Diabetic Foot Ulcer Recurrence Research Articles

Plantar pressure measurement in diabetic foot disease: A scoping review.

Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis - Scoping Review protocol. Peer-reviewed, English-language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real-world settings, and with improved technology.

Recurrence of Diabetic Foot Ulcer and Associated Risk Factors: A 3-Year Retrospective Study

The burden of diabetes foot ulcer is immense, resulting to prolonged hospital stay and high cost of care. The aim of this study is to identify the predictors of ulcer recurrence which will help mitigate this disabling, pocket-draining, but highly preventable complication of diabetes mellitus (DM).
 Methodology: This was a 3-year retrospective study of patients hospitalised for diabetic foot ulcer (DFU) in Enugu State University Teaching Hospital from March 2020 to February 2023. Information on demographics, relevant diabetes history and complications, characteristics of DFU, outcome, DFU recurrence were obtained.
 Results: Most of the patients (82.5%) were between 41 and 70 years of age with a mean age is 57.86 ± 12.45. There were marginally more females (52.6%) than male (47.4%). The subjects were predominantly businessmen/traders (43.9%), and 73.7% had DM duration of 1-5 years. Duration of admission was 8 weeks for 31.6% of the patients, 4 weeks for 26.3%, 3 weeks for 21.1% and 12 weeks for 12.3% of the patients. More of the patients were in Wagner grades 3 (43.9%) and 4 (31.6%). The Prevalence of (diabetic peripheral neuropathy) DPN, peripheral artery disease (PAD) and Retinopathy among the patients were 82.5%, 45.6% and 59.6% respectively. Recurrence of DFU occurred in 35% of the subjects. Occupation and wound site positively correlated with reocurrence in this study. The outcome shows that 59.6% of the patients had good healing, 21.1% had ray amputation while 14% had below knee amputation.
 Keywords: Diabetic foot ulcer, recurrence, peripheral neuropathy, peripheral artery disease.

Proximal Tibial Cortex Transverse Distraction Facilitating Healing and Limb Salvage in Severe and Recalcitrant Diabetic Foot Ulcers

Category: Diabetes; Diabetes Introduction/Purpose: The management of severe and recalcitrant diabetic foot ulcers is challenging. Distraction osteogenesis is accompanied by vascularization and regeneration of the surrounding tissues. The longitudinal distraction of the proximal tibia stimulates increased and prolonged blood flow to the distal tibia. However, the effects of the transverse distraction of the proximal tibia cortex on severe and recalcitrant diabetic foot ulcers are largely unknown. Methods: Between July 2014 and March 2017, we treated 136 patients with diabetes and severe ulcers (University of Texas Grade 2B to 3D) that had not responded to treatment for at least 6 months. and their ulcers had a mean ± SD area of 44 cm2 ± 10 cm2. All 136 patients underwent tibial cortex transverse distraction. We compared these patients with the last 136 consecutive patients we treated with standard surgical treatment between May 2011 and June 2013; All patients received standard off-loading and wound care. We compared the groups with respect to ulcer healing (complete epithelialization without discharge, maintained for at least 2 weeks) in a 2-year follow-up, the proportion of ulcers that healed by 6 months, major amputation, recurrence, and complications in the 2-year follow-up. Foot arterial status and perfusion were assessed in the TCTD group using CT angiography and perfusion imaging. Results: The tibial cortex transverse distraction group had a higher proportion of ulcers that healed in the 2-year follow-up than the control group (96% versus 68% ; p < 0.001). By 6 months, a higher proportion of ulcers healed in the TCTD group than in the control group (93% versus 41% ; p < 0.001). Lower proportions of patients in the TCTD group underwent major amputation (2.9% versus 23%; p < 0.001) or had recurrences 2.9% versus 17%, OR 0.20 [95% CI 0.05 to 0.45]; p < 0.001) than the control group in 2-year follow-up. In the feet of the patients in the TCTD group, there was a higher density of small vessels and higher blood flow and blood volume 12 weeks postoperatively than preoperatively. Conclusion: Proximal tibial cortex transverse distraction substantially facilitated healing and limb salvage and decreased the recurrence of severe and recalcitrant diabetic foot ulcers. The surgical techniques were relatively straightforward although the treatment was unorthodox, and the complications were few and minor. These findings suggest that tibial cortex transverse distraction is an effective procedure to treat severe and recalcitrant diabetic foot ulcers compared with standard surgical therapy. Randomized controlled trials are required to confirm these findings.

