Risk Of Diabetic Foot Ulcers Research Articles

The role of vitamin D in diabetic foot ulcer; an umbrella review of meta-analyses.

Complications related to diabetic foot ulcers (DFU) due to diabetes are increasing. One of the factors influencing the management and treatment of complications related to DFU is the vitamin D serum levels of patients. Therefore, we sought to comprehensively review meta-analyses from randomized controlled trials and observational studies examining the link between serum vitamin D levels and DFU outcomes in diabetic patients. We searched PubMed, Scopus, and ISI Web of Science until September 2024 and extracted the required data from related articles according to Inclusion criteria. The certainty of the evidence and the quality of conduct of the published meta-analyses were rated using the ASMTAR 2 tools, respectively. A total of 8 meta-analyses studies that met inclusion criteria were included. Based on the obtained results, it has been noted that individuals with DFU exhibit serum vitamin D levels significantly lower, ranging from -7.14 (5.44, 8.83) to -0.93 (95% CI: 0.17, 1.68) ng/ml, compared to those with diabetes but without DFU. Furthermore, individuals exhibiting severe vitamin D deficiency are found to be at least 1.82 times more susceptible to developing DFU. Conversely, administering varying doses of vitamin D supplementation has been shown to positively affect the size and number of ulcers in DFU patients. This study suggests a potential link between lower levels of vitamin D in the blood and the risk of DFU, hinting at the benefits of vitamin D supplementation in improving outcomes associated with DFU. However, caution is warranted due to the potential bias present in the included studies.

Screening tools for diabetic foot ulcers: a narrative review.

The prevalence of diabetic foot ulcers (DFUs) is 4 to 10% among people with diabetes mellitus. DFUs are associated with increased morbidity and mortality as well as reduced quality of life and have a significant impact on overall healthcare expenditure. The main predisposing factors for DFU are diabetic neuropathy, peripheral arterial disease, and trauma. The fact that a range of tests can be used to identify patients at risk for DFU often causes confusion among practitioners regarding which screening tests should be implemented in clinical practice. Herein we sought to determine whether tests of somatic nerve function, such as pinprick sensation, thermal (cold/hot) test, ankle reflexes, vibration perception, 10-g monofilament, Ipswich touch test, neuropathy disability score, and nerve conduction studies, predict the development of DFUs. In addition, we examined whether sudomotor function screening tests, such as Neuropad, sympathetic skin response, and other tests, such as elevated plantar pressure or temperature measurements, can be used for DFU screening. If not treated properly, DFUs can have serious consequences, including amputation, early detection and treatment are vital for patient outcomes.

Disease Knowledge and Behavior Regarding the Diabetic Foot in Persons at Different Risks for Foot Ulceration According to the International Working Group on the Diabetic Foot Guidelines.

We aimed to analyze levels of knowledge and behavior regarding diabetic foot care and prevention in persons with diabetes according to the International Working Group on the Diabetic Foot (IWGDF) risk stratification system. This descriptive study included 83 persons with diabetes at different risk levels for diabetic foot ulceration (DFU) (IWGDF risk 0-3). The previously validated Patient Interpretation of Neuropathy questionnaire was used to analyze their levels of understanding of foot complications. Participants responded using a 5-point Likert scale. Patients with IWGDF risk 3 knew that good circulation and absence of polyneuropathy in their feet were related to healthy feet relative to the other groups. In addition, they knew that a DFU is not painful relative to the other groups. High-risk patients knew which physical causes could affect the development of a DFU and that foot self-care and medical control could prevent DFU. Patients with IWGDF risk 3 knew the natural progression of diabetic foot complications and how to prevent them. Clinicians should focus their efforts on educating patients with diabetes who are at lower risk for DFU.

The Effect of Dimple Insole Design on the Plantar Temperature and Pressure in People with Diabetes and in Healthy Individuals.

