Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study

Williams, Lisa H.; Rutter, Carolyn M.; Katon, Wayne; Reiber, Gayle E.; Ciechanowski, Paul; Heckbert, Susan R.; Lin, Elizabeth; Ludman, Evette; Oliver, Malia; Young, Bessie A.; Korff, Michael Von

doi:10.1016/j.amjmed.2010.01.023

Cited by 97 publications

(75 citation statements)

References 31 publications

(40 reference statements)

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“…24 Another important correlation found by some authors is the presence of foot ulcers and depressive symptoms -people with these symptoms showed a 2-fold higher risk of diabetic foot ulceration. 25 In this study, there was no significant association between these conditions. This was due to the fact that the number of individuals with diabetic ulcers was very small, making it impossible to compare.…”

Section: Resultscontrasting

confidence: 40%

Clinical variables associated with depression in patients with type 2 diabetes

Ferreira

Piaia

Cadore

et al. 2015

Rev. Assoc. Med. Bras.

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Background: the aim of the study was to evaluate the relationship between type 2 diabetes (T2DM), depression and depressive symptoms and their clinical impact on T2DM. Methods: the authors evaluated 214 outpatients, 105 with diabetes (T2DM group) and 109 non-diabetics (control group), with ages ranging between 50 and 75 years (T2DM group 65.1 ± 5.6 years, control group 63.4 ± 5.8 years). Use of antidepressant treatment or score ≥ 16 on the Beck depression inventory (BDI) was considered depression. Complications of diabetes and total symptom score (TSS) for peripheral neuropathy were reported by patients. Results: diabetes group had a higher frequency of depression (35.2%) compared to controls (21.1%) (p=0,021), with 2.4 times increased risk of depression. The presence of depressive symptoms was also higher in T2DM group (mean BDI 9.5 ± 8.8 versus 6.9 ± 6.2; p=0.039). Symptoms of diabetic neuropathy were higher in depressed subjects. The metabolic control and presence of complications in T2DM group were not associated with depression. Conclusion: T2DM led to an increased risk of depression, but this did not influence the metabolic control or the presence of other complications.

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Section: Resultscontrasting

confidence: 40%

Clinical variables associated with depression in patients with type 2 diabetes

Ferreira

Piaia

Cadore

et al. 2015

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

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“…There is also evidence to suggest that depression is an important risk factor for first (but not subsequent) DFUs (58)(59)(60) even though this relationship is not mediated by reduced foot self-care (58,59). In contrast, patient cognitive and emotional appraisals of DFU risk are important predictors of foot self-care (61,62).…”

Section: Depression Foot Self-care and Incident Dfusmentioning

confidence: 99%

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

et al. 2018

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Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.Despite considerable advances made over the last 25 years, diabetic foot ulcers (DFUs) continue to present a very considerable health care burdendone that is widely unappreciated. DFUs are common, the median time to healing without surgery is of the order of 12 weeks, and they are associated with a high risk of limb loss through amputation (1-4). The 5-year survival following presentation with a new DFU is of the order of only 50-60% and hence worse than that of many common cancers (4,5). While there is evidence that mortality is improving with more widespread use of cardiovascular risk reduction (6), the most recent datadderived from a Veterans Health Adminstration populationdreported that 1-, 2-, and 5-year survival was only 81, 69, and 29%, respectively, and the association between mortality and DFU was stronger than that of any macrovascular disease (7). Iversen et al. (8) have also shown that the occurrence of a DFU was an independent predictor of mortality even at 10 years.The cost to health care services is also enormous. The estimated global cost of diabetes in 2015 was $1.3 trillion (9), and it has been reported that up to one-third of diabetes expenditure is on lower-limb-related problems in the U.S. (10). The latest data from the U.K. estimate that the total annual cost of management of DFUs exceeds £1 billion ($1.32 billion) and represents almost 1% of the total National Health Service budget (11). The equivalent figure from the U.S. has been estimated to be $9-13 billion (12). GEOGRAPHIC DIFFERENCES IN CLINICAL OUTCOMEThere is also wide variation in clinical outcome within the same country (13-15), suggesting that some people are being managed considerably less well than others.

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“…Williams et al [12] reported a cohort study of 3474 older adults with a mean age of 64.1 years and followed them up for 4 years. Of these participants, 11.1 and 8.3% of them had major depressive and minor depressive disorders respectively.…”

Section: Cohort Studiesmentioning

confidence: 99%