Is there an association between anemia and diabetic foot ulcers? A systematic review and meta‐analysis

Yammine, Kaissar; Hayek, Fady; Assi, Chahine

doi:10.1111/wrr.12902

Cited by 31 publications

(19 citation statements)

References 31 publications

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“…Previous studies proved that anemia was related to DFU risk and adverse outcomes [ 28 ]. A meta-analysis of 2895 patients showed an association between anemia and DFUs, a correlation between the severity of anemia and the severity of DFUs, and that anemia may be a predictor of amputation or death in patients with DFUs [ 29 ]. However, whether improvement of anemia can prevent the occurrence and progression of DFUs still needs to be clarified by further prospective, randomized controlled studies.…”

Section: Discussionmentioning

confidence: 99%

A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers

Shi

Wei

Zhang

et al. 2021

Diabetol Metab Syndr

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Background Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes. This study aimed to establish weighted risk models for determining DFU occurrence and severity in diabetic patients. Methods This was a multi-center hospital-based cross-sectional study. A total of 1488 diabetic patients with or without an ulcer from three tertiary hospitals were included in the study. Random forest method was used to develop weighted risk models for assessing DFU risk and severity. Receiver operating characteristic curves were used to validate the models and calculate the optimal cut-off values of the important risk factors. Results We developed potent weighted risk models for evaluating DFU occurrence and severity. The top eight important risk factors for DFU onset were plasma fibrinogen, neutrophil percentage and hemoglobin levels in whole blood, stroke, estimated glomerular filtration rate, age, duration of diabetes, and serum albumin levels. The top 10 important risk factors for DFU severity were serum albumin, neutrophil percentage and hemoglobin levels in whole blood, plasma fibrinogen, hemoglobin A1c, estimated glomerular filtration rate, hypertension, serum uric acid, diabetic retinopathy, and sex. Furthermore, the area under curve values in the models using plasma fibrinogen as a single risk factor for determining DFU risk and severity were 0.86 (sensitivity 0.74, specificity 0.87) and 0.73 (sensitivity 0.76, specificity 0.58), respectively. The optimal cut-off values of plasma fibrinogen for determining DFU risk and severity were 3.88 g/L and 4.74 g/L, respectively. Conclusions We have established potent weighted risk models for DFU onset and severity, based on which precise prevention strategies can be formulated. Modification of important risk factors may help reduce the incidence and progression of DFUs in diabetic patients.

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Section: Discussionmentioning

confidence: 99%

A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers

Shi

Wei

Zhang

et al. 2021

Diabetol Metab Syndr

View full text Add to dashboard Cite

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“…However, there are conflicting reports on the correlation between anemia and DFU prognosis. A meta-analysis found that increasing anemia severity was associated with DFU severity and could serve as a predictor of amputation and mortality [ 45 ]. Retrospective cohort studies identified anemia as significantly associated with larger, deeper ulcers, more severe infections, high amputation risk, and increased mortality rates [ 46 , 47 ], while observational studies in Nigeria have found anemia to be associated with poor wound healing, amputation, and increased mortality [ 48 , 49 ].…”

Section: Pathophysiology Associated With Diabetic Wound Healingmentioning

confidence: 99%

Diabetic Wound-Healing Science

et al. 2021

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Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds.

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“…An increased weight and body mass index are known to exert pressure on plantar ulcers and are key factors delaying wound healing . The esmolol with SoC group showed significantly greater wound closure in people with characteristics that impair wound healing, including those with peripheral arterial disease, anemia, and nephropathy compared with SoC alone …”

Section: Discussionmentioning

confidence: 98%

Topical Esmolol Hydrochloride as a Novel Treatment Modality for Diabetic Foot Ulcers

Rastogi,

Kulkarni,

Agarwal

et al. 2023

JAMA Netw Open

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ImportancePreclinical and phase 1/2 studies with esmolol hydrochloride suggest its potential role in treatment of diabetic foot ulcers (DFUs).ObjectiveTo study the efficacy of topical esmolol for healing of uninfected DFUs.Design, Setting, and ParticipantsA randomized, double-blind, multicenter, phase 3 clinical trial was conducted from December 26, 2018, to August 19, 2020, at 27 referral centers across India. Participants included adults with DFUs.InterventionsParticipants were randomized after a run-in phase (1 week) to receive esmolol, 14%, gel with standard of care (SoC), SoC only, or vehicle with SoC (3:3:1 proportion) for 12 weeks (treatment phase) and followed up subsequently until week 24.Main Outcomes and MeasuresThe primary outcome was the proportion of wound closure within the 12-week treatment phase in the esmolol with SoC and SoC only groups. Analysis was conducted using an intention-to-treat safety evaluable population, full analysis set or efficacy-evaluable population, and per-protocol population comparing the esmolol plus SoC and SoC only treatment groups.ResultsIn the study, 176 participants (122 men [69.3%]; mean [SD] age, 56.4 [9.0] years; mean [SD] hemoglobin A1c level, 8.6% [1.6%]) with DFUs classified as University of Texas Diabetic Wound Classification system grade IA and IC (mean [SD] ulcer area, 4.7 [2.9] cm2) were randomized to the 3 groups. A total of 140 participants were analyzed for efficacy. The proportion of participants in the esmolol with SoC group who achieved target ulcer closure within 12 weeks was 41 of 68 (60.3%) compared with 30 of 72 (41.7%) participants in the SoC only group (odds ratio [OR], 2.13; 95% CI, 1.08-4.17; P = .03). A total of 120 participants completed the end of study visit which were analyzed. Target ulcer closure by the end of the study (week 24) was achieved in 44 of 57 (77.2%) participants in the esmolol with SoC group and 35 of 63 (55.6%) participants in the SoC only group (OR, 2.71; 95% CI, 1.22-5.99; P = .01). The median time for ulcer closure was 85 days for the esmolol with SoC group and was not estimable for SoC only group. Significant benefits of Esmolol with SoC were seen in patients with factors that impede the healing of DFU. Treatment-emergent adverse events were noted in 18.8% of the participants, but most (87.3%) of these events were not attributable to the study drug.Conclusions and RelevanceIn this multicenter, randomized, double-blind clinical trial, the addition of esmolol to SoC was shown to significantly improve the healing of DFUs. With these results, topical esmolol may be an appropriate addition to SoC for treating DFUs.Trial RegistrationClinicalTrials.gov Identifier: NCT03998436; Clinical Trial Registry, India CRI Number: CTRI/2018/11/016295

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Is there an association between anemia and diabetic foot ulcers? A systematic review and meta‐analysis

Cited by 31 publications

References 31 publications

A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers

A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers

Diabetic Wound-Healing Science

Topical Esmolol Hydrochloride as a Novel Treatment Modality for Diabetic Foot Ulcers

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