Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand's experience

Abstract

AimsThe aims of this study were to evaluate the outcomes of treatment among hospitalized patients with diabetic foot ulcers, the risk factors for non-healing ulcers, and the rate of major amputation among Thai patients.MethodsA retrospective study of hospitalized diabetic foot patients treated at Theptarin Hospital during the period of 2009–2013. The complete healing rate was assessed at 12 months after admission.ResultsDuring the study period, 232 patients (123 males and 109 females) with 262 admissions were included (mean age 65.6 ± 11.9 years, mean duration of diabetes 17.2 ± 9.9 years) with a mean follow-up of 17.5 ± 16.7 months. Major amputations were performed in 4.2% of the patients and peripheral vascular disease (PVD) was a predictive factor (OR 5.25; 95% CI [1.43–19.29]; p-value 0.006). Complete healing (including minor amputations) was achieved in 82.1% of the admissions. Only DFU of the heel was a statistically significant (OR 3.34; 95% CI [1.11–10.24]; p-value 0.041) predictor of non-healing ulcers. Three patients (1.1%) died during hospitalization.ConclusionsManagement of diabetes-related foot ulcers with a multidisciplinary approach resulted in a limb salvage rate that was greater than 90% and a complete healing rate that was greater than 80%. Successful management of diabetic foot ulcers might be possible in Thailand utilizing this approach.

Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu, Nigeria

“…The associated comorbidities detected in our patients were slightly lower than in the study in Thailand, which reported nephropathy in up to 44.4 % of patients [48]. Comorbidities such as hypertension, dyslipidemia, and chronic kidney diseases may influence outcome when they are present as most of these are associated with atherosclerosis and cause impaired endothelial function.…”

Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

“…DFU is the most frequent cause of hospitalization among diabetic patients and LEA is the most feared consequence of foot ulceration ( 2 , 3 , 7 ). The present study examined whether or not certain baseline characteristics and laboratory measures can predict the risk of LEA.…”

“…Our hospital was considered as the main referral medical center in Central Java District, thus hospitalized patients contained complexities and more advanced DFU with an increased risk of extensive surgical management. This fact becomes a relatively common scenario in developing countries while there was a sequential timeline of patients before referred to the hospital and brings considerable delay for optimal management when an amputation surgery was inevitable ( 3 – 5 ).…”

“…Foot ulceration poses a distinct barrier to conservative therapies attributed to difficulty in properly offloading the wounds, inability to provide daily foot hygiene, and compromised distal vascular flow in diabetes. DFU are difficult to treat, frequently get infected, and become a leading cause of diabetes-related hospital admission ( 1 , 3 ). Compared to healthy persons, diabetes mellitus holds a 15- to 20-fold increased risk of lower extremity amputations (LEA) and the majority of diabetes amputation are reported to be preceded (up to 85%) by a poor healing ulcer ( 4 ).…”

Nurses' knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: A cross‐sectional institution‐based study

“…Although diabetic ulcers should ideally be managed by a multidisciplinary healthcare team (Thewjitcharoen et al, 2014), the primary responsibility is with the nurses globally (Fourie, 2013). Optimum knowledge and positive attitudes of nurses are necessary for best practice on diabetic ulcer care (Gagliardino et al, 2007).…”