An increase in plantar pressure and skin temperature is commonly associated with an increased risk of diabetic foot ulcers. However, the effect of insoles in reducing plantar temperature has not been commonly studied. The aim was to assess the effect of walking in insoles with different features on plantar temperature. Twenty-six (F/M:18/8) participants-13 with diabetes and 13 healthy, aged 55.67 ± 9.58 years-participated in this study. Skin temperature at seven plantar regions was measured using a thermal camera and reported as the difference between the temperature after walking with an insole for 20 m versus the baseline temperature. The mixed analyses of variance indicated substantial main effects for the Insole Condition, for both the right [Wilks' Lambda = 0.790, F(14, 492) = 4.393, p < 0.01, partial eta squared = 0.111] and left feet [Wilks' Lambda = 0.890, F(14, 492) = 2.103, p < 0.011, partial eta squared = 0.056]. The 2.5 mm-tall dimple insole was shown to be significantly more effective at reducing the temperature in the hallux and third met head regions compared to the 4 mm-tall dimple insole. The insoles showed to be significantly more effective in the diabetes group versus the healthy group, with large effect size for the right [Wilks' Lambda = 0.662, F(14, 492) = 8.037, p < 0.000, Partial eta-squared = 0.186] and left feet [Wilks' Lambda = 0.739, F(14, 492) = 5.727, p < 0.000, Partial eta-squared = 0.140]. This can have important practical implications for designing insoles with a view to decrease foot complications in people with diabetes.

Effect of different inner pressures of air insoles and walking durations on plantar pressure time integral

Air insoles have provided insights for reducing the risk of diabetic foot ulcers (DFU). The pressure time integral (PTI) is an effective assessment that considers the time effect in various physical activities. We investigated the interactions between three different insole inner pressures (80, 160, and 240 mmHg) and two walking durations (10 and 20 min). The big toe (T1), first metatarsal head (M1), and second metatarsal head (M2) were investigated in 13 healthy participants. One-way analysis of variance (ANOVA) showed that the effects of each insole inner pressure significantly differed (P < 0.05) with a 10 min walking duration. The PTI values resulting from 80 mmHg in M2 (38.4 ± 3.8, P = 0.002) and 160 mmHg in M1 (44.3 ± 4.3, P = 0.027) were lower than those from 240 mmHg. Additionally, the paired t test showed that the effects of each walking duration were also considerably different at 160 mmHg. The PTI at 10 min was lower than that at 20 min in M1 (44.31 ± 4.31, P = 0.015) and M2 (47.14 ± 5.27, P = 0.047). Thus, we suggest that walking with a pressure of 160 mmHg for 10 min has a lower risk of DFU.

Performance of risk prediction models for diabetic foot ulcer: a meta-analysis.

The number of prediction models for diabetic foot ulcer (DFU) risk is increasing, but their methodological quality and clinical applicability are uncertain. We conducted a systematic review to assess their performance. We searched PubMed, Cochrane Library, and Embase databases up to 10 February 2024 and extracted relevant information from selected prediction models. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) checklist was used to assess bias risk and applicability. All statistical analyses were conducted in Stata 14.0. Initially, 13,562 studies were retrieved, leading to the inclusion of five development and five validation models from eight studies. DFU incidence ranged from 6% to 16.8%, with age and hemoglobin A1C (HbA1c) commonly used as predictive factors. All included studies had a high risk of bias, mainly due to disparities in population characteristics and methodology. In the meta-analysis, we observed area under the curve (AUC) values of 0.78 (95% CI [0.69-0.89]) for development models and 0.84 (95% CI [0.79-0.90]) for validation models. DFU risk prediction models show good overall accuracy, but there is a risk of bias. Adherence to the PROBAST checklist is crucial for improving their clinical applicability.

Incretin-based therapy and the risk of diabetic foot ulcers and related events.