Risk Factors for Ulcer Recurrence in Diabetic Patients Managed by an Integrated Foot Care Protocol.

The aim of our study was to identify risk factors for the recurrence of diabetic foot ulcers (DFUs) in a selected population of patients in secondary prevention treated, according to International Guidelines, with an integrated foot care protocol by a referral diabetic foot clinic. A retrospective study was performed with the inclusion of selected outpatients with diabetes at higher risk for ulceration with a history of previous ulcer and/or amputation followed in our diabetic foot clinic between January 2015 and December 2021. According to the presence or absence of recurrence, patients were divided into 2 groups: ulcer recurrence and without ulcer recurrence. One hundred twenty-seven (127) patients were included, 47 patients (37%) developed an ulcer recurrence while 80 patients (63%) did not. The mean age was 71.7 years; 65% were male; 97% were affected by type 2 diabetes with a mean duration of 21.1 years, the mean HbA1c was 63 + 21 mmol/mol. Both groups of patients had foot deformities, such as claw and hammertoes; hallux valgus, and prominent metatarsal heads (MTHs). The presence of deformity was significantly associated with ulceration. The group with ulcer recurrence showed a higher rate of prominence MTHs in comparison to a group without ulcer recurrence. The MTHs resulted as the only independent predictor for recurrence. This study shows that the presence of the prominent MTH is a significant risk factor for ulcer recurrence in a selected population of diabetic foot patients treated in the best way with integrated foot care.

Use of the SINBAD score as a predicting tool for major adverse foot events in patients with diabetic foot ulcer: AFrench multicentre study.

To assess the relationship between the site, ischaemia, neuropathy, bacterial infection, area, depth (SINBAD) score and major adverse foot events in patients with diabetes and foot ulcers. For this retrospective ancillary study, patients (n=537) followed for a diabetic foot ulcer (DFU) in six French hospitals were included between 1 February 2019 and 17 March 2019, and between 1 February 2020 and 17 March 2020. The SINBAD score was assessed at inclusion. The frequency of a composite outcome consisting of eight major adverse foot events (MAFE) was assessed after 5-6months of follow-up: hospitalisation for DFU, septic surgery, revascularisation, minor amputation, major amputation, death, secondary infection and ulcer recurrence. A logistical regression explored the link between the SINBAD score and MAFE and each of its component. A low SINBAD score (from 0 to 3) was observed in 61% of patients and a high (from 4 to 6) in 39%. MAFE occurred in, respectively, 24% and 28% of these patients. Multivariate analyses showed a significant relationship between the SINBAD score and MAFE, with the continuous SINBAD score: odds ratio (OR) 1.72 [95% CI (1.51-1.97)] or dichotomic SINBAD score (values: 0-3 and 4-6): OR 3.71 [95% CI (2.54-5.42)]. The SINBAD score (continuous or dichotomic) at inclusion was also significantly associated with six out of the eight components of the MAFE. The SINBAD score is a useful tool for predicting major adverse foot events.

The effectiveness of a thermography-driven preventive foot care protocol on the recurrence of diabetic foot ulcers in low-medical resource settings: An open-labeled randomized controlled trial

