Systemic nutritional interventions for treating foot ulcers in people with diabetes

Corcoran, Meave Anne; Moore, Zena

doi:10.1002/14651858.cd011378

Cited by 5 publications

(2 citation statements)

References 67 publications

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“…12,13 Despite an excellent outline, a Cochrane Review planned for 2014 into nutrition in patients with DFU remains incomplete. 14 This study sought to further inform the baseline levels of nutritional deficiency in this complex group of patients and assess effects of nutritional levels on amputation.…”

Section: Introductionmentioning

confidence: 99%

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Brookes

Jaya

Tran

et al. 2019

The International Journal of Lower Extremity Wounds

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Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients’ micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia’s largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C ( P < .01), albumin ( P = .03), and hemoglobin ( P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients.

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Section: Introductionmentioning

confidence: 99%

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Brookes

Jaya

Tran

et al. 2019

The International Journal of Lower Extremity Wounds

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“…Good nutrition plays a major role in wound prevention and healing. 1,2 International advisory bodies incorporate nutritional assessment and support as standard for wound care prevention and management. 1,[3][4][5] The National Institute for Health and Care Excellence (NICE) recommend malnutrition screening for all hospital inpatients on admission, and all outpatients at their first clinic appointment.…”

Section: Introductionmentioning

confidence: 99%

Assessment of hyperbaric patients at risk of malnutrition using the Malnutrition Screening Tool – a pilot study

et al. 2018

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Background: Nutritional assessment and support is essential for wound management. The hyperbaric oxygen clinic is a unique outpatient service where chronically unwell patients present daily for hyperbaric oxygen treatment (HBOT) over several weeks, allowing time for effective nutritional intervention. This is the first study to examine the prevalence of those at risk of malnutrition in a cohort of hyperbaric medical patients. Methods: A prospective study was undertaken over six months. Following consent, 39 enrolled patients had the Malnutrition Screening Tool and Baseline Characteristic Collection Form completed. Those at risk of malnutrition were given an option to be assessed by a dietitian to complete a Subjective Global Assessment (SGA). At the completion of treatment, the patients completed a questionnaire. Results: Twelve of the 39 patients screened were at risk of malnutrition using our screening process. Of these, all the patients with available SGA results were diagnosed with moderate to severe malnutrition. Patients receiving HBOT for non-healing wounds and osteoradionecrosis were most at risk of malnutrition. Conclusion: The prevalence of patients being at risk of malnutrition in our hyperbaric medical service was about one in three. Malnutrition screening should be part of routine patient assessment in order to ensure patients receive timely nutritional intervention. This may improve wound healing.

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Nutritional interventions for treating foot ulcers in people with diabetes

Moore

Corcoran

Patton

2020

Cochrane Database of Systematic Reviews

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Systemic nutritional interventions for treating foot ulcers in people with diabetes

Cited by 5 publications

References 67 publications

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Assessment of hyperbaric patients at risk of malnutrition using the Malnutrition Screening Tool – a pilot study

Nutritional interventions for treating foot ulcers in people with diabetes

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