Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

Abstract

Aims/hypothesis We sought to identify factors related to shortterm outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n=2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31.The characteristics of the remaining 2,480 patients were: 1,465 men, age 68±15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. Results The healing rate without major amputation in surviving patients was 90.6% (n=1,867). Sixty-five per cent (n=1,617) were healed primarily, 9% (n=250) after minor amputation and 8% after major amputation; 17% (n=420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to comorbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. Conclusions/interpretation Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

“…14,15 Incidence of Peripheral neuropathy in our study was 25.4% as similar to findings of Gershater MA who reported the incidence as 27% in his study and peripheral arterial disease as 40% which is similar to 37% in our study. 16 Statistically significant association was found with PN and peripheral arterial disease in our study as similar to many others. Other factors like smoking, alcoholism, site of the ulcer, past history of treatment for DFI had no significant association with development of DFI in our study.…”

Prospective study on microangiopathy in type 2 diabetic foot ulcer

“…Another new finding was that microangiopathy was absolutely equal in neuroischaemic and neuropathic patients. The fact that all our ischaemic patients were also neuropathic should not be misleading and or even considered a bias as, in our experience [14] and in the literature [15][16][17], it is becoming increasingly clear that the population of patients with ischaemic diabetic foot corresponds exactly to these characteristics. There are conflicting reports about skin capillary blood flow in the diabetic foot.…”

“…Foot ulcers take a notoriously long time to heal: the International Working Group on the Diabetic Foot reports a mean healing time of 6 months for diabetic foot ulcers [29]. The foot ulcer healing time reported in many studies varies widely depending on the patients' characteristics [30,31] and in particular were different for patients with neuropathic or ischaemic ulcers [16,32]. This is probably because in diabetic patients revascularisation can restore normal blood flow in the large vessels, including the pedal arteries, but cannot restore normal microvascular flow [33][34][35].…”

Prevalence of TEM and SHV Genes among Extended Spectrum Beta-Lactamase (ESBL) Producing Escherichia coli Isolates from Infected Diabetic Foot Ulcers in a Tertiary Care Hospital

“…In this study 36% of patients with foot ulcers had diabetes for more than 10 years. A prospective cohort study involving 2840 patients found that the risk of lower limb amputation is 1.88 times higher in diabetics of more than 23 years (Gershater et al, 2009).…”