BackgroundPlantar temperature monitoring, along with a comprehensive preventive foot care approach, is utilized to prevent recurrence of diabetic foot ulcers. However, there is a lack of standardized protocols for individuals with diabetic foot ulcer history in low-medical resource countries. ObjectiveThis study investigated the efficacy of nurse-led, thermographic-evaluation-guided foot care in preventing diabetic foot ulcer recurrence in a low-medical resource country. DesignSingle-blind, 1:1 allocation randomized controlled trial. SettingsTwo wound care facilities with wound care nurse specialists in Indonesia. Participants120 patients with a diabetic foot ulcer history. InterventionIn the intervention group, baseline risk assessment including smartphone thermography evaluation was performed. Personalized foot care and education were conducted monthly for participants whose thermographs showed increased foot lesion temperature at baseline risk assessment. The control group received usual care and education using a booklet at baseline. The follow-up period was six months. Main outcomeTime to recurrence was evaluated using Kaplan–Meier survival analysis, and between-group comparisons were performed using the log-rank test. Potential risk factors were incorporated into the multivariate Cox regression model. Secondary outcomes included quality of life (European Quality of Life 5 Dimensions 3 Level Version) and foot care behavior, were analyzed using Mixed Models for Repeated Measures at baseline, third, and sixth follow-up (3 and 6 months from baseline). Results120 participants (intervention 60, control 60) were randomized. The intervention group had a significantly lower recurrence rate than the control group (15% vs. 35%, p = 0.011) and a significant difference in time to ulceration (log-rank test, p = 0.009) after a 6-month follow-up period. Intervention care reduced the risk of diabetic foot ulcer recurrence by 59% (Hazard ratio 0.41, 95% confidence interval 0.18, 0.96, p = 0.039) in multivariate Cox regression analysis. On the third follow-up, total diabetic foot care behavior score (p < 0.001) was significantly improved by the intervention. On the sixth follow-up, mobility (p = 0.020), self-care (p = 0.023), pain/discomfort (p < 0.001), anxiety/depression (p = 0.016), EuroQol Visual Analogue Scale score (p = 0.002), and total diabetic foot care behavior score (p < 0.001) showed significant improvements in the intervention group. ConclusionsFoot care and personalized education delivered at a frequency based on the risk level assessed by thermography effectively reduced diabetic foot ulcer recurrence, and improved quality of life and foot care behaviors. Registration numberUMIN000039012. Tweetable abstractNurse-led diabetic foot care and education reduced diabetic foot ulcer recurrence in Indonesia.

The effect of the boron-based gel on the treatment of diabetic foot ulcers: A prospective, randomized controlled trial

BackgroundChronic ulcers represent impaired healing capacity with high mortality in the elderly or patients with systemic disorders such as diabetes. Boron is an effective agent in wound healing by promoting cell migration and proliferation and reducing inflammation in the wound area. This study aimed to evaluate the therapeutic effect of a sodium pentaborate-based topical formulation compared to control on the treatment of diabetic foot ulcers. MethodsA prospective, double-blind, randomized controlled trial was conducted to apply randomly the topical sodium pentaborate 3% gel or topical conventional remedy (control) by patients diagnosed with diabetic foot ulcers. The 171 eligible participants aged 18–75 years received the allocated medicines twice a day for a month with an allocation ratio of 3:1. Twenty-five days and two months after the end of the trial, participants were reinvestigated for their ulcer condition and any recurrence. Wagner’s classification of diabetic foot ulcers was applied to this purpose (0−5). Results161 participants (57 females, 104 males; mean age: 59.37) completed this study. After the intervention, most participants in the intervention group had a lower ulcer grade than the control group (adjusted mean difference (95% CI): − 0.91 (−1.1 to −0.73); p < 0.001). Moreover, most participants in the intervention group (n = 109 (90.8%)) were treated at a higher rate than the control group (n = 5 (12.2%)) after intervention (adjusted odds ratio (95% CI): 0.008 (0.002–0.029); p < 0.001). There was no case of recurrence in the intervention group while its rate was (n = 2 (40%)) in the control group (p < 0.001). ConclusionThe present study suggests that topical sodium pentaborate gel may help treat and decrease the grade of diabetic foot ulcers and prevent the recurrence of diabetic foot ulcers.

Getting Ready for Foot Care Certification: Implementing Off-loading Interventions to Prevent or Manage Injury.

Getting Ready for Foot Care Certification: Implementing Off-loading Interventions to Prevent or Manage Injury.

