The impact of glycaemic variability on wound healing in the diabetic foot – A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

Dhatariya, Ketan; Sin, Edwin Li Ping Wah-Pun; Cheng, Joyce Oi Suet; Yue, Anson Wei Yue; Gooday, Catherine; Nunney, Ian

doi:10.1016/j.diabres.2017.10.022

Cited by 27 publications

(24 citation statements)

References 38 publications

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“…We found a strong concordance between high TP and high ankle pressure values. Furthermore, we found no relationship between glycated hemoglobin (HBA1c) and DFU healing impairment, although this relationship has been reported [ 23 , 24 ].…”

Section: Discussioncontrasting

confidence: 68%

Photo-Optical Transcutaneous Oxygen Tension Measurement Is of Added Value to Predict Diabetic Foot Ulcer Healing: An Observational Study

Leenstra

Kleijn

Kuppens

et al. 2020

JCM

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Currently, transcutaneous oxygen tension measurement (TCpO2) is the most favorable non-invasive test for diabetic foot ulcer (DFU) healing prognosis. Photo-optical TCpO2 is novel, less time-consuming and more practical in use compared to regular electro-chemical TCpO2. We prospectively investigated the clinical value of photo-optical TCpO2 to predict DFU healing. Patients with suspected DFU undergoing conservative treatment underwent an ankle pressure, toe-pressure and photo-optical TCpO2 test. The primary endpoint was DFU wound healing at 12 months. Based on their clinical outcome, patients were divided into a DFU healing and DFU non-healing group. Healing was defined as fully healed ulcers and non-healing as ulcers that deteriorated under conservative treatment or that required surgical amputation. Differences between groups were analyzed and an optimal TCpO2 cut-off value was determined. In total, 103 patients were included, of which 68 patients (66%) were classified as DFU healing. The remaining 35 patients (34%) had deteriorated ulcers, of which 29 (83%) eventually required surgical amputation. An optimal TCpO2 cut-off value of 43 mmHg provided a sensitivity, specificity and odds ratio of 0.78, 0.56 and 4.4, respectively. Photo-optical TCpO2 is an adequate alternative tool to validate the vascular status of the lower extremity indicating healing prognosis in patients with DFU. Therefore, we recommend that photo-optical TCpO2 can be safely coapplied in clinical practice to assist in DFU treatment strategy.

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Section: Discussioncontrasting

confidence: 68%

Photo-Optical Transcutaneous Oxygen Tension Measurement Is of Added Value to Predict Diabetic Foot Ulcer Healing: An Observational Study

Leenstra

Kleijn

Kuppens

et al. 2020

JCM

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“…In patients with large long-term GV, a variety of effects have been reported including involvement of micro-angiopathy such as an increase in CV events [ 17 , 18 , 39 - 42 ], onset of retinopathy [ 43 ], and onset of diabetic neuropathy [ 44 ]. Also noted have been vascular endothelial dysfunction [ 45 ] and healing time of foot ulcers [ 46 ]; development of chronic obstructive pulmonary disease (COPD) [ 47 ]; and development of Alzheimer’s disease (AD) [ 48 ]. However, many of these were retrospective studies, and there are many uncertainties as to what conditions those patients had and which factors caused the increased long-term GV.…”

Section: Long-term Glycemic Variabilitymentioning

confidence: 99%

Type 2 Diabetes and Glycemic Variability: Various Parameters in Clinical Practice

Sakamoto

2018

J Clin Med Res

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It has become possible to measure blood glucose levels continuously from 24 h to approximately 2 weeks due to the recent development of relevant devices such as continuous glucose monitoring and flash glucose monitoring systems. This has enabled not only medical professionals but also patients to monitor details of glycemic variability (GV) which was not possible in the past. Details of GV for both short and intermediate periods can now be obtained, and it is important in patient care to appropriately evaluate the data obtained. Types of GV in terms of time frame vary from short-term to long-term. Several studies reported that long-term GV was related to micro- and macro-angiopathies in patients with type 2 diabetes mellitus (T2DM). However, there are still unknown aspects regarding the relationships of various durations of GV with prognosis. Further clinical trials are required to examine the mechanism of GV and to evaluate whether GV can be a valuable therapeutic target in treatment of patients with T2DM.

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“…In patients with type 1 diabetes, HbA1c variability was found as an important risk factor for vascular complications such as cardiovascular diseases (CVDs) [8], microvascular diseases (MVDs) [8][9][10][11], and hospitalized hypoglycemia [12]. In patients with type 2 diabetes, although cumulative evidence shows the predictive role of HbA1c variability in the risks of hypoglycemia [12], CVDs [13][14][15][16][17][18][19][20] (such as subclinical left ventricular remodeling and dysfunction [21], reduced baroreflex sensitivity [22], and high thrombotic risk [23]), and allcause mortality [15][16][17][18][19][20][24][25][26][27][28][29][30], studies on MVDs [15,19,22,[31][32][33][34][35][36][37] are relatively limited and yield inconsistent results [34][35][36].…”

Section: Introductionmentioning

confidence: 99%

Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2 diabetes

Chen

Hung

et al. 2020

Cardiovasc Diabetol

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Background: To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes. Methods: Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments. Results: In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42-and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol). Conclusions: HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.

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The impact of glycaemic variability on wound healing in the diabetic foot – A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

Abstract: Our data suggest that there was a significant association between HbA1c variability and healing time in diabetic foot ulcers.

Cited by 27 publications

References 38 publications

Photo-Optical Transcutaneous Oxygen Tension Measurement Is of Added Value to Predict Diabetic Foot Ulcer Healing: An Observational Study

Photo-Optical Transcutaneous Oxygen Tension Measurement Is of Added Value to Predict Diabetic Foot Ulcer Healing: An Observational Study

Type 2 Diabetes and Glycemic Variability: Various Parameters in Clinical Practice

Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2 diabetes

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