Outcome Of Diabetic Foot Ulcers Research Articles

A Cross Sectional Study to Assess the Outcomes of Diabetic Foot Ulcer in Government Chengalpattu Medical College and Hospital

The diabetic foot syndrome is a set of disorders in which tissue breakdown caused by ischaemia, neuropathy, and infection can result in morbidity and even amputation. Diabetes is no longer just a condition of the developed world. It is a cross-sectional study that was carried out for a year at Chengalpattu Medical College to analyse the various conservative and surgical treatment options for various grades of diabetic foot ulcers and to evaluate the outcomes of diabetic foot ulcers based on the severity of diabetes mellitus. One hundred and twenty six diabetic patients with foot lesions were found overall in Govt. Chengalpattu Medical College & Hospital from January 2021 to February 2022, and they were all included in the study. Male patients made up 58% of the total (73), while female patients made up 42%. (53). The patients in this group ranged in age from 20 to 87. In the vast majority of cases, 55% of the patients were between the ages of 50 and 69. In our investigation, the average peak incidence of diabetic foot lesions was sixty years old. Close communication between surgeons, physicians, diabetologists, dieticians, podiatrists, vascular surgeons, and community health care providers is required for the multidisciplinary management of diabetic foot ulcers.

Association of vitamin D status with all-cause mortality and outcomes among Chinese individuals with diabetic foot ulcers.

The aim of this study was to examine the correlation between serum vitamin D concentrations and prognosis among Chinese individuals with diabetic foot ulcers (DFUs). We retrospectively recruited 488 adults with DFUs in West China Hospital from 1 January 2012 to 31 December 2019. After telephone follow up, 275 patients were finally included. We compared serum vitamin D concentrations among DFUs patients with different prognostic status, and examined the association of vitamin D status with prognostic variables by Kaplan-Meier analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for all-cause mortality. The median concentration of serum vitamin D of patients with DFUs was 37.78 nmol/L (interquartile range 27.91-50.66 nmol/L), with 31.6% having vitamin D deficiency (<30 nmol/L) and 42.2% having insufficient vitamin D (<50 nmol/L). During a median follow-up period of 52 months, 65 patients died, with an all-cause mortality of 23.64%. Vitamin D deficiency was independently linked to increased all-cause mortality after multivariable adjustments (hazard ratio 0.565, 95% confidence interval 0.338-0.946, P = 0.030). There were no significant differences between vitamin D concentrations and other outcomes of DFUs. Patients who suffered amputations had a tendency of lower vitamin D concentrations (34.00 [interquartile range 26.90-41.81] vs 40.21 [interquartile range 29.60-53.96] nmol/L, P = 0.053). Vitamin D deficiency was significantly associated with increased all-cause mortality in Chinese individuals with DFUs. Vitamin D supplementation might be a potential therapy for DFUs to prevent premature death and improve outcomes.

