Risk Of Diabetic Foot Complications Research Articles

Effects of Hypogonadism and Testosterone Therapy on Diabetic Foot Complications.

Results of recent studies suggest that high levels of endogenous testosterone decrease the risk of diabetes. Testosterone therapy may delay the transition from prediabetes to diabetes and accelerate healing of diabetic foot ulcers in hypogonadal men. We investigated whether testosterone therapy in this population decreases the occurrence of diabetic foot complications within 1 and 5 years of diabetes diagnosis. Optum's deidentified Clinformatics Data Mart database was searched for male patients with diabetes. Associations between testosterone therapy and the occurrence of ulceration or the use of wound care were explored in the entire population and in those with and without hypogonadism using both bivariate and multivariate analyses. Contrary to the hypotheses, testosterone therapy seems to confer increased risk of diabetic foot complications. In hypogonadal men with at least 1 year of follow-up after diabetes diagnosis, any use of testosterone therapy increased the odds of wound care utilization by a factor of 1.10 (95% confidence interval, 1.03-1.17), and the odds of ulceration by a factor of 1.13 (95% confidence interval, 1.03-1.24). Similar results are seen in all men, both with and without hypogonadism. Further exploration reveals that hypogonadism also increases the risk of wounds among people with diabetes with care utilization in the entire population. Further research is needed to elucidate the mechanisms by which hypogonadism and testosterone therapy impact diabetic foot complications, and whether these mechanisms are mediated by vascular or neurologic factors.

Self-Intuitive Therapy and Psychomotor Activity with Angel Brachial Index (ABI) To Prevent the Risk of Diabetic Foot Complications at The Mokoau Health Center

Therapy Self Intuitive Dan Activity Psikomotor Dengan Angel Brachial Index (Abi) Self Intuitive Therapy and Psychomotor Activity with Angel Brachial Index (Abi) To Prevent the Risk of Diabetic Foot Complications at Mokoau Health Center Blood flow disorders in the legs can be detected by measuring the ankle brachial index (ABI). This..

Diabetic Foot Risk Assessment among Patients with Type 2 Diabetes in Kenya.

Screening for diabetic foot complications is often neglected, especially during routine and/or annual diabetes check-ups. We assessed the risk of diabetic foot complications among patients with type 2 diabetes in Kenya using the International Working Group on Diabetic Foot risk stratification guidelines to highlight the need for improved foot care. We conducted a descriptive cross-sectional study in Mathari National Teaching and Referral Hospital in Kenya between July and October 2015. Seven hundred patients with type 2 diabetes were identified and 147 were systematically sampled. A trained podiatrist examined patients, and urine and blood samples were taken for biochemical tests and assessed by the investigating team. In total, 44(29.9%) men and 103(70.1%) women were sampled; 75(51.0%) were aged over 55 years, 113(76.9%) were overweight/obese, 117(79.6%) had poor glycaemic control and 125(85%) had never had their feet screened for complications. Thirty participants (20.4%) were categorised as being at high risk for developing diabetic foot complications while 54(36.7%) had moderate risk, 53(36.1%) had low risk and 10(6.8%) had no risk. Compared to other risk groups, those with moderate risk for developing diabetic foot problems had higher mean levels of glycated haemoglobin (9.4%), albumin-creatinine ratio (50.3) and high-density lipoprotein cholesterol (1.4 mmol/L) at presentation. No other differences in clinical and laboratory profiles were noted. Our results show high rates of obesity, and poor glycaemic control in patients with type 2 diabetes and 56.5% of patients are categorised as being a moderate-to-high risk for foot problems. This highlights the need for healthcare professionals and patients in Kenya to be sensitised regarding the importance of foot screening to prevent lower-extremity complications.

Results from a community based diabetic foot screening campaign

A community-based diabetic foot screening campaign was introduced during one week in the French-speaking part of Switzerland to emphasize the preventive impact of systematic foot inspections. Of 494 screened people, 46 % never had their feet checked - and as many as 63% if only standardized examinations according to the recommendations are considered. The risk of diabetic foot complications may appear as early as a few years after diagnosis, underlining the importance of a systematic annual check-up.

