Increased risk of hospital-acquired foot ulcers in people with diabetes: large prospective study and implications for practice

Abstract

AimsDiabetes increases the risk of costly and potentially preventable hospital-acquired pressure ulceration. Given that peripheral arterial disease and neuropathy, important risk factors for foot ulceration, are more common in people with diabetes, their risk of hospital-acquired foot ulceration (HAFU) in particular may be even greater. This study aims to determine this risk.MethodsUsing data collected over 2 years from all admissions to the Ipswich Hospital NHS Trust, we conducted a prospective multilevel regression analysis of the risk of HAFU in 5043 admissions of people with diabetes versus 23 599 without diabetes. Patients over 50 years who developed HAFU at least 48 hours after admission were included in analyses. Progressive adjustment for important risk factors and subgroup analyses were conducted to compare patients with and without diabetes.ResultsThere were significant differences between patients with and without diabetes among a range of covariates including sex, Comorbidity Score, and length of stay (p value <0.001). After progressive adjustment for age, sex, and other risk factors, there persisted a significant increase risk of HAFU in people with diabetes (OR 2.24; 95% CI 1.80 to 2.69). There were no substantial differences between clinically relevant subgroups.ConclusionsThese analyses demonstrate at least a twofold increase in the risk of HAFU in patients with diabetes and suggest further work should focus on specific processes to detect those inpatients with diabetes at increased risk, in whom preventative measures may reduce the prevalence of this costly complication.

The effect of high‐voltage monophasic pulsed current on diabetic ulcers and their potential pathophysiologic factors: A systematic review and meta‐analysis

“…8,25,28 Increased plantar pressure is a significant risk factor for the formation of DFUs, 29,30 and diabetes mellitus may constitute a risk factor for the development of foot PrUs. 31,32 Failure of chronic wounds to heal might have a common molecular pathophysiologic origin, despite the heterogeneity in their aetiology. 2,33 Persistent inflammatory state due to repeated trauma, low-level bacterial contamination or ischemia might constitute a common underlying mechanism in chronic wounds.…”

“…Moreover, a common factor in the development of both PrUs and DFUs is increased pressure, 26 and both are managed by reducing pressure (offloading) 8,25,28 . Increased plantar pressure is a significant risk factor for the formation of DFUs, 29,30 and diabetes mellitus may constitute a risk factor for the development of foot PrUs 31,32 …”

Managing patients with comorbidities: future models of care

“…For a person with diabetes, it recommends a foot examination to detect loss of protective foot sensation. 9 The tool also describes a quick and simple method to do this. As with all the conditions where diabetes is a comorbidity, it recommends excluding hypoglycaemia, DKA and HHS, any of which may be relevant where a fall led to the fracture.…”

Development and characterization of an automated portable wound irrigation device for diabetic ulcers

“…A previous study showed that a lower limb is amputated every 30 s due to DM, and the average annual cost for a diabetic foot is $8,659 per patient [3]. In a recent meta-analysis, the pooled odd ratio (OR) of the incidence of decubitus ulcers in patients with DM was 1.74 (95% confidence interval (CI) 1.40 to 2.15) compared with patients without DM [4], [5]. At the foot surface, decubitus ulcers could occur at the heel, malleolus, and occiput.…”