806 Foot burns in diabetic patients: A systematic review

IntroductionPatients with diabetes are prone to foot injuries and burns. Managing burned feet in patients with diabetes can be difficult due to multiple concomitant patient comorbidities that delay wound healing. Burn surgeons tasked with treating these complex foot burns understand that these patients are at risk of developing significant complications, such as infections and non-healing diabetic foot ulcers, which may ultimately lead to amputation. Although there are many studies that examine the causes and outcomes of diabetic foot ulcers and their management, there is a lack of consensus on how to best manage lower extremity burns in patients with diabetes.MethodsA systematic review was performed according to PRISMA criteria and identified 18 articles addressing the management of burned feet in patients with diabetes. Means and standard deviations of scale variables and frequencies derived from nominal and ordinal variables abstracted from the literature were compared between each group. A meta-analysis was attempted but existing data was not of sufficient quality for meaningful analysis, and data aggregation was done where applicable.ResultsThe three-database search identified 726 articles, which yielded 18 full text articles that met inclusion criteria. mean age of patients was 54 years (SD 7), and 80% (n=203) were male. Most (90%, n=179) had type II diabetes, and 10% (n=20) had Type I diabetes. Mean duration of diabetic disease was 11 years (SD 4), and mean A1c at admission was 9% (SD 1). Peripheral neuropathy (64%, n=123) was the most common comorbidity. Median TBSA burned was 2% (IQR 2), and scald (56%, n=155) was the most common mechanism of injury. Full thickness burns (70%, n=102) were most common, followed by partial thickness (28%, n=41), and superficial thickness (2%, n=2). A majority (55%, n=88) had burn wound infection identified at admission. Patients had a median delay in presentation from time of injury to hospital admission of 4 days (IQR 4.5). Sixty percent of patients received surgical treatment via excision and grafting, had a median length-of-stay of 20.5 days despite a median total body surface area involvement of 2%, and experienced sequelae of impaired wound healing such as infections, graft loss, and need for further surgery. Ultimately, 23% of patients had significant wound healing issues that resulted in amputation.ConclusionsExcision and grafting may not be the optimal approach for managing foot burns in patients with diabetes, many of whom are at high risk of amputation. Non-operative management of foot burns in patients with diabetes should be explored as a method to decrease amputations in patients with foot burns.

Ankle brachial indices and anaerobes: is peripheral arterial disease associated with anaerobic bacteria in diabetic foot ulcers?

Background:Lower extremity amputations from diabetic foot ulcers (DFUs) are rebounding, and new biomarkers that predict wound healing are urgently needed. Anaerobic bacteria have been associated with persistent ulcers and may be a promising biomarker beyond currently recommended vascular assessments. It is unknown whether anaerobic markers are simply a downstream outcome of peripheral arterial disease (PAD) and ischemia, however. Here, we evaluate associations between two measures of anaerobic bacteria—abundance and metabolic activity—and PAD.Methods:We built a prospective cohort of 37 patients with baseline ankle brachial index (ABI) results. Anaerobic bacteria were measured in two ways: DNA-based total anaerobic abundance using 16S rRNA gene amplicon sequencing and resulting summed relative abundance, and RNA-based metabolic activity based on bacterial read annotation of metatranscriptomic sequencing. PAD was defined three ways: PAD diagnosis, ABI results, and a dichotomous definition of mild ischemia (versus normal) based on ABI values. Statistical associations between anaerobes and PAD were evaluated using univariate odds ratios (ORs) or Spearman’s correlations.Results:Total anaerobe abundance was not significantly associated with PAD diagnosis, ABI results, or mild ischemia (ORPAD = 0.47, 95% CI = 0.023–7.23, p = 0.60; Spearman’s correlation coefficientABI = 0.24, p = 0.17; ORmild ischemia = 0.25, 95% CI = 0.005–5.86, p = 0.42). Anaerobic metabolic activity was not significantly associated with PAD diagnosis, ABI results, or mild ischemia (ORPAD = 1.99, 95% CI = 0.17–21.44, p = 0.57; Spearman’s correlation coefficientABI = 0.12, p = 0.52; ORmild ischemia = 0.90, 95% CI = 0.03–15.16, p = 0.94).Conclusion:Neither anaerobic abundance nor metabolic activity was strongly associated with our three definitions of PAD. Therefore, anaerobic bacteria may offer additional prognostic value when assessing wound healing potential and should be investigated as potential molecular biomarkers for DFU outcomes.