The risk of diabetic foot complication among type 2 diabetes mellitus patients in Kendari City, Indonesia

This study identified the risk of diabetic foot complications among type 2 diabetes mellitus patients and their relationship with the patients’ characteristics. This cross-sectional study examined 93 diabetic patients. Participants included in this study were age more than 20 years old, diagnosed with diabetes mellitus type 2, and has no diabetic ulcer. A questionnaire based on the International Working Group on Diabetic Foot guidelines was used to measure diabetic foot complications. The statistical testing was using the Chi-square test. This study found that 53 participants (57%) are at risk of diabetic foot complications. Age and duration of diabetes variables had a significant relationship with the diabetic foot complication ( p < 0.005), while gender did not have a significant relationship with diabetic foot complications ( p > 0.005). Half patients are at risk of diabetic foot complications, and it is related to the patients’ age and duration of suffering diabetic.

Individualised screening of diabetic foot: creation of a prediction model based on penalised regression and assessment of theoretical efficacy.

A large proportion of people with diabetes do not receive proper foot screening due to insufficiencies in healthcare systems. Introducing an effective risk prediction model into the screening protocol would potentially reduce the required screening frequency for those considered at low risk for diabetic foot complications. The main aim of the study was to investigate the value of individualised risk assignment for foot complications for optimisation of screening. From 2015 to 2020, 11,878 routine follow-up foot investigations were performed in the tertiary diabetes clinic. From these, 4282 screening investigations with complete data containing all of 18 designated variables collected at regular clinical and foot screening visits were selected for the study sample. Penalised logistic regression models for the prediction of loss of protective sensation (LOPS) and loss of peripheral pulses (LPP) were developed and evaluated. Using leave-one-out cross validation (LOOCV), the penalised regression model showed an AUC of 0.84 (95% CI 0.82, 0.85) for prediction of LOPS and 0.80 (95% CI 0.78, 0.83) for prediction of LPP. Calibration analysis (based on LOOCV) presented consistent recall of probabilities, with a Brier score of 0.08 (intercept 0.01 [95% CI -0.09, 0.12], slope 1.00 [95% CI 0.92, 1.09]) for LOPS and a Brier score of 0.05 (intercept 0.01 [95% CI -0.12, 0.14], slope 1.09 [95% CI 0.95, 1.22]) for LPP. In a hypothetical follow-up period of 2years, the regular screening interval was increased from 1year to 2years for individuals at low risk. In individuals with an International Working Group on the Diabetic Foot (IWGDF) risk 0, we could show a 40.5% reduction in the absolute number of screening examinations (3614 instead of 6074 screenings) when a 10% risk cut-off was used and a 26.5% reduction (4463 instead of 6074 screenings) when the risk cut-off was set to 5%. Enhancement of the protocol for diabetic foot screening by inclusion of a prediction model allows differentiation of individuals with diabetes based on the likelihood of complications. This could potentially reduce the number of screenings needed in those considered at low risk of diabetic foot complications. The proposed model requires further refinement and external validation, but it shows the potential for improving compliance with screening guidelines.

Diabetic foot complications-lessons learned from real-world data derived from aspecialized Austrian hospital.

Diabetic foot complications, one of the most severe late complications of type2 diabetes mellitus, are associated with a tremendous personal and financial burden. In order to drive the prevention of diabetic foot complications forward and facilitate early detection and personalized screening of high-risk patients, longitudinal studies are needed to identify risk factors associated with diabetic foot complications in large patient datasets. This is aretrospective cohort study on 3002patients with type2 diabetes mellitus aged ≥ 18years without prior foot complications. The data were collected between 2006 and 2017 in an Austrian hospital department specialized for diabetic patients. In addition to aunivariate Cox regression analysis, multivariate Cox regression models were established to identify independent risk factors associated with diabetic foot complications and adjust for potential confounders. We observed atotal of 61diabetic foot complications in 3002patients. In the multivariate Cox regression model, significant risk factors (hazard ratio, 95% confidence interval) for foot complications were age at diagnosis > 70years (3.39, 1.33-8.67), male gender (2.55, 1.42-4.55), neuropathy (3.03, 1.74-5.27), peripheral arterial disease (3.04, 1.61-5.74), hypertension > 10years after diagnosis (2.32, 1.09-4.93) and HbA1c > 9% (2.44, 1.02-5.83). The identified risk factors for diabetic foot complications suggest that personalized early detection of patients at high risk might be possible by taking the patient's clinical characteristics, medical history and comorbidities into account. Modifiable risk factors, such as hypertension and high levels of blood glucose might be tackled to reduce the risk for diabetic foot complications.

