Diabetic Foot Ulcers; Correlation of Nutritional Status of Type 2 Diabetic Patients of Hyderabad Sindh Pakistan

Shaikh, Imran; Masood, Naila; Shaikh, Fouzia; Shaikh, Munir A

doi:10.17957/tpmj/17.3869

Cited by 6 publications

(8 citation statements)

References 16 publications

(16 reference statements)

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“…Shaikh et al had suggested that nutritional status deteriorates as the severity of DFU increases (and presumably vice versa). 22 Our study builds on this and links amputation outcome with biochemical nutritional levels.…”

Section: Discussionmentioning

confidence: 93%

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Brookes

Jaya

Tran

et al. 2019

The International Journal of Lower Extremity Wounds

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Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients’ micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia’s largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C ( P < .01), albumin ( P = .03), and hemoglobin ( P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients.

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Section: Discussionmentioning

confidence: 93%

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Brookes

Jaya

Tran

et al. 2019

The International Journal of Lower Extremity Wounds

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“…Similar results were published by Shaik et al who observed significantly lower levels of albumin in Wagner grade 4 and 5 ulcers. 7 Deakin et al in their study observed that 61.5% of patients had hypoalbuminemia with a mean albumin level of 2.5 g/dl. 9…”

Section: Discussionmentioning

confidence: 91%

“…This is consistent with the findings of Imran Shaik et al who observed that Wagner grade 4 and 5 ulcers had significantly lower hemoglobin. 7 Also, Ibrahim et al observed in their study that anemia was detected in 180 (53.6%) subjects with 88 (48.9%) of them requiring blood transfusion. Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034).…”

Section: Discussionmentioning

confidence: 92%

A study to assess anemia and hypoalbuminemia in diabetic patients with ulcers

Devaprashanth¹,

Ramesh²,

Kumar³

2021

Int Surg J

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Background: Diabetic foot is a severe public health issue. Nutrition is important in the repair of soft tissue injuries and wound healing and specific nutrients have been shown to enhance wound healing. Anemia and hypoalbuminemia are among the commonly encountered deficiencies in patients. Early detection of nutritional deficiencies and their prompt treatment is imperative for the effective management of diabetic foot ulcers. The aim of the study was to investigate the prevalence of anemia and hypoalbuminemia in diabetic foot patients presenting at our institution.Methods: Hemoglobin and albumin levels of 175 patients with diabetic foot were collected. Data was tabulated and analysed with descriptive statistics.Results: Hemoglobin varied from 6.5 g/dl to15 g/dl (10.5±2.3 g/dl). 116 (66.28%) patients had anemia. Among the 66 female patients, 43 (65.15%) had anemia. Among the 109 male patients, 73 (66.97%) had anemia. 11 of the 29 patients aged less than 40 had anemia (37.93%), while 105 of the 146 (71.91%) patients above 40 years had anemia. Albumin levels ranged from 1.6 g/dl to 5.4 g/dl (3.3±1.06 g/dl). 93 (53.14%) patients had hypoalbuminemia. 33 of the 66 female patients (50%) had hypoalbuminemia. 60 (55.04%) of the 109 male patients had hypoalbuminemia. 4 of the 29 (13.79%) patients below 40 years had hypoalbuminemia 89 of the 146 patients (60.9%) above 40 years had hypoalbuminemia.Conclusions: Anemia and hypoalbuminemia are common in patients with diabetic foot ulcers, with males being more commonly affected by both than females and older age group being more commonly affected than younger age group.

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“…The GNRI score for assessing nutrition-related risks consists of serum albumin, body weight, and ideal weight. In a study on nutrition and DFU healing, foot prognosis deteriorated with the increase in the risk of malnutrition (GNRI score) (linear trend, P <0.001) and the incidence of major LEA (11.3% vs. 1.8%) in the malnutrition (GNRI<92) group was approximately 6-fold increased [ 53 , 54 ]. Meanwhile, a serum albumin level of <25 g/L, indicating severe malnutrition, has a greater impact on the amputation rate of DFU.…”

Section: Discussionmentioning

confidence: 99%

Machine learning for the prediction of minor amputation in University of Texas grade 3 diabetic foot ulcers

Wang

Zhu

et al. 2022

PLoS ONE

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Minor amputations are performed in a large proportion of patients with diabetic foot ulcers (DFU) and early identification of the outcome of minor amputations facilitates medical decision-making and ultimately reduces major amputations and deaths. However, there are currently no clinical predictive tools for minor amputations in patients with DFU. We aim to establish a predictive model based on machine learning to quickly identify patients requiring minor amputation among newly admitted patients with DFU. Overall, 362 cases with University of Texas grade (UT) 3 DFU were screened from tertiary care hospitals in East China. We utilized the synthetic minority oversampling strategy to compensate for the disparity in the initial dataset. A univariable analysis revealed nine variables to be included in the model: random blood glucose, years with diabetes, cardiovascular diseases, peripheral arterial diseases, DFU history, smoking history, albumin, creatinine, and C-reactive protein. Then, risk prediction models based on five machine learning algorithms: decision tree, random forest, logistic regression, support vector machine, and extreme gradient boosting (XGBoost) were independently developed with these variables. After evaluation, XGBoost earned the highest score (accuracy 0.814, precision 0.846, recall 0.767, F1-score 0.805, and AUC 0.881). For convenience, a web-based calculator based on our data and the XGBoost algorithm was established (https://dfuprediction.azurewebsites.net/). These findings imply that XGBoost can be used to develop a reliable prediction model for minor amputations in patients with UT3 DFU, and that our online calculator will make it easier for clinicians to assess the risk of minor amputations and make proactive decisions.

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Diabetic Foot Ulcers; Correlation of Nutritional Status of Type 2 Diabetic Patients of Hyderabad Sindh Pakistan

Cited by 6 publications

References 16 publications

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers

A study to assess anemia and hypoalbuminemia in diabetic patients with ulcers

Machine learning for the prediction of minor amputation in University of Texas grade 3 diabetic foot ulcers

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