Redefined clinical spectra of diabetic foot syndrome

Abstract

PurposeThe aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations.Patients and methodsThis is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/International Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS.ResultsIn this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revascularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS.ConclusionRedefining DFS into ulcerative, septic and gangrenous by integration of the predominant clinical presentation and the clinical criteria for DFI diagnosis and classification of IDSA/IWGDF showed significant differences in amputation rate. Therefore, it can be used clinically to categorize patients with DFS to predict amputations and to help in planning their management. Further prospective studies are suggested to validate these results.

Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross‐sectional study

“…A significant association between DF and hypertension was also observed in this study. This is consistent with the findings of a meta‐analysis 8 and results reported in the KSA 24 . Obesity and hypertension are important parts of the constellation of metabolic syndrome, which is characterised by insulin resistance, increased advanced glycation end products and high levels of inflammatory markers 20 .…”

“…This study found no association between DF and poor glycemic control as assessed by FBG levels. Previous studies have reported that hyperglycaemia is associated with DF 24,25 . On the other hand, we found an association between DF and the duration of DM.…”

“…Previous studies have reported that hyperglycaemia is associated with DF. 24,25 On the other hand, we found an association between DF and the duration of DM. This is consistent with the results of several studies on different populations.…”

“…This is consistent with the findings of a metaanalysis 8 and results reported in the KSA. 24 Obesity and hypertension are important parts of the constellation of metabolic syndrome, which is characterised by insulin resistance, increased advanced glycation end products and high levels of inflammatory markers. 20 The coexistence of DM and hypertension may increase the risks of peripheral vascular disease and DF.…”

Surgical wound dehiscence complicated by methicillin-resistant Staphylococcus aureus infection in a diabetic patient with femorotibial vascular bypass occlusion

“…Foot infections are common disabling problems affecting the vascular management of diabetic patients resulting in a high rate of amputation and mortality depending on foot-related risk characteristics. 1,2 Prognosis is related to efficacious prevention and early treatment, being worse based on the severity of clinical presentation (ulcer, gangrene and sepsis).…”