow-up. Various diabetic co-morbidities and amputation were assessed as mortality predictors. ResultsOverall, 501 (17.4%) patients in DFU group died compared to 89 (3.1%) (p < 0.01) in nDFU group during a median follow-up of 7(1–14) years. The 5- and 10-year mortality was 22% and 71% in the DFU group with a median survival of 7.72 (7.37–8.08) years compared to 3% (p < 0.01) and 5% (p < 0.01) and survival of 12.6 (10.5–12.7) years (p < 0.001) in nDFU group. 29.3% patients had limb amputations. The mortality risk was independent of glycemic control [OR 1.03 (0.80–1.32; p = 0.83)]. However, diabetes duration > 10 years [OR 1.31(1.02–1.70, p = 0.035)], nephropathy [OR 1.47 (1.04–2.09, p < 0.030)], minor 1.85 (1.40–2.44; p < 0.001) or major amputation 2.96 (2.01–4.34, p < 0.001)] predicted mortality. ConclusionsEvery one-in-three individual with neuropathic DFU has amputation and every sixth individual has an early demise. Prevalent nephropathy and incident amputation following DFU predicts mortality.

The natural history of tarsal tunnel syndrome in diabetic subjects

Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the tibial nerve might change the natural history of the disease. In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU. The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: -0.7% to -29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the risk of ulceration, in patients with (HR: 4.692, p = 0.003) and without (HR: 2.307, p = 0.002) prior DFU. Elevated sensory thresholds in TTS render diabetic patients at a higher risk for DFU. With effective surgery, TTS is likely to be an amenable factor to potentially prevent diabetic foot disease and thereby reduce amputation risk. II.

A prospective study to determine the application of site, ischemia, neuropathy, bacterial infection and depth scoring in the outcome and management of diabetic foot ulcers

Background: The objective of the study was to classify diabetic ulcers based on the recently described SINBAD classification system and to determine the management based on SINBAD score.Methods: Prospective study, conducted in Victoria Hospital from November 2017 to May 2019. 120 patients with diabetic ulcers were classified according to the SINBAD classification system, wherein a score of one is given for site beyond forefoot, presence of ischemia, presence of neuropathy, bacterial infection, area &gt;1 cm2 and depth beyond subcutaneous tissue. The wounds are scored at presentation and the outcome are evaluated according to respective score.Results: In this study 120 patients with mean age of 50.12 years were included. Lower socio-economic groups correlated with higher incidence of diabetic foot. According to SINBAD classification 42.5% had forefoot, 57.5% had hind foot wounds, 56.3% were purely ischemic ulcers, 19.2% were neuropathic ulcers, 40.0% were neuro-ischemic ulcers 68.3% had bacterial infection, 70.8% had ulcer, size &gt;1 cm2, 55% had ulcer deeper than skin &amp; sub cutaneous tissues. Healing probability in score 1 was 100%, score 2 was 87.5%, Score 3 was 70%, score 4 was 58.6% healing, score 5 was 7.1% and score 6 was 1.1% healing (p=0.004). Ischemia, neuropathy, bacterial infection, area &gt;1 cm2 and depth beyond subcutaneous tissue had significant effect on healing.Conclusions: SINBAD classification system includes 6 parameters, describing the pathological evolution of diabetic ulcers. Treatment protocols can be determined based on the score. The system is easy to score and apply in routine practise.

Meta analysis of the effect of continuing nursing intervention on high risk patients with diabetic foot

Objective To evaluate the effect of continuous care on patients with high risk of diabetic foot in China. Methods A random control of continuing care for patients with diabetes foot at high risk before June 2018 was published in the full text of the Chinese VP full text database (VIP), the full text database (CNKI), the Chinese biomedical literature database (CBM), Wan Fang, PubMed, Science Library. The test (randomized clinical trial), by 2 researchers, according to the inclusion and exclusion criteria, the literature quality was evaluated and extracted by the document quality standard of Cochrane cooperation network, and the different subgroups were divided according to the difference of the determination time of each outcome index, and the RevMan5.3 software was used to match the data. The required literature is analyzed by Meta. Results A total of 13 randomized clinical trials were included in the Mate analysis, including 1 450 subjects, 721 in the intervention group and 729 in the control group. The results showed that continuous nursing could effectively reduce the value of fasting blood glucose (combined effect MD=-1.34, 95%CI -1.44--1.24, P < 0.01), and effectively reduce the value of glycosylated hemoglobin (combined effect MD=-0.75, 95%CI -1.24- -0.27, P=0.002), and reduce the diabetic foot in patients with diabetic foot risk(combined effect RR=0.31, 95%CI 0.24-0.40, P<0.01). Continuous care could improve patients′ self-management ability and self-foot nursing ability. Conclusions Continuous care can reduce the fasting blood glucose, glycosylated hemoglobin and the incidence of diabetic foot in high-risk patients with diabetic foot, improve their self-management ability and self-foot nursing ability, which is of great significance to prevent and reduce the occurrence and development of diabetic foot. Key words: Continuous care; Diabetic foot; Intervention study; Meta analysis

Functional gradient structural design of customized diabetic insoles

Diabetic foot is a common and serious complication of diabetes, largely due to sensory neuropathy and excessive mechanical stresses. Studies have shown that reducing the contact pressure can effectively lower the incidence of diabetic foot. A new design method is proposed in this study for optimizing the stress distribution of the contact surfaces between the foot and the insole by applying functional gradient structural properties to the insole. Finite element analysis was employed for studying the contact mechanics, which laid the foundation for modulus readjustment during the optimization process. The moduli of the materials were correlated to the properties of the structural porous units. The customized insoles were manufactured using additive manufacturing technology and put into mechanical test. Results show that the designed insole helps in increasing the foot contact area by approximately 30% and reducing the peak contact pressure by 35%. Hence, the proposed method can be used to design customized insoles, particularly diabetic insoles, by offering better contact mechanics and good potential for reducing the severity of diabetic foot. The methodology is equally applicable to other designs involving optimization of material properties.