Clinical Profile and Outcome of Diabetic Foot Ulcer in Teritary Care Hospital

Background: The goal of this study was to estimate the disease burden of diabetic foot ulcer (DFU) admissions in a tertiary care hospital in a developing country in terms of clinical profile and outcome.&#x0D; Method: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Saveetha medical college and hospital between the period of February to November 2020. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed.&#x0D; Results: There were 180 admissions with diabetic foot problems involving 100 patients. All of the patients had type 2 diabetes, and there was no gender bias. The average age was 50, and diabetes control was poor. The majority of patients had no knowledge what had caused their symptoms. In 56 % of cases, ulcers were neuropathic, 25% were neuro ischemic, and a smaller fraction were pure ischemia. More than 70% of ulcers were Wagner grade 3 or higher, with infection occurring in nearly every patient. Gram-negative bacteria were the most prevalent isolates from culture. A total of 30 lower extremity amputations (LEAs) were performed at various levels of the foot.&#x0D; Conclusion: Diabetic foot problems are a source of morbidity, a reason for LEA surgery, and a cause of death in people who have diabetes mellitus.

Revascularization in Diabetic Foot Ulcer and Outcome

Diabetes is a major public health problem regionally and globally. In 2019, the International Diabetes Federation estimated that 465 million (9.3%) people worldwide had diabetes, and by 2045, the number may rise to 700 million (10.9%) [1]. The pooled prevalence of diabetes in the general population of Bangladesh is 7.8% and prevalence of pre-diabetes is 10.1% [2]. Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. The lifetime risk for foot ulcers in people with diabetes is estimated to be 15% [3]. Development of diabetic foot ulcer is attributed to many interacting factors, the most common ones being peripheral neuropathy and Peripheral Arterial Disease (PAD) [4]. PAD is an important precipitating factor in the outcome of diabetic foot ulcer [4]. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration [5]. Diabetic patients with PAD commonly show involvement of the arteries below the knee, especially at the tibial and peroneal arteries, and involvement of the profunda femoris [6]. Diabetic ulcers always require vascular evaluation, and when ischaemia is suspected the diagnostics should be organized rapidly to ensure revascularisation without delay. Foot ulcer in patients with diabetes is associated with an increased risk of lower limb amputation, and thus the primary aim of treatment for ischemic foot ulcer is limb preservation [4]. Invasive revascularization, including open reconstructive surgery and/or endovascular intervention, is the most effective treatment that may improve peripheral circulation and remedy symptoms [4]. The basic aim of any successful revascularization is to achieve pulsatile flow to the foot. The two methods currently available are peripheral bypass surgery and peripheral angioplasty [7]. Current literature shows that percutaneous transluminal angioplasty (PTA) is the first choice of procedures in revascularization of the lower limb [7].

Is ethnicity an appropriate measure of health care marginalization? A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in Aboriginal populations.

BackgroundAboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations.MethodsWe searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI).ResultsSix cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04–3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias.ConclusionOur analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.

Reliability and Safety of Bedside Blind Bone Biopsy Performed by a Diabetologist for the Diagnosis and Treatment of Diabetic Foot Osteomyelitis.

Bone biopsy (BB) performed by a surgeon or an interventional radiologist is recommended for suspicion of osteomyelitis underlying diabetic foot ulcer (DFU). To facilitate its practice, we developed a procedure allowing bedside blind bone biopsy (B4) by a diabetologist. We conducted a three-step observational study consisting of a feasibility and safety phase (phase 1) to assess the success and side effects of B4, a validity phase (phase 2) to compare DFU outcomes between positive (B4+) and negative (B4-) bone cultures, and a performance phase (phase 3) to compare B4 with the conventional surgical or radiological procedure basic bone biopsy (B3). Primary end points were the presence of bone tissue (phase 1) and complete DFU healing with exclusive medical treatment at 12 months (phases 2 and 3). In phase 1, 37 consecutive patients with clinical and/or radiological suspicion of DFU osteomyelitis underwent B4. Bone tissue was collected in all patients with few side effects. In phase 2, a B4+ bone culture was found in 40 of 79 (50.6%) participants. Among B4+ patients, complete wound healing after treatment was 57.5%. No statistical difference was observed with patients with B4- bone culture not treated with antibiotics (71.8%, P = 0.18). In phase 3, the proportion of patients with positive BB was lower in B4 (40 of 79, 50.6%) than in B3 (34 of 44, 77.3%, P < 0.01). However, complete healing was similar (64.6% vs. 54.6%, P = 0.28). No difference in rate of culture contamination was observed. B4 is a simple, safe, and efficient procedure for the diagnosis of DFU osteomyelitis with a similar proportion of healing to conventional BB.