To investigate the effect of dipeptidyl peptidase-4 inhibitors (DPP4-Is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) on diabetic foot ulcer (DFU) and DFU-related outcomes (lower limb amputation [LLA], DFU-related hospitalization and mortality). We performed a cohort study with data from the Clinical Practice Research Datalink Aurum database with linkage to hospital data. We included people with type 2 diabetes starting treatment with metformin. Then we propensity score matched new users of DPP4-Is and sulphonylureas (N = 98 770), and new users of GLP1-RAs and insulin (N = 25 422). Cox proportional hazards models estimated the hazard ratios (HRs) for the outcomes. We observed a lower risk of DFU with both DPP4-I use versus sulphonylurea use (HR 0.88, 95% confidence interval [CI]: 0.79-0.97) and GLP1-RA use versus insulin use (HR 0.44, 95% CI: 0.32-0.60) for short-term exposure (≤ 400 days) and HR 0.74 (95% CI: 0.60-0.92) for long-term exposure (>400 days). Furthermore, the risks of hospitalization and mortality were lower with both DPP4-I use and GLP1-RA use. The risk of LLA was lower with GLP1-RA use. The results remained consistent across several sensitivity analyses. Incretin-based therapy was associated with a lower risk of DFU and DFU-related outcomes. This suggests benefits for the use of this treatment in people at risk of DFU.

Patient with Diabetic Foot Ulcer Admitted in Surgery Ward; Risk Factors, Associations and Grades of Presentation

Background: The management of chronic diabetic foot ulcers (DFU) poses a great challenge to the treating physician and surgeon. The aim of this study was to identify the risk factors, clinical presentation, and outcomes associated with chronic DFU. Objective: To determine the various risk factors for diabetic foot ulcers and study their associations. To study the grades of diabetic foot ulcers at presentation. Method: Purposive sampling. This study was done in the Surgery department of Shaheed Ziaur Rahman Medical College Hospital (SZMCH), Bogura for period of twelve (12) months. 100 cases were selected after informed consent. Study group (A) comprises of 50 cases of type 2 diabetes with diabetic foot ulcer and control group (B) comprises of 50 cases of age and gender matched type 2 diabetics without foot ulcers. Patients having serious systemic illness, type I diabetics and non-diabetic patients presenting with foot ulcer were excluded. Age, gender, duration of diabetes, duration of ulcer, glycemic control, presence of neuropathy and vascular disease were documented. Grading and Staging of ulcer was done according to New University of Texas Diabetic Wound Classification. Various risk factors were compared between the two groups. Data analyzed via SPSS version 17 with significant p-value &lt; 0.05. Results: Among 100 cases (64 % males &amp; 36 % females); mean age was 58.50 ± 9.8 (group A) versus 50.40 ± 10.5 (group B). Mean duration of diabetes was longer in group A (10.49 ± 7.06 years) vs. group B (8.34 ± 4.83 years) (p = 0.019). Glycemic control was poor in group A (72 %) vs. group B (56 %) (p = 0.045). There was significantly more peripheral vascular disease in group A (50 %) vs. group B (32 %) (p= 0.005). Sensory neuropathy was more in group A (90 %) vs. group B (38 %) (p &lt; 0.0001). Grade-I ulcer was present in 16 % cases, Grade-II in 38 % and Grade-III in 46 %. Conclusion: Neuropathy carries highest risk for diabetic foot ulcer, followed by peripheral vascular disease and poor glycemic control. Therefore, diabetic patient must be educated about these risk factors, foot care and self-examination and to have regular screening by clinician. Appropriate glycemic control and timely medical and surgical intervention may reduce morbidity in diabetics.

Personalized prediction of diabetic foot ulcer recurrence in elderly individuals using machine learning paradigms.

This study utilizes machine learning to analyze the recurrence risk of diabetic foot ulcers (DFUs) in elderly diabetic patients, aiming to enhance prevention and intervention efforts. The goal is to construct accurate predictive models for assessing the recurrence risk of DFUs based on high-risk factors, such as age, blood sugar control, alcohol consumption, and smoking, in elderly diabetic patients. Data from 138 elderly diabetic patients were collected, and after data cleaning, outlier screening, and feature integration, machine learning models were constructed. Support Vector Machine (SVM) was employed, achieving an accuracy rate of 93%. Experimental results demonstrate the effectiveness of SVM in predicting the recurrence risk of DFUs in elderly diabetic patients, providing clinicians with a more accurate tool for assessment. The study highlights the significance of machine learning in managing foot ulcers in elderly diabetic patients, particularly in predicting recurrence risk. This approach facilitates timely intervention, reducing the likelihood of patient recurrence, and introduces computer-assisted medical strategies in elderly diabetes management.

