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Renal impairment considerations have largely been absent diabetic foot literature, despite evidence that people with severe renal impairment are at elevated risk complications following diabetic foot infections. We evaluated clinical outcomes in patients who were admitted to hospital with diabetic foot infections with severe renal impairment compared with patients without a disability. This was a retrospective study of patients with diabetes mellitus who had been hospitalized at a level 1 trauma center with moderate and severe diabetic foot infections. Patients were grouped according to their Glomerular Filtration Rate (GFR). Patients with severe renal impairment were defined as having a GFR < 30mL/min. Primary outcomes were mortality, wound healing and reinfection rates. Primary and secondary outcomes were compared using multivariable regression RStudio. A total of 307 patients with diabetic foot infections (62 patients with SRI and 245 patients without SRI) were included in the analysis. Multivariate analysis revealed that patients with severe renal impairment had higher rates of peripheral arterial disease (87% vs 66.9%; p = 0.003) and lower hemoglobin levels (9.8 vs 12.0; p <0.001). We found that patients with diabetes and severe renal impairment at admission had significantly lower glycosylated hemoglobin levels (7.2% vs 9.2%; p < 0.001). There was no difference in severity of infections between the two groups. We found that diabetic patients with severe renal impairment had higher mortality rates (8.1% vs 2.0%; p = 0.044) and higher rates of re-admission of new infections at different sites (51.6% vs 22.9%; p < 0.001). There was no significant difference between the other outcomes of interest (wound healing and reinfection). In conclusion, patients with severe renal impairment who were admitted to hospital moderate and severe diabetic foot infections had higher mortality rates and elevated readmission risk than those without severe renal impairment. Disclosure T.L.Coye: None. P.Crisologo: None. M.A.Suludere: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.

In diabetic patients on dialysis, glycemic control may improve spontaneously, leading to normal glycated hemoglobin (HbA1c) levels and termination of antidiabetic medications; this phenomenon is known as “burnt-out diabetes.” It has been previously shown that diabetic patients on dialysis with normal and less than normal glycated hemoglobin levels may have a higher risk of mortality. The aim of this systematic review and meta-analysis is to determine the prevalence of diabetic burn-out in patients with diabetic nephropathy on dialysis. Web of Science, Scopus, and PubMed were searched from inception to January 2023. Only studies that obtained samples from populations which reported the number of patients with diabetic burn-out, defined as: HgbA1c < 6.0%, cessation of antidiabetic medication, and on dialysis were included. The primary meta-analysis outcome was prevalence of diabetic burn-out. A random effects meta-analysis was carried out using RStudio software. Four studies, conducted between 2007 and 2018, met the inclusion criteria and contributed 139,690 diabetic patients (sample size range, 1296-60,019). The pooled estimation of prevalence of diabetic burn out in patients on dialysis was 28.8% (95% CI, 28.6%-29.0%). Prevalence in the included studies varied from 18.6% to 39.7%. We found a high heterogeneity (I2= 100%, p < 0.000, Q = 6641.79) in prevalence reported among studies. In conclusion, we found that the “burnt-out diabetes” phenomenon may exist in 28.8% of HD patients with diabetes in terms of HbA1c levels. Additional studies are needed to determine the optimal target for hemoglobin A1c levels in hemodialysis patients with diabetes. Disclosure T.L.Coye: None. P.Crisologo: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.

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