Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

Abstract

Objective: This single-centred study aims to evaluate the incidence, risk factors and treatment outcomes of a podiatry led, evidence-based diabetic foot ulcer (DFU) clinic. Research design and methods: Data from the DFU database and patient electronic health records were retrospectively collected from patients with new DFUs who were referred for treatment to the Department of Podiatry, Dasman Diabetes Institute, Kuwait, from 1 October 2014, to 31 December 2016. Patients were followed-up until healing occurred or until 6 months after the study end date, whichever came first. Results: All data were analysed using IBM SPSS version 24 software. Data were collected from 230 patients with 335 DFUs. Most DFUs (67%) were present for <3 months from the time of the first podiatry appointment. A total of 56% of DFUs were classified as neuropathic. Most (72%) DFUs healed, with a median healing time of 52.0 days. Chronic kidney disease (p = 0.001), retinopathy (p = 0.03), smoking (p = 0.02), ulcer location (p = 0.03), peripheral arterial disease (PAD) (p = 0.004) and osteomyelitis (p = 0.05) were found to have a meaningful association with DFU outcome. The number of days to heal was associated with ulcer classification (p = 0.005), bacterial infection (p = 0.002), osteomyelitis (p = < 0.001) and PAD (p = < 0.001). Conclusions: The incidence of new DFUs in our tertiary clinic is 3.4%. The incidence of diabetic foot ulceration, days to heal, healing rate and the risk factors influencing healing are in accordance with other multidisciplinary facilities with podiatry input.

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

“…Several studies have investigated factors related to the healing time of DFU (diabetic foot ulcer). Evidence suggests a possible association between healing time and factors such as HbA 1c , ulcer size, infection, peripheral artery disease, etiology, and longer duration of diabetes [4–7]. A recent study presented a linear relationship between HbA 1c and the healing rate of diabetic foot ulcers (every 1% increase in baseline HbA 1c resulted in a decrease of wound area healed per day by 0.028 cm 2 , p = 0.02) [4].…”

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice

“…Specifically, the examination of diabetes patients living with DFU involves a wound classification instrument that provides an indication describing whether ulcers pose a risk of limb amputation or not. Wound dressing selection is carried out by considering the wound size, depth, infection status, necrosis, amount of exudate and the condition of the surrounding tissue . DFU treatment is focused on screening for loss of protective tissue, adequate vascular perfusion assessment, debridement, infection management and pressure alleviation .…”

Diabetes and the direct secondary use of electronic health records: Using routinely collected and stored data to drive research and understanding

“…Many studies reported multiple limitations; many conference abstracts however were brief and did not outline limitations. The most commonly reported limitation was that of missing data values, 29 examples include failures to record whether glucose values were fasting or random 30 and limited information on diabetes-specific outcome measures such as foot amputation 31 or cause of death in the community following hypoglycaemia or diabetic ketoacidosis. 32 …”

“… 27 There were, however, concerns regarding a lack of longitudinal data in certain EHRs and fragmentation of patient data across diverse EHRs. 30 , 31 These data fragmentation and longitudinal concerns were more prominent in US studies, rather than UK studies, which would be expected from the nature of NHS records; however, without a single national EHR there will remain problems, despite all patients having a single national identifier number (NHS number).…”