Exploring the influence of dietary habits on foot risk in type 2 diabetes patients: An observational study

Background & AimTo date, there are no studies demonstrating the impact of the Mediterranean diet on the risk of diabetic foot ulcer. The aim of this research was to examine the connection between adherence to the Mediterranean diet and the level of risk of diabetic foot ulcers in individuals with type 2 diabetes. MethodsObservational pilot study collecting sociodemographic, anthropometric, lifestyle, and type 2 diabetes-related data. Loss of protective sensation was assessed using the Semmes Weinstein 5.07-10g monofilament, considered altered when not perceived in four points. Vascular status was assessed by palpating pulses and ankle-brachial index, indicating peripheral arterial disease if ankle-brachial index was less than 0.9 or if both pulses were absent. Foot deformities were recorded. The risk of diabetic foot ulcers was stratified into two categories: no risk and risk of diabetic foot ulcers. Adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener-14 questionnaire (good adherence with score > 7). ResultsOf the 174 patients with type 2 diabetes mellitus who participated (61.5% men and 38.5% women) with a mean age of 69.56 ± 8.86 years and a mean duration of type 2 diabetes of 15.34 ± 9.83 years. Non-adherent patients to the Mediterranean diet exhibited a higher association of diabetic foot ulcers (p=0.030) and a lower average score on the Mediterranean Diet Adherence Screener-14 (p=0.011). Additionally, a lower incidence of diabetic foot ulcers was observed in those who consumed nuts three or more times a week (p=0.003) and sautéed foods two or more times a week (p=0.003). Multivariate analysis highlighted the importance of physical activity (OR=0.25, 95% CI 0.11-0.54; p<0.001), podiatric treatment (OR=2.59, 95% CI 1.21-5.56; p=0.014), and duration of type 2 diabetes (OR=3.25, 95% CI 1.76-5.99; p<0.001) as significantly associated factors related to the risk of diabetic foot ulcers. ConclusionsAdhering to the Mediterranean diet correlates with a lower incidence of diabetic foot ulcers in individuals diagnosed with type 2 diabetes mellitus. Furthermore, factors such as regular physical activity, podiatric treatment, and the duration of type 2 diabetes mellitus emerge as pivotal in preventing diabetic foot ulcers.

The association between tobacco smoking and systolic toe pressures in active foot ulceration

Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine whether toe pressures differed in smokers with a foot ulcer, when compared to non-smokers and ex-smokers, as well as ulcer outcomes at 12 months, among patients attending Blacktown Hospital High Risk Foot Service (HRFS). This study is a retrospective analysis of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or a minimum of 12 months. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .002) and tended towards lower socioeconomic status (p = .067). Current smokers were significantly more likely to have ischaemic grade 3 toe pressures (< 30 mmHg) of their left foot (p = .027), suggestive of reduced perfusion. At the end of follow up period, smokers had the numerically highest rates of minor amputations. In conclusion, smokers ulcerate younger and are more likely to have grade 3 ischaemia. Collecting information about the brachial artery pressures and the time since the last cigarette may clarify any relationship between smoking and toe pressures.Trial registration: WSLHD HREC ethics approval 2111-02 and ANZCTR registration 382470. Registered on 15/09/2021.

Foot and Ankle Care by Podiatrists and Amputations in Patients With Diabetes and Kidney Failure