New public health policy intervention for diabetic foot management in Mexico

Abstract Problem In Mexico, an estimated 12 million people have diabetes, with complications of diabetes contributing to 25-90% of non-traumatic amputations. Description of the Problem We conducted a review through the literature of available studies in English-language databases and libraries, including PubMed and UNAM digital Library to determine the role of teaching first contact health workers and the creation of limb salvage teams in the prevention of amputations. Through this review, we present the basis of our proposal about implementing these strategies to improve a care coordination system for diabetic foot management in Mexico. Results There were 25 publications from different countries, 12 eligible for this review. The review emphasizes that the creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers could help to achieve the following objectives which result in the reduction of amputations and improved patient outcomes: Standardize and simplify the diabetic foot clinical examination. Timely reference of patients with DM with a moderate and high risk of diabetic foot complications. Timely reference of patients with diabetic foot and peripheral arterial disease to third-level hospitals. Periodic first-contact health workers training on risk detection and stratification of diabetic foot. Lessons Implementing the policy of creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers will contribute to reducing major amputations due to diabetes in our country. We aim to implement a successful policy in Mexico to strengthen the health system and improve outcomes and therefore the quality of life of patients with diabetic foot complications. We aim to serve as a legislative voice for all patients in Mexico facing major amputations and other diabetes complications. Key messages New public health policy implementation for diabetic foot management in Mexico. Prevention of major amputations.

Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission

ObjectiveDaily remote foot temperature monitoring is an evidence-based preventive practice for patients at risk for diabetic foot complications. Unfortunately, the conventional approach requires comparison of temperatures between contralaterally matched anatomy,...

Remote Temperature Monitoring in Patients With Visual Impairment Due to Diabetes Mellitus: A Proposed Improvement to Current Standard of Care for Prevention of Diabetic Foot Ulcers.

Two debilitating sequelae of diabetes are foot ulcerations and vision impairing conditions including retinopathy, open-angle glaucoma, and cataracts. Current standard of care recommends daily visual screening of feet. Despite willingness, many patients are impeded by visual impairment. We investigate whether once-daily remote temperature monitoring can improve self-screening for patients at risk for diabetic foot complications. We followed four male veterans with diabetes mellitus, peripheral neuropathy, impaired visual acuity, and at least one other diabetes-related visual impairment in a high-risk podiatry clinic. Patients received a telemedicine remote temperature monitoring mat and instructed on proper daily use. Each patient developed a "hotspot," defined as a 1.75°C localized temperature difference between matched pedal locations, which resulted in telephone triage outreach. In three cases, outreach resulted in a sooner appointment where patients were found to have a relevant outcome at the hotspot. Patients in cases 1-3 had University of Texas (UT) 1A ulcerations. The patient in case 4 had inflammation from trauma. All patients had refractive errors plus another vision impairing condition that potentially delayed identification of lesions. Patients in cases 1 and 2 have cataracts, patients in cases 2 and 3 have retinopathy, and patient in case 4 has glaucoma. As an adjunct to daily preventative diabetic self-care, once-daily remote temperature monitoring technology can augment self-screening to prompt necessary outreach and treatment and potentially prevent costly and debilitating diabetic foot complications. This case series serves as a pilot study for real-world application of thermometry, where further large-scale research is needed.

Knowledge, Attitude, and Practice of Foot Care among Type 2 Diabetic Patients Attending Diabetic Clinic. Al Ribat Teaching Hospital in Sudanese Patients