Foot Care Knowledge and Education In An Effort To Prevent The Recurrent Of Diabetic Foot Ulcer (Dfu)

Diabetic Foot Ulcer (DFU) is a complication of Diabetes Mellitus (DM), which is a major health problem throughout the world with a high recurrence rate. It is estimated that approximately 40% of patients have a recurrence within one year of ulcer healing, nearly 60% within three years, and 65% within five years. One of the efforts to prevent DFU recurrence can be made with foot care which is preceded by knowledge of foot care. This study aimed to compare the knowledge of DFU patients before and after being given education. This study is a pre-post-test with 21 respondents who routinely received wound care at Rumah Perawatan ETN CENTER. Measurement of initial knowledge using a questionnaire consists of 11 questions that have been tested for content validity (CVI &gt; 80%). Then the patient is given foot care education using a video, and after that, the video link is distributed to the patient; patient knowledge was measured again after three weeks using the same questionnaire. There is a comparison of knowledge before and after being given foot care education with a p-value = 0.000. Foot care is one of the efforts to prevent recurrent DFU. There was an increase in patient knowledge after being given an education

The short-term impact of non-removable offloading devices on quality of life in people with recurrent diabetic foot ulcers

Recurrent diabetic foot ulcers (DFUs) are associated with poor health-related quality of life and reduced mobility. Current guidelines recommend application of non-removable offloading devices (NROLDs) as they may improve the healing of DFUs, but there is a lack of information on the wider effects of wearing these devices. Few studies have examined the impact of NROLDs on holistic wellbeing or physical activity. We aimed to investigate the short-term impact of NROLDs on physical activity and DFU-related quality of life (DFU-QoL) in a small sample of community-dwelling people with recurrent DFUs. We measured DFU-QoL and physical activity (GPAQ) in people with DFUs, recruited from a single clinic before NROLD application, and at three and six weeks after device fitting. Participants were aged from 39-81 years (mean 58.4±10.1 years) with an equal number of male and female participants. The study cohort comprised 18 participants, of whom 14 (78%) completed six-week questionnaires. Although there was some interim decline observed within individual domains of the DFU-QoL (financial: mean difference (MD) 16.2 (95% confidence interval (CI) 2.1, 30.2); p=0.03); non-compliance: MD 12.5 (95% CI-0.2, 25.2); p=0.05), no differences were observed over six weeks. Levels of physical activity declined over time, with over half (56%) of participants classified as having low levels of physical activity at baseline, rising to two-thirds (67%) at follow-up. Future studies should explore the longer-term holistic impact of NROLDs and develop more personalised approaches to care at the point of prescription, during and post-device use.

Quality of life in patients with recurrent diabetic foot ulcers

Aim: The study aimed to evaluate the association between quality of life and wound severity in patients with recurrent diabetic foot ulcers (DFUs). Design: A cross-sectional study. Methods: The total sample comprised 86 DFU patients. The Diabetic Foot Ulcer Scale &#8211; Short Form scale was used to collect quality of life data, and Wagner grading was used to assess wound severity. Statistical analyses were conducted using the Mann-Whitney U-test and Kruskal-Wallis test. Results: The results showed that quality of life (QOL) in all domains was low. There were no significant differences between demographic and wound characteristics and QOL of patients. Significant differences were found between diabetes mellitus (DM) duration and Leisure / enjoying life (p = 0.020); Trigger and Worried about ulcers (p = 0.002); Trigger and Dependence / daily life (p = 0.006); Trigger and Negative emotions (p = 0.006); and Trigger and Bothered by ulcer care (p = 0.000). However, there were no significant differences between demographic and wound characteristics and physical health. Conclusion: The study showed that QOL of patients with recurrent diabetic ulcers was low. There was no correlation between quality of life or wound severity and recurrent DFUs. However, there was a correlation between DM duration and Leisure / enjoying life; Trigger and Worried about the ulcer; Trigger and Dependency / daily life; Trigger and Negative emotions; and Trigger and Bothered by ulcer care.

Value of cystatin C in predicting recurrence in patients with severe diabetic foot and diabetic foot ulcer.