Patients with kidney failure have an increased risk of diabetes-related foot complications. The benefit of regular foot and ankle care in this at-risk population is unknown. To investigate foot and ankle care by podiatrists and the outcomes of diabetic foot ulcers (DFUs) in patients with kidney failure. This retrospective cohort study included Medicare beneficiaries with type 2 diabetes receiving dialysis who had a new DFU diagnosis. The analysis of the calendar year 2016 to 2019 data from the United States Renal Data System was performed on June 15, 2023, with subsequent updates on December 11, 2023. Foot and ankle care by podiatrists during 3 months prior to DFU diagnosis. The outcomes were a composite of death and/or major amputation, as well as major amputation alone. Kaplan-Meier analysis was used to estimate 2 to 3 years of amputation-free survival. Foot and ankle care by podiatrists and the composite outcome was examined using inverse probability-weighted Cox regression, while competing risk regression models were used for the analysis of amputation alone. Among the 14 935 adult patients with kidney failure and a new DFU (mean [SD] age, 59.3 [12.7] years; 35.4% aged ≥65 years; 8284 men [55.4%]; Asian, 2.7%; Black/African American, 35.0%; Hispanic, 17.7%; White, 58.5%), 18.4% (n = 2736) received care by podiatrists in the 3 months before index DFU diagnosis. These patients were older, more likely to be male, and have more comorbidities than those without prior podiatrist visits. Over a mean (SD) 13.5 (12.0)-month follow-up, 70% of those with podiatric care experienced death and/or major amputation, compared with 74% in the nonpodiatric group. Survival probabilities at 36 months were 26.3% vs 22.8% (P < .001, unadjusted Kaplan-Meier survival analysis). In multivariate regression analysis, foot and ankle care was associated with an 11% lower likelihood of death and/or amputation (hazard ratio [HR], 0.89 95% CI, 0.84-0.93) and a 9% lower likelihood of major amputation (above or below knee) (HR, 0.91; 95% CI, 0.84-0.99) than those who did not. The findings of this study suggest that patients with kidney failure at risk for DFUs who receive foot and ankle care from podiatrists may be associated with a reduced likelihood of diabetes-related amputations.

Self-care of chronic illness prevents the risk of diabetic foot ulcers in patients with diabetes: a cross-sectional study

Introduction: Diabetic foot ulcer (DFU) is a serious and chronic complication of diabetes mellitus (DM). This study aims to explain a model of self-care of chronic illness on the prevention of DFU risk in patients with DM, including foot self-care of maintenance, monitoring, and management. Methods: This study was an analytical study with a cross-sectional approach, with 300 patients randomly selected from six Public Health Centers in Surabaya, Indonesia, from June to August 2022. The inclusion criteria were individuals with DM and aged more than 26 years. Exclusion criteria were reading disabilities or having cognitive impairments Data were collected using a questionnaire. The correlation between variables was analyzed using the statistical method of Partial Least Squares. Results: The risk of DFU in patients with DM was 40% with low risk, 38% with moderate risk, 8% with high risk, 5% remission, and 10% with DFU. This research shows that there is a significant correlation between foot self-care management and the risk of DFU, where the p-value = 0.000, while the indicators of foot self-care maintenance and self-care monitoring do not have a significant correlation with the risk of DFU, where the p-value is respectively equal to 0.350 and 0.844. Conclusions: Foot self-care management was a factor that directly correlates with the risk of DFU. Autonomous self-care management behaviors still needed to be improved, because most patients still had these inadequate behaviors. Further research is needed to improve the behavior quality of patients with DM in managing foot care independently.

The Influence of Honey and Hydrogel Products Therapy on Healing Time in Diabetic Foot.

Diabetic foot ulcer is a serious and common complication of diabetes that often leads to significant morbidity and even amputation if not properly treated. Current treatment options, such as wound dressing, have limitations in promoting efficient healing. There is a need for effective interventions that can expedite the healing process and enhance the time required for complete healing. This prospective single-blinded randomized control trial studied diabetic mellitus type 2 patients with ulcer in their second-degree feet from February 2019 to February 2023 in the Diabetic Foot Center, King Fahad Specialist Hospital Al Qassim-KSA. This study involved 120 patients with a mean age of 59.64 ± 10.21. And 63% to 52.5% of them were males and 57% to 47.5% were females. The mean healing time was about 12.76 ± 4.08 days. Cases were divided into 4 equal groups with altered treatment procedures: honey alone, hydrogel alone, honey, and hydrogel combination alternately (3 intervention groups), and fucidin ointment or cream alone (1 control group), with 30 participants in each group. We revealed that the mean healing times for honey alone, hydrogel alone, and honey and hydrogel alternately were 12.20, 13.97, and 10.83 days, respectively. While it was 14.03 days in the control Fucidin ointment or cream [significantly P < .05 (P = .004)]. From the findings of the present study, we noticed that faster healing time among diabetic foot cases could be accomplished by treatment with a combination of honey and hydrogel alternately. Therefore, this therapy is effective in reducing the risk of diabetic foot ulcers.

