Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

Lee, Kyung Mook; Kim, Woon Hoe; Lee, Jang Hyun; Choi, Matthew

doi:10.5999/aps.2013.40.2.123

Cited by 31 publications

(24 citation statements)

References 19 publications

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“…Prevalence rates are increasing all the world and the incidence of diabetic foot ulcers is increasing at a higher rate than other complications of diabetes. 1,2 In the United States, diabetic patients account for around 3% of the total population and more than 50% of them suffer lower limb amputations. Around 1 to 4% of diabetic patients develop foot ulcers each year and around 15% will suffer ulceration at least once in their lives.…”

Section: Introductionmentioning

confidence: 99%

“…Around 1 to 4% of diabetic patients develop foot ulcers each year and around 15% will suffer ulceration at least once in their lives. 2,3 Additionally, it is estimated that from 30 to 50% of those who have an amputation will require additional amputations within 1 to 3 years and 50% of them will die within 5 years of the first major amputation. 1 Diabetes, and specifically the problem of the diabetic foot, represent a severe challenge to and burden on the public health system.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with diabetic foot amputations

et al. 2015

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Background: Diabetes and the problem of the diabetic foot specifically are a severe burden on the public healthcare system. Amputations caused by this condition are still common in our setting (Brazil), although the true magnitude of the problem is not known with certainty. Lower limb amputation rates have come to be seen as an indicator of the quality of preventative care of the diabetic foot. Objective: To identify associations between amputations and factors related to people, to morbidities and to primary care received. Methods: This was a cross-sectional study of a sample of 137 patients with diabetic feet admitted to a large hospital in the city of Recife, Pernambuco, Brazil. Logistic regression analysis was conducted. Results: Associations with amputation were detected for the following variables: age over 60; resident of the Metro zone; income of three minimum salaries or less; presence of gangrene on admission; glycemia ≥ 126 mg/dL; smoking; not receiving information about results of glycemia testing; not having feet examined, and not being given guidance on caring for feet at consultations during the previous year. Conclusions: Factors related to Primary Care, such as time since onset of ulcers, information about results of glycemia testing and lack of guidance on how to care for their feet, were associated with occurrence of lower limb amputations. ResumoContexto: O diabetes e especificamente o problema do pé diabético representam grave adversidade ao sistema de saúde pública. As amputações resultantes deste agravo ainda são frequentes em nosso meio, embora não se conheça ao certo a sua magnitude. A taxa de amputações de membros inferiores tem sido considerada um indicador da qualidade dos cuidados preventivos do pé diabético. Objetivo: Identificar a existência de associação entre amputações e fatores relacionados às pessoas, à morbidade e à atenção básica recebida. Métodos: Estudo transversal que incluiu uma amostra de 137 portadores de pé diabético internados em hospital de grande porte da cidade do Recife. Realizou-se análise de regressão logística. Resultados: Verificou-se associação para as variáveis: idade de 60 anos ou mais; procedência da Região metropolitana; renda de até três salários mínimos; presença de gangrena à admissão; glicemia de 126 mg/ dL ou mais; tabagismo; não receber informação dos resultados da glicemia; não ter os pés examinados, e não receber orientação sobre cuidados com os pés nas consultas do ano anterior. Conclusões: Fatores relacionados à Atenção Básica, tais como o tempo de ocorrência da úlcera, a informação dos resultados do exame de glicemia e a falta de orientação sobre cuidados com os pés, estiveram associados com a ocorrência de amputações de membros inferiores.Palavras-chave: pé diabético; amputação; atenção básica.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with diabetic foot amputations

et al. 2015

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“…Yang et al reported that diabetes patients with renal complications had higher rates of lower‐extremity amputation, compared with Chinese and Indians. Furthermore, Kyung et al suggested the serum creatinine level was found to be an important predictive risk factor for the foot ulcerations. However, Cr is not a sensitive index which can reflect the early impairment of renal function.…”