Objective: Our objective is to investigate the risk factors and predictive ability of severe diabetic foot(DF) and diabetic foot ulcers (DFUs). Patients & methods: The efficacy of cystatin C in predicting the recurrence of DF and DFU was evaluated using a receiver operating characteristic curve. Results: The findings indicate that, in contrast to non-severe patients, severe cases exhibit elevated levels of cystatin C (p <0.05). Additionally, a statistically significant increase in cystatin C levels was observed in the subgroup of patients with recurrent DFU (p <0.01). Conclusion: Cystatin C emerged as a significant risk factor for severe DF and recurrent DFU, with the potential for predicting their occurrence.

Development and validation of a risk prediction model for the recurrence of foot ulcer in type 2 diabetes in China: A longitudinal cohort study based on a systematic review and meta-analysis.

To develop and validate a risk prediction model for Chinese patients with type 2 diabetes with the recurrence of diabetic foot ulcers (DFUs) based on a systematic review and meta-analysis. A prospective analysis was performed with 1333 participants and followed up for 60months. Three models were analysed using a derived cohort. The risk factors were screened using meta-analysis and logistic regression, and the missing variables were interpolated by multiple imputation. The internal validation was performed using the bootstrap procedure, and the validation cohort was applied to the external validation. The performance of the model was evaluated in the area under the discrimination Receiver Operating Characteristic Curve (ROC). Calibration and discrimination methods were used for the validation cohort. The variables were selected according to their clinical and statistical importance to construct the nomograms. Three models were developed and validated. Model 1 included seven social and clinical indicators like sex, diabetes mellitus duration, previous DFU, location of ulcer, smoking, history of amputation, and foot deformity. Model 2 included four more indicators besides those in Model 1, which were statin agents used, antiplatelet agents used, systolic blood pressure, and body mass index. Model 3 added further laboratory indicators to Model 2, such as LDL-C, HbA1C, fibrinogen, and blood urea nitrogen. In the derivation cohort, 20.1% (206/1027) participants with DFU recurred as compared to the validation cohort, which was 38.2% (117/306). The areas under the curve in the derivation cohort for Models 1-3 were 0.781 (0.744-0.817), 0.843 (0.813-0.873), and 0.899 (0.876-0.922), respectively. The Youden indexes for Models 1-3 were 0.430, 0.559, and 0.653, respectively. Model 3 showed the highest sensitivity and specificity. All models performed well for both discrimination and calibration. Models 1-2 were non-invasive, which indicate their role in general screening for patients at a high risk of recurrence of DFU. However, Model 3 offers a more specific screening due to its best performance in predicting the risk of DFU recurrence amongst the three models.

Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study

BackgroundDiabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12-month follow-up period.MethodsWe included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow-up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors.ResultsDuring the follow-up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively.ConclusionsWe observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU.

Influencing factors for the recurrence of diabetic foot ulcers: A meta-analysis.

This study aims to systematically review and identify the related influencing factors for the recurrence of diabetic foot ulcers (DFUs)in diabetic patients. We searched PUBMED, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang and VIP databases to identify eligible studies published before March 31, 2022 to collect case-control studies or cohort studies on the related influencing factors for the recurrence of DFUs. Two reviewers independently screened the literature, and extracted data. Also, they assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale. A meta-analysis was performed using RevMan5.4.1 software. 20 studies were included; 4238 patients were enrolled, in which 1567 were in the DFU recurrence group and 2671 were in the non-recurrent DFU group. Risk factors for the recurrence of DFUs included diabetic peripheral neuropathy (odds ratio [OR]=4.05, 95% CI, 2.50-6.58, P < 0.00001), peripheral vascular disease (OR=3.94, 95% CI, 2.65-5.84, P < 0.00001), poor blood glucose control (OR=3.27, 95% confidence interval [CI], 2.79-3.84, P < 0.00001), plantar ulcer (OR=3.66, 95% CI, 2.06-6.50, P < 0.00001), osteomyelitis (OR=7.17, 95% CI, 2.29-22.47, P=0.0007), smoking (OR=1.98, 95% CI, 1.65-2.38, P < 0.00001), history of amputation (OR=11.96, 95%CI, 4.60-31.14, P < 00001), multidrug-resistant bacterial infection (OR=3.61, 95%CI, 3.13-4.17, P < 0.00001), callus (OR=5.70, 95%CI, 1.36-23.89, P=0.02), previous diabetic foot ulcer (OR=4.10, 95% CI, 2.58-6.50, P < 0.00001), duration of previous diabetic foot ulcer >60d (OR=1.02, 95% CI, 1.00-1.03, P=0.004), history of vascular intervention (OR=3.20, 95% CI, 2.13-4.81, P < 0.00001) and Wagner grade III/IV (OR=4.40, 95% CI, 2.21-8.78, P < 0.0001). However, no significant differences were found in age, duration of diabetes, body mass index, total cholesterol or foot deformity. Recurrence of diabetic foot ulcers is affected by a variety of factors. Thus, we should focus on high-risk groups and take targeted interventions as soon as possible to reduce the recurrence rate of DFUs, because of the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.