Retrospective real-world comparative effectiveness of ovine forestomach matrix and collagen/ORC in the treatment of diabetic foot ulcers.

The retrospective pragmatic real‐world data (RWD) study compared the healing outcomes of diabetic foot ulcers (DFUs) treated with either ovine forestomach matrix (OFM) (n = 1150) or collagen/oxidised regenerated cellulose (ORC) (n = 1072) in out‐patient wound care centres. Median time to wound closure was significantly (P = .0015) faster in the OFM group (14.6 ± 0.5 weeks) relative to the collagen/ORC group (16.4 ± 0.7). A sub‐group analysis was performed to understand the relative efficacy in DFUs requiring longer periods of treatment and showed that DFUs treated with OFM healed up to 5.3 weeks faster in these challenging wounds. The percentage of wounds closed at 36 weeks was significantly improved in OFM treated DFUs relative to the collagen/ORC. A Cox proportional hazards analysis showed OFM‐treated wounds had a 18% greater probability of healing versus wounds managed with collagen/ORC, and the probability increased to 21% when the analysis was adjusted for multiple variables. This study represents the first large retrospective RWD analysis comparing OFM and collagen/ORC and supports the clinical efficacy of OFM in the treatment of DFUs.

Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea

BackgroundLow socioeconomic position (SEP) is associated with a high incidence of diabetic foot ulcers (DFUs). However, reports on the association between SEP and DFU outcomes are limited. Therefore, in this study, we investigated this association and determined the prognostic factors of DFU outcomes.MethodsThe total cohort comprised 976,252 individuals. Using probability sampling, we randomly selected a sample of patients by reviewing the data from the Health Insurance Review and Assessment Service database of South Korea during 2011–2015. Residence, household income, and insurance type represented SEP. The primary outcome was amputation, and the secondary outcome was mortality. A multivariate model was applied to identify the predictive factors. Amputation-free survival and overall survival were calculated using the Kaplan-Meier method.ResultsAmong 976,252 individuals in the cohort, 1362 had DFUs (mean age 62.9 ± 12.2 years; 42.9% were women). Overall amputation and mortality rates were 4.7 and 12.3%, respectively. Male sex (hazard ratio [HR], 2.41; p < 0.01), low SEP (HR 5.13, 5.13; p = 0.018), ophthalmopathy (HR, 1.89; p = 0.028), circulatory complications (HR, 2.14; p = 0.020), and institutional type (HR, 1.78; p = 0.044) were prognostic factors for amputation. Old age (HR, 1.06; p < 0.01), low SEP (HR, 2.65; p < 0.01), ophthalmopathy (HR, 1.74; p < 0.01), circulatory complications (HR, 1.71; p < 0.01), and institution type (HR 1.84; p < 0.01) were predictors of mortality.ConclusionsDFU patients with a low SEP are strongly associated with increased amputation and mortality rates. Along with age and comorbidities, SEP could provide the basis for risk assessment of adverse outcomes in DFU. Providing targeted care for this population considering SEP may improve the prognosis.

The Influence of Multidrug-Resistant Bacteria on Clinical Outcomes of Diabetic Foot Ulcers: A Systematic Review.

