Prevention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents

Schaper, Nicolaas C.; Netten, Jaap J. van; Apelqvist, Jan; Lipsky, Benjamin A.; Баккер, К.

doi:10.1016/j.diabres.2016.12.007

Cited by 258 publications

(281 citation statements)

References 5 publications

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“…Participants were recruited from community podiatry‐led and multi‐disciplinary diabetic foot ulcer clinics. Eligibility criteria were: diagnosis of diabetes mellitus; foot ulcer suspected of being infected based on clinical signs and symptoms using Infectious Diseases Society of America/International Working Group on the Diabetic Foot 16, 20 criteria and clinical judgement; plan to treat with antibiotics for their infected ulcer; and age ≥ 18 years with written consent provided.…”

Section: Methodsmentioning

confidence: 99%

“…The European Study Group on Diabetes and the Lower Extremity (Eurodiale) study 5, 15 in people with a new diabetic foot ulcer presenting to one of 14 diabetic foot ulcer clinics, and for whom there was a 1‐year follow‐up, identified independent predictors of delayed healing as: older age;, male sex; larger ulcer size; heart failure; inability to stand or walk without help; end‐stage renal disease; peripheral neuropathy; and peripheral arterial disease 15. Current guidelines for the management of infected diabetic foot ulcer 16, 17, 18, 19, 20 highlight the importance of prevention, early diagnosis and appropriate therapy delivered by a multidisciplinary team.…”

Section: Introductionmentioning

confidence: 99%

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Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

et al. 2017

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AimsTo determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer.MethodsThis multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence.ResultsIn the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).ConclusionsClinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

et al. 2017

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“…Type 2 diabetes mellitus was defined as a documented medical diagnosis of type 2 diabetes mellitus in the patient's medical record . A DFU was defined as an existing active full‐thickness wound on the plantar surface of the foot . DPN was defined as a lack of protective sensation to a 10‐gram monofilament on at least two of three plantar forefoot locations on one foot .…”

Section: Methodsmentioning

confidence: 99%

Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

Sheahan

Canning

Refausse

et al. 2017

International Wound Journal

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The aims of our study were to investigate multiple daily activity outcomes in patients with diabetic foot ulcers (DFU) compared to diabetic peripheral neuropathy (DPN) and diabetes (DM) controls in their free-living environments. We examined daily activity outcomes of 30 patients with DFU, 23 DPN and 20 DM. All patients wore a validated multi-sensor device for > 5 days (>22 hours per day) to measure their daily activity outcomes: steps, energy expenditure (kJ), average metabolic equivalent tasks (METs), physical activity (>3·0 METs) duration and energy expenditure, lying duration, sleep duration and sleep quality. We found that DFU patients recorded fewer median (interquartile ranges, IQR) daily steps [2154 (1621-4324)] than DPN [3660 (2742-7705)] and DM [5102 (4011-7408)] controls (P < 0·05). In contrast, DFU patients recorded more mean ± SD daily energy expenditure (kJ) (13 006 ± 3559) than DPN (11 085 ± 1876) and DM (11 491 ± 1559) controls (P < 0·05). We found no other differences in daily activity outcomes (P > 0·1). We conclude that DFU patients typically take fewer steps but expend more energy during their normal daily activity than DPN and DM controls. We hypothesise that the increased energy expenditure for DFU patients may be due to wound healing or an inefficient gait strategy. Further investigations into this energy imbalance in DFU patients may improve healing in future.

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“…Pathological impairment of wound healing response causes persistent ulceration, as seen in diabetic patients or in subjects with vasculopathy, leading to a poor quality of life and a higher risk to develop infections . To date, the therapeutic approaches include surgical debridement (for local wound care), dressings promoting, a moist wound environment, wound off‐loading, vascular assessment, treatment of active infection, and glycemic control . Full thickness skin grafts are commonly used to cover the fingertip soft tissue defects and in some case the use of autologous growth factor blood derivatives is mandatory .…”

Section: Introductionmentioning

confidence: 99%

Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study

Gallelli

Cione

Serra

et al. 2019

International Wound Journal

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Wound healing, especially diabetic ones, is a relevant clinical problem, so it is not surprising that surgical procedures are often needed. To overcome invasive procedures, several strategies with drugs or natural compound are used. Recently, in an experimental study, we described an increase in keratinocyte proliferation after their exposition to quercetin plus oleic acid. In the present clinical study, we evaluated both the clinical efficacy and the safety of nano‐hydrogel embedded with quercetin and oleic acid in the treatment of lower limb skin wound in patients with diabetes mellitus (DM). Fifty‐six DM patients (28 men and 28 women, mean age 61.7 ± 9.2 years) unsuccessfully treated with mechanical compression were enrolled and randomised to receive an add on treatment with hyaluronic acid (0.2%) or nano‐hydrogel embedded with quercetin and oleic acid. The treatment with nano‐hydrogel embedded with quercetin and oleic acid significantly (P < .01) reduced the wound healing time, in comparison to hyaluronic acid (0.2%) without developing of adverse drug reactions, suggesting that this formulation could be used in the management of wound healing even if other clinical trials must be performed in order to validate this observation.

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Prevention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents

Cited by 258 publications

References 5 publications

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study

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