Association between antidepressants and the risk of diabetic foot ulcers and amputation in antidepressant-naïve type 2 diabetes mellitus patients: A nested case-control study

AimsAntidepressants are widely used by individuals with type 2 diabetes mellitus (T2DM). This study aimed to explore the correlation between antidepressant use, considering specific antidepressant subclasses or cumulative doses, and diabetic foot ulcer (DFU) risk. MethodsThis nested case-control study was conducted using a representative population-based Korean cohort database from 2002 to 2019. Participants with DFUs were matched with participants without DFUs based on age, sex, date of T2DM diagnosis, and follow-up duration. In total, 791 DFUs and 3900 controls were included. The association between antidepressant use or cumulative dose of each antidepressant subclass, DFU risk and amputation risk was examined using a conditional logistic regression model. ResultsAntidepressant ever-use was associated with an increased incidence of DFUs compared with non-use. Furthermore, an increase in DFU risk was evident with increasing cumulative antidepressant dosage, particularly among tricyclic antidepressant (TCA) ever-users and selective serotonin reuptake inhibitors (SSRIs) ever-users. Additionally, antidepressant ever-users displayed a higher risk of DFUs requiring amputation, which was consistently observed when the cumulative dosages of overall antidepressants and TCAs were considered. ConclusionCaution is advised when administering TCAs and SSRIs in antidepressant-naïve T2DM patients to reduce DFU and the consequent amputation risk.

Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry.

Diabetic foot ulcer (DFU) is a leading cause of lower limb amputations in people with diabetes. This study was aimed to retrospectively analyze factors affecting DFU using real-world data from a large, prospective central-European diabetes registry (DPV [Diabetes-Patienten-Verlaufsdokumentation]). We matched adults with type 1 (T1D) or type 2 diabetes (T2D) and DFU to controls without DFU by diabetes type, age, sex, diabetes duration, and treatment year to compare possible risk factors. Cox regression was used to calculate hazard ratios for amputation among those with DFU. In our cohort (N = 63 464), male sex, taller height, and diabetes complications such as neuropathy, peripheral artery disease, nephropathy, and retinopathy were associated with DFU (all p < .001). Glycated hemoglobin (HbA1c) was related to DFU only in T1D (mean with 95% confidence interval [CI]: 7.8 [6.9-9.0] % vs 7.5 [6.8-8.5] %, p < .001). High triglycerides and worse low-density lipoprotein/high-density lipoprotein ratio were also associated with DFU in T1D, whereas smoking (14.7% vs 13.1%) and alcohol abuse (6.4% vs 3.8%, both p < .001) were associated with DFU in T2D. Male sex, higher Wagner grades, and high HbA1c in both diabetes types and insulin use in T2D were associated with increased hazard ratios for amputations. Sex, body height, and diabetes complications were associated DFU risk in adults with T1D and T2D. Improvement in glycemic control and lipid levels in T1D and reduction of smoking and drinking in T2D may be appropriate interventions to reduce the risk for DFU or amputations.

Residential Address Amplifies Health Disparities and Risk of Infection in Individuals With Diabetic Foot Ulcers.

To determine the association between social determinants of health (SDOH) and a diagnosis of diabetic foot ulcer (DFU) infection. Targeted interrogation of electronic health record data using novel search engines to analyze individuals with a DFU infection during a 5-year period (2013-2017) was performed. We extracted geolocated neighborhood data and SDOH characteristics from the National Neighborhood Data Archive and used univariate and multiple logistic regression to evaluate associations with outcomes in the population with diabetes. Among 4.3 million people overall and 144,564 individuals with diabetes seen between 2013 and 2017, 8,351 developed DFU, of which cases 2,252 were complicated by a DFU infection. Sex interactions occurred, as men who experienced a DFU infection more frequently identified as having nonmarried status than their female counterparts. For the population with DFU infection, there were higher rates for other SDOH, including higher neighborhood disadvantaged index score, poverty, nonmarriage, and less access to physician/allied health professionals (all P < 0.01). In multiple logistic regression, those individuals who developed DFU infection came from neighborhoods with greater Hispanic and/or foreign-born concentrations (odds ratio 1.11, P = 0.015). We found significant differences in neighborhood characteristics driving a higher risk for DFU infection in comparisons with the grouping of individuals with diabetes overall, including increased risk for individuals with Hispanic and/or foreign-born immigration status. These data strongly support the need to incorporate SDOH, particularly ethnic and immigration status, into triage algorithms for DFU risk stratification to prevent severe diabetic foot complications and move beyond biologic-only determinants of health.