Diabetic foot complications are a major challenge for the healthcare system, with enormous economic consequences for the patients, their families, and the society and a leading cause of mortality and morbidity in developing countries. Diabetic foot ulcer (DFU) is the most costly and devastating complication, which affects 15% of diabetic patients during their lifetime. Good knowledge, attitude, and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputations. The aim of this study was to assess the knowledge, attitude, and practice of foot care among type 2 diabetic patients and to determine the relationship between proper foot care and diabetic foot lesions. This is an observational, descriptive, cross-sectional, hospital- based study. It was conducted in the diabetic out-patient clinic at Al-Ribat University Hospital, in Khartoum, Sudan 2016. A total number of 156 type 2 diabetic patients were enrolled in this study; with 75% of the participants were females and 25% males. Duration of DM, exercise, smoking adherent to diabetic diet, type of therapy, co-morbidity, foot lesions, and foot care knowledge, attitude, and practice were tested. Having diabetes longer than 10 years were 37.8%, mean age was 53.4 ± 7.68 years. There was high prevalence of peripheral neuropathy(PN) symptoms 56.4% while 42.3% of the patients had peripheral arterial disease symptoms .17 patients had loss of sensation while only 2 patients had loss of peripheral pulses (dorsalis pedis and posterior artery pulses). Regarding knowledge, attitude, and practice about diabetic foot care, 56.5% had good foot care knowledge, 70.5% had bad attitude, and 62.2% had moderate practice. Based on Chi square test of relationship between proper foot care and diabetic foot ulcer (DFU), there was association between bad knowledge, attitude, and practice about foot care and DFU, P. values: 0,03, 0,000, 0.036 respectively. Advising the diabetics about frequent foot care clinic visits, regular feet examination, proper footwear, exercise program, and smoking cessation would be beneficial in preventing diabetic foot complication. Policy and decision makers should initiate interventional foot care education programs throughout the country, with our ultimate goal is to save limbs.

Prevalence of ankle equinus and correlation with foot plantar pressures in people with diabetes

BackgroundAn association between equinus and plantar pressure may be important for people with diabetes, as elevated plantar pressure has been linked with foot ulcer development. To determine the prevalence of equinus in community dwelling people with diabetes and to examine any association between presence of equinus and forefoot plantar pressures. MethodsBarefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, non-weight bearing ankle range of motion and neuropathy status were assessed in 136 adults with diabetes (52.2% male; 47.8% with neuropathy; mean (standard deviation) age and diabetes duration: 68.4 (11.5) and 14.6 (11.1) years respectively). FindingsEquinus, when measured as ≤5° dorsiflexion, was present in 66.9% of the cohort. There was a significant correlation between an equinus and barefoot (r = 0.247, p = 0.004) and in-shoe forefoot pressure time integrals (r = 0.214, p = 0.012) and in-shoe forefoot alternate pressure time integrals (r = 0.246, p = 0.004). Significantly more males (p < 0.01) and people with neuropathy (p = 0.02) or higher glycated haemoglobin levels (p < 0.01) presented with an equinus. InterpretationCommunity dwelling adults with diabetes have a high rate of ankle equinus which is associated with increased forefoot pressure time integrals and a two-fold increased risk of high in-shoe peak pressures. Clinical assessment of an ankle equinus may be a useful screening tool to identify adults at increased risk of diabetic foot complications.

Lower limb ischemia and microrheological alterations in patients with diabetic retinopathy.

Diabetes mellitus is frequently associated with vascular pathologies and hemorheological disorders. 105 patients with diabetic retinopathy (DRP) (mean age 64.64±9.01 years, 56 males, 49 females), 35 age-matched non-diabetic (mean age 61.65±7.6 years, 14 males and 21 females) and 42 young healthy volunteers (mean age 25.52±3.32 years, 22 males, 20 females) were recruited. Lower extremity artery disease (LEAD) and microcirculatory alterations were screened by hand-held Doppler, transcutaneous partial tissue oxygen tension (tcpO2), tuning fork test, 6-minute walk test, erythrocyte aggregation and deformability. High prevalence of LEAD was detected in diabetic population: 55.3% fulfilled the criteria of LEAD based on ankle-brachial index; severely impaired tcpO2 was measured in 18.6%. The results of non-invasive measurements of the diabetic patients were significantly worse than those of the control groups (p < 0.05). Hemorheological disturbances could be characterized by the significantly higher erythrocyte aggregation (p < 0.05) and lower erythrocyte deformability (p < 0.05) in the diabetic population. Macro- and microcirculatory lower limb disorders could be revealed at high prevalence in diabetic patients with retinopathy. Measurement of tcpO2 and hemorheological variables could be useful to discover patients at higher risk for diabetic foot complications.

