Changing the patterns of hospitalized diabetic foot ulcer (DFU) over a 5-year period in a multi-disciplinary setting in Thailand

Abstract

Background: After years of decline, the rate of amputations was reported to increase by 50% in the U.S. population between 2009 and 2015. Few studies have examined the most recent trends in hospitalized diabetic foot ulcer (DFU) in Asian patients. This study aimed to examine recent trends and outcomes in hospitalized DFU at a tertiary diabetes center in Bangkok. Methods: We conducted a retrospective study from consecutive hospitalized DFU admissions from 2014 to 2018 at Theptarin Hospital, a multidisciplinary diabetes center, led by diabetologists. Results: During the study period, 290 patients (male 57.4%, age 65.5 ± 13.3 years, T2DM 99.4%, DM duration 18.8 ± 11.5 years, A1C 8.6 ± 2.3%) with 350 admissions were included. DFU were classified into neuropathic wounds (38.0%), ischemic wounds (2.6%), and mixed-type wounds (59.4%). The median length of stay was 8 days. Severe DFU (Wagner grade 3-5) composed 68.3% of all DFU and one-third of patients had prior history of amputations. Complete healing was achieved in 73.5% of the patients. Major amputation was performed in 16 (4.6%) and minor amputation was performed in 78 (22.3%) of all DFU. The mortality rate at 1 year after discharge was 12.0%. Advanced diseases with higher co-morbidities were associated with worse outcomes. When compared with our previous published data from 2009 to 2013, the annual rate of ischemic wounds from peripheral arterial diseases (PAD) and severity of DFU were increased in this study period. The major amputation rate slightly decreased from 6.0 to 4.6% but the minor amputation rate increased from 18.7 to 22.3%. Conclusion: The changing trend of DFU provides an excellent outlook into the inadequacies of our current diabetes care systems and global trend of aging population. After considerable successes in reducing major amputations over the past decade, the current analysis revealed a discouraging change in the healing rate of DFU and a stable pattern of major amputation. The prevalence of PAD among Thai patients with DFU increased significantly and affected the results of DFU treatments. Redefined organization of care with multidisciplinary team approach and coordination with referral centers are urgently required to improve outcomes of DFU.

Length of stay and readmissions for people with diabetes-related foot ulceration admitted to two public tertiary referral hospitals in Australia

“…Median LOS was 8-10 days for DFU-related hospital admissions from 2012-17. These results are comparable to a study in Thailand where a median LOS of 8 days for DFU-related hospital admission was reported 28 . In Australia, one study reported an average LOS of 17 days for diabetesrelated foot complications 29 ; however, the sample differed from the current study's specific focus on DFU-related inpatient care.…”

Test

“…Among 103 subjects under study, patients with glucose level below 200mg/dl were found to be high In our study of subject size 103, 56.3% of the patients are previously diagnosed DFU patients and 43.6% are newly diagnosed patients. In our study with subject size of 103 subjects, most number of patients fall under grade-1(30%), grade-2(20.3%), grade-3(20.3%), which states that patients mostly fall in moderate severity, which is similar to a study conducted by Andrew J. Boulton et al in general population of US states that patients who fall under grade-1,2,3 will heal in a moderate time period [6].…”

Diabetic Foot Ulcers: Surgical Characteristics, Treatment Modalities and Short-Term Treatment Outcomes at a Tertiary Hospital in South-Western Uganda

“…Higher mortality rates among hospitalized DFU patients were reported to be 10.6% in a Thai study. 36 This study, however, was retrospective and done over a 3-year period, unlike our study which followed patients for only 5 weeks.…”