Multidrug-resistant organism infections have become important in recent years due to the increased prevalence of diabetic foot ulcers and their possible consequences. This study aimed to systematically review and evaluate ulcer duration, healing time, hospital stay, amputation, and mortality rates in patients with diabetic foot ulcers caused by infection with multidrug-resistant organisms. PubMed, the Cochrane Library, and Web of Science were searched in May 2020 to find observational studies in English about the clinical outcomes of multidrug-resistant organism infection in diabetic foot ulcers. Eight studies met the inclusion criteria, and these studies included 923 patients. The overall methodological quality of the study was moderate. Ulcer duration was described in six studies, and there was no practical association with multidrug-resistant organisms. Two out of three studies reported a longer healing time in multidrug-resistant organism infections than in non-multidrug-resistant organism infections. Clinical outcomes included the duration of hospitalisation, surgeries, amputations, and deaths. Lower limb amputation was the most reported clinical outcome in the included studies, and was more prevalent in the multidrug-resistant organism infections. We concluded that there was not enough evidence that multidrug-resistant organisms hindered the healing of diabetic foot ulcers. In contrast to the clinical outcomes, multidrug-resistant organisms affect both amputation rates and mortality rates.

“Clinical Profile and Outcome of Diabetic Foot Ulcer in South Indian Tertiary Care Centre”

Aim: To study the clinical profile and outcome of diabetic foot ulcer in a Tertiary Care Centre. Theclinical profile of 200 patients with diabetic foot ulcer was studied. Methods: Patients with diabeticfoot ulcer of both genders with age above 18 years willing to participate were included in the study.All patients were subjected to routine diabetic work up with Doppler study and X-ray foot to rule outbone involvement. Results &amp; discussion: The majority of patients with diabetic foot ulcers were ofage group 51 to 60 years, male predominant, mostly with a duration of diabetes mellitus more than6 years had intermittent claudication and most population with a single ulcer. Conclusion: Ourstudy gives important information that diabetic foot ulcer is more common among middle-agedpeople with male predominance which gives the importance of screening diabetic patients forneuropathy and peripheral vascular disease.

Association of glycaemic status and outcomes in diabetic foot problems: a retrospective evidence from South India.

Emerging shreds of evidence indicates that the risk of diabetic foot ulcer and associated morbidity can be reduced through the intensive glycemic control. There are very few studies which assessed the effects of glycemic control on diabetic foot problems among Indian patients. We aimed to assess the effect of glycemic control on the outcomes of diabetic foot problems among adult type 2 diabetes (T2DM) patients with foot ulcers. A cross sectional study was conducted among the T2DM patients from a tertiary care teaching hospital in South India. The demographic characters, risk factors, treatment characters, glycemic status were collected among the patients and analyzed against the outcomes of diabetic foot ulcers by reviewing their medical records. Descriptive statistics were used to present the data. The Chi-square test and ANOVA were used for was used for the categorical variables and continuous parameters to identify the factors affecting the outcomes, respectively. All analysis was performed in SPSS v21. Out of the 100 participants included in the study, 70% were male. The majority (78%) were from an age group of 40 to 70 years, and the mean age was found to be 59.91±10.6 years. The mean duration of diabetes was 9.66years. Only ankle-brachial Index score (p=0.001) was significantly associated with the type of ulcers, whereas other factors not (p>0.05). A high level of average HbA1c, BMI, ABI index and poor glycemic status was associated with a significant debridement strategy and longer duration of hospitalization; however, it was not substantial. Our study inferred that poor glycemic status is associated with a significant debridement strategy andlonger duration of hospitalization. However, these findingsneed to be strengthened with adequately powered prospective studies.

I Cannot Afford Off-loading Boots: Perceptions of Socioeconomic Factors Influencing Engagement in Self-management of Diabetic Foot Ulcer.

This study aimed at uncovering the factors influencing individuals' ability to engage in self-management of diabetic foot ulcer (DFU) and presenting a theoretical model depicting these factors and the outcomes. We used constructivist grounded theory methodology to guide this study and recruited 30 participants with an active DFU attending a wound care clinic in Ontario, Canada. The study's findings indicate that participants' engagement in self-management of DFU was influenced by internal and external factors. While some factors contributed to enhance participants' engagement in everyday self-management, others seemed to have prevented them from achieving engagement and hence the desired DFU outcomes.