Novel Plantar Sensory Insoles Providing Physiologic Data and Remote Patient Monitoring to Prevent Foot Ulcer Recurrence and Guide Treatment Plans in Patients with Diabetic Peripheral Neuropathy

High plantar pressure is a major risk factor in the development of diabetic foot ulcer (DFU). Recent evidence shows continuous plantar pressure monitoring and dynamic offloading guidance can lead to reduced DFU recurrence. This case series examines the use of sensory insoles in patients at risk for DFU. This novel sensory technology collects plantar data to inform treatment decisions and reduce DFU risk.

A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

ObjectivesThe impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU. MethodsWe evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period. ResultsWe identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in the non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in the non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016). ConclusionA comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.

Post-healing follow-up study of patients in remission for diabetic foot ulcers Pied-REM study.

The rate of recurrence for diabetic foot ulcer (DFU) is 50% at 2 years Armstrong DG, 2017. International recommendations call for regular monitoring to prevent DFU recurrence. We aim to investigate the relation between post-healing follow-up and recurrence rates. The study will begin in November 2021 and end in April 2022; final study results are scheduled for December 2022. The purpose of the study is to evaluate the benefit of the multidisciplinary follow-up of healed DFU patients at the rate of two annual consultations and its impact on foot wound recurrence.

The Effectiveness of Preventive Foot Care with Thermography-Driven Risk Assessment on the Recurrence of Diabetic Foot Ulcers in Indonesia: An Open-Labeled Randomized Controlled Trial

The Effectiveness of Preventive Foot Care with Thermography-Driven Risk Assessment on the Recurrence of Diabetic Foot Ulcers in Indonesia: An Open-Labeled Randomized Controlled Trial

Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China.

ObjectiveTo investigate the characteristics of diabetic foot ulcer (DFU) recurrence.MethodsA total of 573 patients with DFUs were recruited and divided into an initial group (395 patients) and a recurrence group (178 patients). The factors related to recurrence were analyzed using multivariate regression.ResultsThe recurrence group had longer diabetes duration (odds ratio [OR] 192; 95% confidence interval 120, 252 vs. 156; 96, 240); lower glycated hemoglobin levels (OR 8.1; 95% CI 6.8, 9.6 vs. 9.1; 7.4, 10.5), and higher rates than the initial group of amputation (37.5% vs. 2.0%), history of vascular intervention (21.3% vs. 3.9%), retinopathy (77.7% vs. 64.7%), callus (44.4% vs. 20.8%), foot deformity (51.2% vs. 24.6%), and outdoor sports shoe wearing (34.0% vs. 21.2%). Multiple factor logistic regression analysis showed that diabetes duration (OR 1.004), callus (OR 2.769), vascular intervention (OR 2.824) and amputation (OR 22.256) were independent risk factors for DFU recurrence.ConclusionDiabetes duration, callus, history of vascular intervention, and amputation were independent risk factors for recurrent DFUs in a cohort of Chinese patients with active DFU. The prevention and treatment of DFUs, especially callus treatment, foot care, and blood glucose control, should be improved in China.