Risk factors associated with poor outcome in diabetic foot ulcer patients

Risk factors associated with poor outcome in diabetic foot ulcer patients

Background/aim: Diabetic foot ulcers and related complications are a major cause of morbidity and hospital admissions. Our aim was to evaluate the risk factors associated with poor outcome in diabetic foot ulcers. Materials and methods: A prospective study was conducted on patients with diabetic foot ulceration attending the Madinah Teaching Hospital from June 2014 to December 2015. Potential risk factors and laboratory test results at presentation were recorded and their association with outcome (healing vs. amputation) was analyzed using IBM SPSS Statistics for Windows, Version 22.0. Results: In total, 112 patients were studied during our study period. The majority of the patients were male (60.7%) and aged 50 years and older (62.5%). Regarding the outcome, 68% healed completely, 27.7% underwent amputation, and 4.5% died during this period. Patient age of 50 and older, long duration of diabetes (>10 years), rural origin, and heel ulcers were significantly associated with poor outcome (P < 0.05). Conclusion: Patients with diabetes should have a detailed annual foot examination; those having risk factors for poor outcome require more frequent foot care, patient education, and early referral to tertiary care centers.

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  • 1. O’Rourke I, Heard S, Treacy J, Gruen R, Whitbread C. Risks to feet in the top end: outcomes of diabetic foot complications. ANZ J Surg 2002; 72: 282-286.
  • 2. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA-J Am Med Assoc 2005; 293: 217- 228.
  • 3. Vileikyte L, Peyrot M, Bundy C, Rubin RR, Leventhal H, Mora P, Shaw JE, Baker P, Boulton AJ. The development and validation of a neuropathy and foot ulcer specific quality of life instrument. Diabetes Care 2003; 26: 2549-2555.
  • 4. Van Acker K, De Block C, Abrams P, Bouten A, De Leeuw I, Droste J, Weyler J, Peter-Riesch B. The choice of diabetic foot ulcer classification in relation to the final outcome. Wounds 2002; 14:16-25.
  • 5. Frykberg RG, Banks J. Management of diabetic foot ulcers: a review. Federal Practitioner 2016; 33:16-23.
  • 6. Boulton, AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, Lavery LA, Lemaster JW, Mills JL Sr, Mueller MJ et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31: 1679-1685.
  • 7. Davis WA, Norman PE, Bruce DG, Davis TM. Predictors, consequences and costs of diabetes related lower extremity amputations complicating type 2 diabetes: The Freemantle Diabetes Study. Diabetologia 2006; 49: 2634-2641.
  • 8. Larsson J, Apelqvist J. Towards less amputation in diabetic patients: incidence, cause, cost, treatment and prevention: a review. Acta Orthop Scand 1995; 66: 181-192.
  • 9. Boulton AJ, Kirsner RS, Vileikyte L. Clinical practice. Neuropathic diabetic foot ulcers. New Engl J Med 2004; 351: 48-55.
  • 10. Ho TK, Leigh RD, Tsui J. Diabetic foot disease and oedema. British Journal of Diabetes and Vascular Disease 2013; 13: 45- 50.
  • 11. Lyons TE. Management of diabetic foot complications. In: Veves A, Malik R, editors. Diabetic Neuropathy, Clinical Management. New York, NY, USA: Humana Press; 2008. pp. 480-482.
  • 12. Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic foot ulcers receiving standard treatment. A metaanalysis. Diabetes Care 1999; 22: 692-695.
  • 13. Dargis V, Pantelejeva O, Jonushaite A, Vileikyte L, Boulton AJ. Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study. Diabetes Care 1999; 22: 1428-1431.
  • 14. Aydin K, Isildak M, Karakaya J, Gürlek A. Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach. Endocrine 2010; 38: 87-92.
  • 15. Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med 1998; 158: 157-162.
  • 16. Riaz M, Miyan Z, Zaidi SI, Alvi FD, Fawwad A, Ahmadani MY, Zafar AB, Malik RA, Basit A. Characteristics and outcomes of subjects with diabetic foot ulceration. Diabetes Care 2012; 35: e63.
  • 17. Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care 2001; 24: 84-88.
  • 18. Ali SM, Basit A, Fawwad A, Ahmedani MY, Miyan Z, Malik RA. Presentation and outcome of diabetic foot at a tertiary care unit. Pak J Med Sci 2008; 24: 651-656.
  • 19. Clayton W Jr, Elasy TA. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. Clinical Diabetes 2009; 27: 52-55.
  • 20. Ahmad N, Thomas GN, Gill P, Torella F. The prevalence of major lower limb amputation in the diabetic and non-diabetic population of England 2003–2013. Diabetes and Vascular Disease Research 2016; 13: 348-353.
  • 21. IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA: IBM Corp.; 2013.
  • 22. Shahi SK, Kumar A, Kumar S, Singh SK, Gupta SK, Singh TB. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. Journal of Diabetic Foot Complications 2012; 3: 83-91.
  • 23. Merza Z, Tesfaye S. The risk factors for diabetic foot ulceration. Foot 2003; 13: 125-129.
  • 24. Unachukwu C, Babatunde S, Ihekwaba EI. Diabetes, hand and/ or foot ulcers: a cross-sectional hospital-based study in Port Harcourt, Nigeria. Diabetes Res Clin Pr 2007; 75: 148-152.
  • 25. National Health and Medical Research Council. National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes Mellitus). Melbourne, Australia: NHMRC; 2010.
  • 26. Younes NA, Albsoul AM, Awad H. Diabetic heel ulcers: a major risk factor for lower extremity amputation. Ostomy Wound Manag 2004; 50: 50-60.
  • 27. Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 2003; 26: 491-494.
  • 28. Bowering K, Embil JM. Foot Care. Canadian Diabetes Association 2013. Clinical practice guidelines for the prevention and management of diabetes in Canada: pharmacologic management of type 2 diabetes. Can J Diabetes 2013; 37: 145- 149.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: 6
  • Yayıncı: TÜBİTAK
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