Impact of Diabetes on Burn Injury: Preliminary Results From Prospective Study

Abstract

Reducing diabetes mellitus complications has been a major focus for Healthy People 2010. A prior retrospective cohort of our burn center's admissions revealed worse outcomes among diabetic patients, that is, increased infection rates, grafting and graft complications, and increased length of hospital stay. Therefore, a prospective study has been designed to carefully assess wound repair and recovery of diabetic and nondiabetic burn patients. Our long-term aim is to determine the characteristics of the wound milieu along with global responses to injury that may predict poor outcome among diabetic patients. This is an initial phase of a larger observational study of in-hospital diabetic (types 1 and 2) and nondiabetic patients, prospectively matched for age (18-70 and >70 years) and burn size (<5, 5-15, and 16-25%). Time (days) to complete index wound closure, documented through serial photography, is the main outcome measure. Secondary measures compare delays in presentation, prevalence of infections, graft rates, wound and graft complications, adverse events, and length of hospital stay. Detailed history, physical, and baseline hemoglobin A1C are elicited from all subjects who are assessed daily over the initial 72 hours poststudy entry, then weekly until complete index wound closure, and finally monthly through 3 months. Forty subjects are presented herein, 24 diabetic and 16 nondiabetic patients. Time to index wound closure was significantly prolonged in diabetic patients, despite increased grafting. These findings suggest that excision and grafting in diabetic patients may not alone be sufficient to ensure rapid closure, as graft complications may contribute to protracted closure. Evaluating graft need may be more complex among diabetic patients, suggesting the need for alternative management strategies. The current prospective study confirms our previous retrospective analysis, notably manifested by significant delays in index wound closure. Our efforts continue in identifying the most important predictors of outcome, especially modifiable factors that would create a basis of intervention to improve care.

Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality

“…However, despite the increased risk of HAIs, no difference in the risk of inpatient mortality was seen. Our findings support previous research which found that DM increased the average length of stay and the incidence of complications (which include infections) [20–23]. …”

Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients

“…7,10 Hence, graft take rates compared with relatively healthy patients are distinctly lower. 8,10,11 In our patients, we could confirm that punctual bleeding after tangential excision was not very significant. Nevertheless, split-skin take was rather high when using TNP.…”

“…10 Therefore, diabetic patients with foot burns show a high rate of amputations. 8,9,11 It is known that topical negative pressure (TNP) dressings alias negative pressure wound therapy can increase graft take rate, even in burned patients. 12,13 However, the effectiveness of TNP on grafts in diabetic patients with foot scalds has never been reported.…”

Thymosin beta 4 improves dermal burn wound healing via downregulation of receptor of advanced glycation end products in db/db mice

“…Hyperglycemic conditions induce various manifestations of cellular stress, including increased apoptosis, decreased vascular recovery, an aberrant inflammatory response, and delayed cellular turnover in diabetic wounds, resulting in impaired wound healing [1,10,24,25]. Although previous studies have indicated various causes for impaired wound healing in diabetes, AGE have been recognized as major factors in the pathogenesis of impaired wound healing in diabetes.…”