Outcomes of Diabetic Foot Ulcers in a Tertiary Referral Interdisciplinary Clinic: A Retrospective Canadian Study

ObjectivesThe objectives of this work were to evaluate demographic data, healing rate, recurrence rate, amputation rate and death rate of patients with diabetic foot ulcers (DFUs) treated in a Québec outpatient diabetic foot ulcer multidisciplinary clinic. Another objective was to determine factors associated with higher ulcer recurrence. MethodsWe conducted a retrospective cohort study of adults with diabetes with a DFU referred to a Québec City diabetic foot clinic between December 1, 2013 and May 1, 2019. The primary outcome was recurrence rate at 6 months after first ulcer healing. We also evaluated the recurrence rate at 12 months, mean and median time for ulcer healing, mean and median time before recurrence after first ulcer healing, amputation rate, mortality rate and factors associated with DFU recurrence. ResultsOf the 85 patients included in the study, 26 (37.1%) and 36 (54.4%) had DFU recurrence at 6 months and 12 months, respectively, after first ulcer healing. Mean healing time from first consultation in the ulcer clinic was 19.64±21.02 weeks. Of the patients, 36.9% patients underwent lower limb amputation and 30.6% died during follow up. Both previous history of a DFU before first consultation and amputation after first DFU consultation were statistically significant risk factors for DFU recurrence at 12 months. ConclusionsDFU recurrence was significantly higher in patients with a past history of DFU before the first one evaluated in the diabetic foot clinic and a previous history of amputation. Thus, systematic follow up should be done specifically with these patients.

Role of ulcer grading classification in predicting level of amputation in diabetic foot ulcer.

Objectives: The study was designed to analyze and predict the diabetic foot ulcer outcome in terms of either healing or progression to amputation in patients presenting with diabetic foot. Study Design: Cross Sectional study. Setting: POF Hospital Wah Cantt. Period: January 2017 to December 2017. Material &amp; Methods: Demographics of patients along with duration of diabetic foot ulcer and its grade according to Wagner classification were recorded. Nonprobability consecutive sampling was done for the data collection. Management of ulcer was carried out with debridement, daily dressings and appropriate antibiotic. Patients were followed over period until ulcer healed completely or amputation performed. The outcome of diabetic foot ulcer was noted to complete the study. Results: One hundred patients with mean age were 54.24±3.65 years. Mean duration of diabetic ulcer was 17.61±4.6 days. All patients with grade I ulcer recovered completely without the need of amputation. Out of 25 patients with grade II ulcers 13 (52%) patients recovered without amputation while 12 (48%) patients had minor amputation. Similarly 16 patients presenting with grade III ulcers 12 (75%) had minor amputation while 4 (25%) underwent major amputation. Out of 18 patients with grade IV ulcers, 6 (33%) had minor amputation while 12 (67%) had major amputation. All 13 patients with grade V ulcer underwent major amputation. Relation of grades of ulcer with respect to level of amputation inside the grading classification of ulcer showed significant (p=0.000). Conclusion: Healing of the diabetic foot ulcer with preservation of limb function must be a goal of treating diabetic foot. Wagner classification of diabetic foot ulcer high grade is associated with increased risk along with high level of foot amputation.

Malnutrition and its relation with diabetic foot ulcer severity and outcome: a review

