Comparison of four systems of classification of diabetic foot ulcers in Tanzania

Abbas, Z. G.; Lutale, Janet; Game, Frances; Jeffcoate, William

doi:10.1111/j.1464-5491.2007.02308.x

Cited by 48 publications

(80 citation statements)

References 14 publications

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“…By contrast, the profile was similar to that encountered in countries with similar economic status, in which the prevalence of ischaemia has also been reported to be low and in which infection was the factor most closely associated with outcome (29)(30)(31)(32). The independent association noted between neuropathy and outcome has also been reported very recently in a similar study undertaken in Tanzania (32). These results reinforce the importance of taking note of regional differences when making comparisons between different centres.…”

Section: Area Gradecontrasting

confidence: 32%

“…The failure to demonstrate an association between healing and arteriopathy in the studied population probably reflects the very low prevalence of severe PAD in this population (5.3%). By contrast, the profile was similar to that encountered in countries with similar economic status, in which the prevalence of ischaemia has also been reported to be low and in which infection was the factor most closely associated with outcome (29)(30)(31)(32). The independent association noted between neuropathy and outcome has also been reported very recently in a similar study undertaken in Tanzania (32).…”

Section: Area Gradementioning

confidence: 48%

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Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population

Parisi

Zantut-Wittmann²,

Pavin³

et al. 2008

European Journal of Endocrinology

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Objective: The aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the size (area, depth), sepsis, arteriopathy, denervation system (S(AD)SAD) systems in a specialist clinic in Brazil. Methods: Ulcer area, depth, appearance, infection and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated. Follow-up was for at least 6 months. The primary outcome measure was the incidence of healing. Results: Mean age was 57.6 years; 57 (60.6%) were male. Forty-eight ulcers (51.1%) healed without surgery; 11 (12.2%) subjects underwent minor amputation. Significant differences in terms of healing were observed for depth (PZ0.002), infection (PZ0.006) and denervation (PZ0.002) using the S(AD)SAD system, for UT grade (PZ0.002) and stage (PZ0.032) and for Wagner grades (PZ0.002). Ulcers with an S(AD)SAD score of %9 (total possible 15) were 7.6 times more likely to heal than scores R10 (P!0.001). Conclusions: All three systems predicted ulcer outcome. The S(AD)SAD score of ulcer severity could represent a useful addition to routine clinical practice. The association between outcome and ulcer depth confirms earlier reports. The association with infection was stronger than that reported from the centres in Europe or North America. The very strong association with neuropathy has only previously been observed in Tanzania. Studies designed to compare the outcome in different countries should adopt systems of classification, which are valid for the populations studied.European Journal of Endocrinology 159 417-422

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Section: Area Gradecontrasting

confidence: 32%

Section: Area Gradementioning

confidence: 48%

Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population

Parisi

Zantut-Wittmann²,

Pavin³

et al. 2008

European Journal of Endocrinology

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“…The association between severe peripheral neuropathy and non-healing diabetic ulcers was reported from developing countries (15, 17). In our study, the combination of peripheral neuropathy and ischemia was the commonest predictor of non-healing DFU.…”

Section: Discussionmentioning

confidence: 92%

Associated risk factors and management of chronic diabetic foot ulcers exceeding 6 months’ duration

Musa

Ahmed

2012

Diabetic Foot & Ankle

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BackgroundThe 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>6 months’ duration.MethodsThis prospective study was performed in Jabir Abu Eliz Diabetic Centre (JADC), Khartoum, Sudan. A total of 108 patients who had DFU for >6 months were included. Recorded data included patient's demographics, DFU presentation, associated comorbidities, and outcomes. DFU description included size, depth, protective sensation, perfusion, and presence of infection. Comorbidities assessed included eye impairment, renal and heart disease. All patients received necessary local wound care with sharp debridement of any concomitant necrotic and infected tissues and off-loading with appropriate shoe gear and therapeutic devices.ResultsThe mean age of the studied patients was 56+SD 9 years with a male to female ratio of 3:3.3. The mean duration of DFU was 18±SD 17 months (ranging from 6 to 84 months). Ulcer healing was significantly associated with off-loading, mainly the use of total contact cast (TCC) (p=0.013). Non-healing ulcerations were significantly associated with longer duration of the chronic DFU>12 months (p=0.002), smoking (p=0.000), poor glycemic control as evidenced by an elevated HbA1c (>7%), large size (mean SD 8+4 cm), increased depth (p<0.001), presence of skin callus (p<0.000), impaired limb perfusion (p=0.001), impaired protective sensation as measured by 10 g monofilament (p=0.002), neuroischemia (p=0.002), and Charcot neuroarthropathy (p=0.017).DiscussionRisk factors associated with chronic DFU of>6 months’ duration included the presentation of an ulcer with increased size and depth, with associated skin callus and neuroischemia, in a diabetic patient with a history of smoking and increased HbA1c >7%. Off-loading mainly with the use of TCC is an effective method of managing long-standing DFU.

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“…Objective sensory loss was defined as reduction in vibration, Joint position sense (JPS), or monofilament at the great toe in either foot. The presence of dorsalis pedis, posterior tibial pulses, and foot ulceration using the Wagner score 15 were recorded. An ophthalmologist examined patients for the presence of diabetic eye disease and graded according to criteria used in the Liverpool Diabetes Eye Study.…”

Section: Setting Queen Elizabeth Central Hospital (Qech) Inmentioning

confidence: 99%

A Survey of the Management, Control, and Complications of Diabetes Mellitus in Patients Attending a Diabetes Clinic in Blantyre, Malawi, an Area of High HIV Prevalence

Cohen¹,

Allain²,

Glover³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. The aim of this study was to describe the current status of diabetes care in an urban diabetes clinic in Malawi and the prevalence of human immunodeficiency virus (HIV) in this population, investigating possible associations between HIV and diabetes. A systematic prospective survey of patients attending the diabetes clinic at a teaching hospital in Blantyre, Malawi was conducted. Six hundred twenty patients were assessed. Seventy-four percent had glycosylated hemoglobin (HbA1C) > 7.5%. Systolic blood pressure was > 140 mm Hg in 52% of patients. Hypertension was more common in patients with raised creatinine ( P < 0.003), retinopathy ( P = 0.01), and stroke ( P < 0.0002). Microvascular complication rates were high, specifically nephropathy (34.7%), retinopathy (34.7%), and neuropathy (46.4%). HIV seroprevalence was 13.7%. HIV-positive subjects had a lower body mass index (BMI) and lower fasting blood sugar, and they were more likely to have albuminuria (48.0% versus 33.3%; P < 0.05). Control of glycemia and hypertension were poor, and microvascular complications were common. Nephropathy in diabetic patients may be affected by HIV status.

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Comparison of four systems of classification of diabetic foot ulcers in Tanzania

Cited by 48 publications

References 14 publications

Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population

Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population

Associated risk factors and management of chronic diabetic foot ulcers exceeding 6 months’ duration

A Survey of the Management, Control, and Complications of Diabetes Mellitus in Patients Attending a Diabetes Clinic in Blantyre, Malawi, an Area of High HIV Prevalence

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