A high ankle-brachial index is associated with obesity and low serum 25-hydroxyvitamin D in patients with diabetes

Peripheral artery disease (PAD), when present with diabetes, is associated with significant morbidity and mortality. The spectrum of PAD in diabetes includes atherosclerosis with stenotic disease; and diffuse medial calcification with non-compliant arteries, as reflected by high ankle brachial index. The clinical characteristics of a high ABI are less well characterized than that of low ABI.The aim of this study was to determine the unique clinical phenotype of patients with diabetes who have high ankle brachial index (ABI) reading. We performed a cross sectional observational study including 360 patients. Subjects were grouped according to normal (≥ 0.8 ≤ 1.3), low (<0.8) or high ABI (>1.3) result. Subjects with high ABI were characterised by higher BMI, higher waist/height ratio (WHtR), and lower serum lower vitamin D. Although reduced renal function and neuropathy was present more frequently in those with high ABI, this was also the case in those with low ABI. Similarly to those with low ABI result, a high ABI result was associated with increased risk of diabetic foot complications including amputation. When adjusted for known risk factors for PAD, higher WHtR and lower vitamin D were significant predictors of high ABI. These results suggest an association between increased WHtR and low vitamin D with high ABI; whether there is a causal relationship requires further exploration.

Prevention and treatment of diabetic foot ulcers.

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

Delay between Onset of Symptoms and Seeking Physician Intervention Increases Risk of Diabetic Foot Complications: Results of a Cross-Sectional Population-Based Survey.

We present a post hoc analysis of 17,530 questionnaires collected as part of the 2012 screening for neuropathy using Norfolk Quality of Life tool in patients with diabetes in Romania, to assess the impact on foot complications of time between the onset of symptoms of diabetes/its complications and the physician visit. Odds ratios (ORs) for self-reporting neuropathy increased from 1.16 (95% CI: 1.07–1.25) in those who sought medical care in 1–6 months from symptoms of diabetes/its complications onset to 2.27 in those who sought medical care >2 years after symptoms onset. The ORs for having a history of foot ulcers were 1.43 (95% CI: 1.26–1.63) in those who sought medical care in 1–6 months and increased to 3.08 (95% CI: 2.59–3.66) in those who sought medical care after >2 years from symptoms of diabetes/its complications onset. The highest ORs for a history of gangrene (2.49 [95% CI: 1.90–3.26]) and amputations (2.18 [95% CI: 1.60–2.97]) were observed in those who sought medical care after >2 years following symptoms onset. In conclusion, we showed that waiting for >1 month after symptoms onset dramatically increases the risk of diabetic foot complications. These results show the need for accessible educational programs on diabetes and its chronic complications and the need to avoid delays in reporting.

Knowledge and practice of foot care among the patients of diabetic foot: a hospital based cross-sectional study

Background: Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and that will decrease the chances of amputation of the limb.Methods: Present study was hospital based cross- sectional study, conducted at a tertiary care centre of Ahmedabad city. Total 103 patients of diabetic foot, who had attended out patient department (OPD) of surgery from January 2015 to December 2015, were selected by purposive non probability sampling method. Twenty questions for knowledge of foot care and 14 questions for current foot care practice were included in the questionnaire and each positive answer was assigned one mark. Their knowledge and practice scores were classified as good, satisfactory and poor depending upon the score. For the knowledge and practice, if score was ≥70%, it was regarded as good, 50-69% was regarded as satisfactory and less than 50% score was regarded as poor. Results: Only 24(23%) patients had good knowledge, 51 (50%) patients had satisfactory knowledge and 28(27%) had poor knowledge about diabetic foot care. Majority of the patients, i.e., 53 (51%) had poor practice, 34 (33%) had satisfactory practice and 16 (15%) had good practice. Duration of the diabetes and frequency of diabetic foot had significant statistical association with knowledge and practices of foot care.Conclusions: Average Knowledge and poor practice were observed among the diabetic foot patients who have attended the OPD of surgery. It indicates need of giving proper knowledge to diabetes patients by education.

Knowledge and Practice of Diabetic Foot Care in an In- Patient Setting at a Tertiary Medical Center.

Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients' knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 'yes' or 'no' questions on foot care knowledge and practice. Score of 1 was given for each 'yes' answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.

Diabetic Foot Examination

The 60-second tool (2012)(©) uses a cost-effective, simple, standardized approach to identifying, in a timely fashion, which individuals are at high risk for diabetic foot complications. Using this tool, occupational health nurses can screen for diabetic foot complications in varied clinical settings.

Diabetic Foot Examination

The 60-second tool (2012)(©) uses a cost-effective, simple, standardized approach to identifying, in a timely fashion, which individuals are at high risk for diabetic foot complications. Using this tool, occupational health nurses can screen for diabetic foot complications in varied clinical settings.