Evaluation of usability, adherence, and clinical efficacy of therapeutic footwear in persons with diabetes at moderate to high risk of diabetic foot ulcers: A multicenter prospective study.

To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. All the patients included in the research were prescribed with their first pair of therapeutic footwear. Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5-8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations.

Diabetic foot ulcers risk prediction in patients with type 2 diabetes using classifier based on associations rule mining

Identifying diabetic patients at risk of developing foot ulcers, as one of the most significant complications of diabetes, is a crucial healthcare concern. This study aimed to develop an associative classification model (CBA) using the Apriori algorithm to predict diabetic foot ulcers (DFU). This retrospective cohort study included 666 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Iran between April 2020 and August 2022, of which 279 (42%) had DFU. Data on 29 specific baseline features were collected, which were preprocessed by discretizing numerical variables based on medical cutoffs. The target variable was the occurrence of DFU, and the minimum support, confidence, and lift thresholds were set to 0.01, 0.7, and 1, respectively. After data preparation and cleaning, a CBA model was created using the Apriori algorithm, with 80% of the data used as a training set and 20% as a testing set. The accuracy and AUC (area under the roc curve) measure were used to evaluate the performance of the model. The CBA model discovered a total of 146 rules for two patient groups. Several factors, such as longer duration of diabetes over 10 years, insulin therapy, male sex, older age, smoking, addiction to other drugs, family history of diabetes, higher body mass index, physical inactivity, and diabetes complications such as proliferative and non-proliferative retinopathy and nephropathy, were identified as major risk factors contributing to the development of DFU. The CBA model achieved an overall accuracy of 96%. Also, the AUC value was 0.962 (95%CI 0.924, 1.000). The developed model has a high accuracy in predicting the risk of DFU in patients with type 2 diabetes. The creation of accurate predictive models for DFU has the potential to significantly reduce the burden of managing recurring ulcers and the need for amputation, which are significant health concerns associated with diabetes.

Trajectories of Remnant Cholesterol are Associated with Diabetic Foot Ulcer in Adult Patients with Type 2 Diabetes: A Retrospective Cohort Study.

This study aimed to investigate the potential association between long-term variations in remnant cholesterol (RC) levels and the development of diabetic foot ulcers (DFU) in participants with type 2 diabetes (T2D). This was a retrospective cohort study. Variation in RC was assessed by the following metrics: mean, standard deviation (SD), coefficient of variation (CV) and trajectories pattern of RC. To identify RC trajectories, we employed the latent class mixture model. The primary endpoint was the development of DFU, and the time-to-event data were analyzed using Cox regression. A total of 1874 patients with T2D were included, with a median follow-up duration of 4.7 years. Among them, 129 individuals (6.9%) developed DFU. The proportion of DFU was significantly higher in the U-shaped group compared to the median group (P for trend < 0.001). Upon adjustment for confounding variables, the U-shaped trajectory correlated with a higher risk of DFU, demonstrating a hazard ratio (HR) of 2.57 (95% CI, 1.54-4.27). Subgroup analysis showed the U-shaped trajectory had a higher DFU risk regardless of gender (HR=2.40 and 2.81, respectively), glycemic control (HR=1.89 and 7.41, respectively), smoking (HR=2.36 and 2.93, respectively), or hypertension (HR=2.30 and 2.97, respectively). No association was found between mean, SD and CV of RC and DFU. A U-shape trajectory of RC was independently associated with an elevated risk of DFU among patients with T2D.