ABSTRACT Background Malnutrition has a detrimental effect on wound healing; hence, it might influence the outcome in people with a diabetic foot ulcer (DFU). The aim of this manuscript is to overview studies that describe the prevalence of malnutrition in DFU patients and assess the relation between malnutrition, DFU severity, and outcome. Methods A literature review was performed. Malnutrition had to be defined by anthropometry and/or validated screening and assessment tools. Results Five papers were included: one RCT, three prospective cohort studies and one retrospective observational study. A substantial number of patients were at risk for malnutrition (49%–70%) or were malnourished (15%–62%). In one study, nutritional status was related to DFU severity. Three authors demonstrated a negative influence of malnutrition on outcome. Two studies examined the prevalence of malnutrition after six months, but did not detect a decline in malnutrition rates. Conclusions Despite a large heterogeneity, all papers indicated that malnutrition is highly prevalent among DFU patients. Notwithstanding the lack of unequivocal evidence, malnutrition might have a negative influence on DFU outcome. Therefore, clinicians should pay attention to the nutritional status of people with a DFU. Abbreviations: BMI: Body Mass Index; DFU: Diabetic Foot Ulcer; DM: Diabetes Mellitus; GNRI: Geriatric Nutritional Risk Index; HbA1c: Glycated Hemoglobin; IWGDF: International Working Group on the Diabetic Foot; LEA: Lower Extremity Amputation; MNA: Mini Nutritional Assessment; MNA-SF: Mini Nutritional Assessment-Short Form; MUST: Malnutrition Universal Screening Tool; NRS-2002: Nutritional Risk Screening-2002; PAD: Peripheral Arterial Disease; RCT: randomized controlled trial; SGA: Subjective Global Assessment

Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study.

Predictors of outcome of diabetic foot ulcer (DFU) are important to improve the management of patients. Aim of the study was to find these predictors in type 2 diabetic patients with DFU. We recruited 583 patients. They were followed-up by a multidisciplinary team. A holistic and conservative approach was used and all risk factors and co-morbidities were aggressively treated. During the follow-up period, 79.6% of patients healed in a mean time of 7.6 ± 3.8 months, 6.9% showed DFU persistence, 9.9% had minor amputations, and 3.6% experienced major amputation. Seventeen percent of the patients died. Among patients who healed, 37.1% of them showed DFU recurrence. Impairment of renal function was associated to DFU persistence, amputation, and mortality. Previous cardiovascular disease predicted DFU persistence, DFU recurrence, and mortality. Lower BMI predicted DFU persistence and mortality. Osteomyelitis was a predictor of amputation and death. Markers of peripheral artery disease (PAD) predicted minor amputation and DFU recurrence. Our study shows a relatively low incidence of complications of DFU. Some predictors of outcome of DFU were confirmed and new predictors, like BMI and markers of PAD, were found. Our new findings suggest future strategies for nutrition support and revascularization. In addition, a holistic and conservative approach may improve the prognosis.

Clinico-microbiological profile and outcome of diabetic foot ulcers

Background: Diabetic foot ulcers (DFU) are debilitating to the patients and significantly impair their quality of life. DFU associated with infection have the worst outcomes and may lead to amputations if timely intervention is not done. In the present study, aim was to identify the association between the type of organism isolated and the rates of amputations in diabetic foot ulcers.Methods: We retrospectively studied 50 diabetic foot ulcers from January 2017 to June 2017, who were in-patients in a single unit of surgery department in King George Hospital, Visakhapatnam. Baseline clinical examination was done. Parameters such as age, sex, duration, diabetic status and its treatment, organisms isolated, various treatment options for ulcers and the outcomes were studies.Results: Males were the predominant study subjects (M: F=32:18). The age of presentation was 18-65 years with an average of 46 years. Gram negative organisms were the frequent microbial isolates, all being mono-microbial infections. It was dominated by E. coli (17), Pseudomonas (12) and Klebsiella (11). Above-knee amputation was done in one patient and below-knee amputations in three patients. Total mortality in our study was 5. After applying the chi-square test, it was found that there is no significant association between the type of organism and the rate of amputations in our study.Conclusions: Diabetes is a significant risk factor for ulceration in the extremities, which possesses considerable mortality and morbidity. Early intervention, control of diabetes and compliance of the patient treatment are all necessary to reduce the rates of amputations and mortality in patients with diabetic foot ulcers.

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study.

The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571). Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.