Association of diabetic foot ulcer and death in a population‐based cohort from the United Kingdom

Walsh, Jonathan; Hoffstad, Ole; Sullivan, Millicent O.; Margolis, David J.

doi:10.1111/dme.13054

Cited by 343 publications

(259 citation statements)

References 20 publications

(38 reference statements)

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“…As the length of diagnosed diabetes increased, it may have provided time to diagnosis and manage those comorbidities, thereby reducing the risk of foot ulceration. Third, many of the risk factors that predispose to ulceration also increase the risk of death, introducing the possibility of survival bias [31]. …”

Section: Discussionmentioning

confidence: 99%

Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers

Brennan

Guihan

Budiman‐Mak

et al. 2018

Journal of Hypertension

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Objective: SBP variability may be a target for mitigating end-organ damage associated with vascular disease. We evaluated the relationship between increased SBP variability and risk of incident diabetic foot ulceration. Methods: Using a nested case-control design, we followed patients diagnosed with diabetes and treated within the US Department of Veterans Affairs Healthcare system for development of a diabetic foot ulcer (event) between 2006 and 2010. Each case was randomly matched to up to five controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using at least three blood pressure measurements from the year preceding the event. The association between SBP variability and foot ulceration was examined using conditional logistic regression. Potential protective effects of calcium channel blockers, which blunt SBP variability, were also explored. Results: The study sample included 51 111 cases and 129 247 controls. Compared with those in quartile 1 (lowest variability), patients in quartiles 2–4 had higher adjusted odds ratios for diabetic foot ulcer development: 1.11 (95% CI 1.07–1.16), 1.20 (95% CI 1.15–1.25), 1.29 (95% CI 1.24–1.34) (P for trend <0.001). Calcium channel blockers were associated with reduced risks of ulceration for those without peripheral vascular disease (OR = 0.87, 95% CI 0.84–0.90, P< 0.001) or neuropathy (OR = 0.85, 95% CI 0.82–0.89, P< 0.001) in adjusted subgroup analyses. Conclusion: This study describes a graded relationship between SBP variability and risk of diabetic foot ulceration, providing a potential new and modifiable target to reduce this common complication.

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Section: Discussionmentioning

confidence: 99%

Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers

Brennan

Guihan

Budiman‐Mak

et al. 2018

Journal of Hypertension

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“…Patients with DFUs were also found to have a 2.5-fold increased risk of death compared with their diabetic counterparts without foot wounds. 2 Furthermore, patients living with DFUs suffer great morbidity, lower health-related quality of life, and poorer psychosocial adjustment 3 and have a high burden of healthcare interactions. 4 Treatment of DFUs accounts for approximately one-third of the total cost of diabetic care, which was estimated to be U.S. $176 billion in direct healthcare expenditures in 2012.…”

Section: Introductionmentioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

508

380

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Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

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“…DFU and its complications cause inconvenience to diabetic patients and their families and are a considerable financial burden for the health systems and society (3). In England, the annual cost of DFU and lower extremity amputations performed due it was nearly 840 million dollars to the national health services in 2012 (4). In addition to DFU-associated expenses, such as medical examination, follow-up physician visits, and treatment expenses, there are indirect DFU-associated expenses, such as decrease in patients' labor productivity, shortening of life expectancy, and their relatives' participation.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and Practice of Foot Care in Diabetic Inpatients: A Descriptive Cross-Sectional Study

Dündar¹,

Akıncı²

2017

Erciyes Med J

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Objective: To determine whether diabetic patients have adequate information regarding foot care. Materials and Methods:We evaluated history of diabetic foot ulcer (DFU) and data on self-foot care practices collected through face-to-face interviews from 64 diabetic inpatients in a university hospital. Foot care practices were scored based on 20 questions. Questions under the categories of "beware of risky behavior," "foot and nail care," and "elaborate on footwear" were grouped, and the practice subscores and total scores were calculated. A total score of >70% was assessed as "good practice", 50%-70% as "satisfactory practice," and <50% as "poor practice."Results: Fourteen (21.9%) patients had previous or ongoing DFU and five (7.8%) had undergone amputation. Only 44% of the patients stated that they had been informed about the prevention of diabetic foot after the diagnosis was established. This group differed from the uninformed group significantly in terms of regular medical control (p=0.006). The average foot care practice score was 72 for the informed group and 49 for the uninformed group; the percentage of "good practice" score was 46% in the informed group and 11% in the uninformed group. The percentages of having good practice score were found to be significantly high in women, those without DFU, and those informed about foot care (p<0.01).Conclusion: Foot care practices of the patients were found to be mainly inadequate. Health care providers and diabetic patients should be encouraged for good foot care practices.

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Association of diabetic foot ulcer and death in a population‐based cohort from the United Kingdom

Cited by 343 publications

References 20 publications

Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers

Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers

Update on management of diabetic foot ulcers

Knowledge and Practice of Foot Care in Diabetic Inpatients: A Descriptive Cross-Sectional Study

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