Section: Discussionmentioning

confidence: 99%

High cystatin C levels predict undesirable outcome for diabetic foot ulcerations

Zhang

et al. 2016

Wound Repair Regeneration

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OBJECTIVES: Cystatin C is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum Cystatin C levels and the prognosis of diabetic foot ulcerations (DFU). METHOD: Totally 1012 patients with Type 2 diabetes were recruited and divided into two groups: non-diabetic-foot group (NDF, n = 865, 85.5%) and diabetic foot ulcer group (DFU, n = 147, 14.5%). After 1 year follow-up, the patients with DFU were grouped into healing group (n = 110, 74.8%) and non-healing group (n = 37, 25.2%) according to the clinical prognosis. Clinical characteristics and the impact factors of ulcer healing were compared and analyzed. RESULTS: Compared to the cured group, patients in non-healing group were older, had long diabetic duration and significantly higher serum Cystatin C concentrations in DFU (P < 0.01). Multiple logistical regression analysis revealed that Cystatin C was an independent impact factor for non-healing rate of DFU (b =-1.277, P < 0.01). After adjusting for age, duration, renal function, Cystatin C was still linked with increased risk of undesirable DFU outcome (OR = 7.279, 95% CI: 1.299-40.784, P < 0.05). By dividing patients into quar-tiles according to Cystatin C, a downward trend in healing rate was found with increased quartile of serum Cystatin C, there are significant lower healing rate was found in fourth group which was only 57.9% compared with other three groups (P < 0.01). The oddis ratio (OR) analysis showed that the risk of undesirable outcome of DFU in Quartile 4 increased significantly (OR = 4.554, 95% CI: 3.14-5.12, P < 0.05) compared with that of Quartile 1. ROC analysis further indicated that the optimal cutoff of Cystatin C to predict the poor prognosis of DFU was 1.35 mg/L (P < 0.01) with 79.3% of sensitivity and nearly 62% of specificity. CONCLUSIONS: There is a strong and independent association between serum Cys-tatin C and diabetic foot ulceration prognosis, and Cystatin C > 1.35 mg/L predicts more than 6-fold increased risk of incurable foot ulceration. OBJECTIVES: Recent studies highlight a critical interaction between adipocyte fatty acid binding protein (A-FABP) and cardiovascular disorders. However, relationships between serum A-FABP with subclinical atherosclerosis in normal glucose tolerance subjects remain unknown. The study aimed to evaluate the association of serum A-FABP with carotid intima-media thickness (C-IMT) in a Chinese population with normal glucose tolerance. METHOD: 2253 cardiovascular disease-free participants with normal glucose tolerance aged from 20 to 78 years old (835 men, 1418 women) from the Shanghai Obesity Study were enrolled. Serum A-FABP levels were measured by a sandwich enzyme-linked immunosorbent assay. B-mode ultrasound was used to assess C-IMT. RESULTS: Serum A-FABP level was significantly higher in women than men (P < 0.001). Partial correlation analysis showed that serum A-FABP was associated with C-IMT in men, premenopausal and postmenopausal women after adjusting...

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“…Risk factors are important in predicting the prognosis of ulceration, yet many patients already have intractable ulceration prior to hospital admission. As a result, these studies are less helpful for the prognosis of patients in need of surgery for complicated diabetic foot [ 15 , 16 ]. This study differs from previous studies in that it suggests the clinical predictors of limb salvage surgery failure.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for successful limb salvage surgery in diabetic foot patients

2014

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BackgroundThe goal of salvage surgery in the diabetic foot is maximal preservation of the limb, but it is also important to resect unviable tissue sufficiently to avoid reamputation. This study aims to provide information on determining the optimal amputation level that allows preservation of as much limb length as possible without the risk of further reamputation by analyzing several predictive factors.MethodsBetween April 2004 and July 2013, 154 patients underwent limb salvage surgery for distal diabetic foot gangrene. According to the final level of amputation, the patients were divided into two groups: Patients with primary success of the limb salvage, and patients that failed to heal after the primary limb salvage surgery. The factors predictive of success, including comorbidity, laboratory findings, and radiologic findings were evaluated by a retrospective chart review.ResultsThe mean age of the study population was 63.9 years, with a male-to-female ratio of approximately 2:1. The mean follow-up duration was 30 months. Statistical analysis showed that underlying renal disease, limited activity before surgery, a low hemoglobin level, a high white blood cell count, a high C-reactive protein level, and damage to two or more vessels on preoperative computed tomography (CT) angiogram were significantly associated with the success or failure of limb salvage. The five-year survival rate was 81.6% for the limb salvage success group and 36.4% for the limb salvage failure group.ConclusionThis study evaluated the factors predictive of the success of limb salvage surgery and identified indicators for preserving as much as possible of the leg of a patient with diabetic foot. This should help surgeons to establish the appropriate amputation level for a case of diabetic foot and help prevent consecutive operations.

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Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

Cited by 31 publications

References 19 publications

Factors associated with diabetic foot amputations

Factors associated with diabetic foot amputations

High cystatin C levels predict undesirable outcome for diabetic foot ulcerations

Predictive factors for successful limb salvage surgery in diabetic foot patients

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