Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency

Abstract

Background: Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities. Aim: To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer. Method: Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age -81(75-96); diabetes type 2-98.7%; male/female -49/51%; living with a spouse -47%; nursing home 16%; or with home nursing 64%. Result: Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, autoamputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing. Conclusion: Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.

Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross‐sectional study

“…Some previous studies have reported that males are more likely to develop DF, 8,9,19,20 whereas others have found that females are more susceptible to DF. 13,16,22,23 This study found no association between DF and poor glycemic control as assessed by FBG levels.…”

“…1 Moreover, DF can lead to important economical, social and public health burdens, especially in low-income communities. 1 Various factors, including age, gender, 8,9 type 1 DM, 8 duration of DM 8,10 and obesity, 8 are associated with DF.…”

Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

“…The median healing time from inclusion was longer in our study in comparison to other studies. 2,[27][28][29][30] This may be explained by the type of foot ulcer in the included patients; they all had ischemic gangrene, Wagner grade 4 and no superficial non-ischemic ulcers. Healing time is often not uniformly defined in studies examining DFUs.…”

“…In studies with DFUs of mixed cohorts, the reported healing rates for minor amputation levels range from 2.4% to 34%. [27][28][29] These variations can be explained by differences in patient selection, definitions and length of follow-up. There is no randomised controlled study regarding amputation level selection in DFUs and particularly in the presence of gangrene.…”

Bacterial cellulose an effective material in the treatment of chronic venous ulcers of the lower limbs

“…By eliminating these symptoms, the edema reduces, leading to the improvement of local perfusion and bringing more comfort to the patient [42]. In general, a successful CVU therapy is associated with the treatment of metabolic disorders, since the patient's clinical condition directly reflects on the response of the healing process [43] .…”