Systematic review of complications and outcomes of diabetic patients with burn trauma

Sayampanathan, Andrew Arjun

doi:10.1016/j.burns.2016.06.023

Cited by 30 publications

(13 citation statements)

References 38 publications

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“…Wounds and burns in people with diabetes are a worldwide health-care burden. They are difficult to manage, often leading to prolonged hospitalization and treatment and to other complications, such as wound infection and sepsis (Sayampanathan, 2016). Impaired wound healing represents one of the major complications of diabetes in clinical practice and increases the complexity of treatment (Christman et al, 2012; Gee Kee, Kimble, Cuttle, Khan, & Stockton, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Burn wounds display late closure with extended inflammation, high levels of inflammatory cytokines, poor angiogenesis, and less matrix deposition compared with the healing process in nonburn wounds (Azevedo et al, 2015; Qiao, Lu, Dong, & Song, 2011; Schwacha, Nickel, & Daniel, 2008). People with diabetes have an increased risk of complications and death as a result of burn wounds than do healthy individuals (Rani & Schwacha, 2012; Sayampanathan, 2016; Wu, Xue, Liu, Si, & Yang, 2009). Poor glycemic control, as evidenced by higher glycated hemoglobin (HbA1c) levels, is associated with delayed wound healing (Christman, Selvin, Margolis, Lazarus, & Garza, 2012).…”

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confidence: 99%

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Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats

Azevedo

Moreira

Teixeira

et al. 2019

Biological Research For Nursing

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The healing time of burn wounds depends on surface area and depth of the burn and associated comorbidities. Diabetes mellitus (DM) causes delays in the healing process by extending the inflammatory phase. Treatment with topical insulin can improve the inflammatory phase, restore metabolic dysregulation, and modulate impaired cellular signaling in burn wounds. The objective of this study was to evaluate markers of the inflammatory and proliferative phases of second-degree burns after topical insulin treatment in diabetic rats. Type I DM was induced with streptozotocin in male Wistar rats. The animals’ backs were shaved and subjected to thermal burning. Rats were randomized into two groups: control diabetic (DC) and insulin diabetic (DI). At Days 7 and 14 postburn, rats were euthanized, and wound-tissue sections were evaluated by hematoxylin and eosin, Weigert, and Verhöeff staining, immunohistochemistry-paraffin, and enzyme-linked immunosorbent assay. A significant increase in reepithelialization was seen on Days 7 and 14 in DI versus DC rats. On Day 7, interleukin (IL)-1β, IL-6, monocyte chemotactic protein (MCP)-1, and F4/80 expression were increased in DI versus DC rats. On Day 14, MCP-1 expression was decreased and F4/80 increased in DI versus DC rats. On Days 7 and 14, Ki-67, transforming growth factor-β1, vascular endothelial growth factor expression, and formation of elastic fibers were increased in DI versus DC rats. Topical insulin modulates burn-wound healing in diabetic animals by balancing inflammation and promoting angiogenesis and formation of elastic fibers.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats

Azevedo

Moreira

Teixeira

et al. 2019

Biological Research For Nursing

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“…On the other hand in a systematic review of complications and outcomes of diabetic patients with burn trauma, diabetic patients had a higher odds of sustaining wound infections, local infections and urinary tract infection. However, diabetic patients did not have higher odds of mortality [29]. Early burn mortality is attributable to acute infections leading to sepsis, however early excision and grafting and the use of ICU protocols such as ventilator and sepsis bundles has led to the reduction of early sepsis associated burn mortality [30].…”

Section: Discussionmentioning

confidence: 99%

Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality

Knowlin

Strassle

Williams

et al. 2018

Burns

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Background Diabetes mellitus (DM) is a major cause of illness and death in the United States, and diabetic patients are at increased risk for burn injury. We therefore sought to examine the impact of pre-existing DM on the risk of inpatient mortality and hospital acquired infections (HAI) among burn patients. Methods Adult patients (≥18 years old) admitted from 2004 to 2013 were analyzed. Weighted Kaplan–Meier survival curves – adjusting for patient demographics, burn mechanism, presence of inhalation injury, total body surface area, additional comorbidities, and differential lengths of stay–were used to estimate the 30-day and 60-day risk of mortality and HAIs. Results A total of 5539 adult patients were admitted and included in this study during the study period. 655 (11.8%) had a pre-existing DM. The crude incidence of HAIs and in-hospital mortality for the whole burn cohort was 8.5% (n=378) and 4.4% (n=243), respectively. Diabetic patients were more likely to be older, female, have additional comorbidities, inhalational injury, and contact burns. After adjusting for patient and burn characteristics, the 60-day risk of HAI among patients with DM was significantly higher, compared to non-diabetic patients (RR 2.07, 95% CI 1.28, 6.79). However, no significant difference was seen in the 60-day risk of mortality (RR 1.34, 95% CI 0.44, 3.10). Conclusions Pre-existing DM significantly increases the risk of developing an HAI in patients following burn injury, but does not significantly impact the risk of inpatient mortality. Further understanding of the immune modulatory mechanism of burn injury and DM is imperative to better attenuate the acquisition of HAIs.

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“…Scalds in diabetic patients, especially large‐area scalds, can aggravate diabetes and cause complications. The aggravation of diabetes and complications will affect burn treatment and wound repair, forming a vicious circle and increasing the difficulty of treatment 9,10 . Diabetes causes metabolic derangements, wound healing disorders, immune dysfunction, and vascular damage via glycosylation 11 .…”

Section: Discussionmentioning

confidence: 99%

The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self‐efficacy of diabetic patients with scalds

Chen

Gao

et al. 2021

International Wound Journal

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This study aimed to explore the impact of nursing intervention based on staged behaviour change (SBC) on the quality of life (QoL) and self‐efficacy of diabetic patients with scalds. From January 2020 to January 2021, a total of 82 consecutive cases with diabetes and scalds were prospectively enrolled in this study. They were divided into the SBC group (41 cases were given SBC‐based nursing intervention) and the control group (41 cases were given routine intervention) using the random number table method. The granulation tissue growth time and wound healing time were compared between the two groups. Pain intensity, QoL, self‐efficacy, and score of wound exudation at 3, 7, and 15 days after intervention were observed. The granulation tissue growth time and wound healing time of the SBC group were lower than those of the control group with statistical difference (P < 0.05). The 3‐, 5‐, and 7‐day pain intensity of the SBC group were all lower than those of the control group, with statistical difference (P < 0.05, respectively). Before intervention, there were no significant differences in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators of the SBC group were significantly higher than those of the control group (P < 0.05, respectively). Before intervention, there were no significant differences between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively). The score of wound exudation of the SBC group was lower than that of the control group after intervention (P < 0.05). SBC‐based nursing intervention can effectively improve the QoL and self‐efficacy of diabetic patients with scalds and can effectively promote wound healing, and can be recommended for clinical use.

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Systematic review of complications and outcomes of diabetic patients with burn trauma

Cited by 30 publications

References 38 publications

Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats

Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats

Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality

The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self‐efficacy of diabetic patients with scalds

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