Long-Term Outcome and Disability of Diabetic Patients Hospitalized for Diabetic Foot Ulcers

Abstract

OBJECTIVE -The long-term outcome and functional status of subjects hospitalized for diabetic foot ulcers have been poorly studied and thus are the topics of this study.RESEARCH DESIGN AND METHODS -Ninety-four consecutive diabetic subjects hospitalized for diabetic foot ulcers between January 1998 and December 2000 were prospectively followed for mean Ϯ SD 79.5 Ϯ 13.3 months. We calculated rates of primary healing, new ulcers, amputations, mortality, and disability and evaluated the global therapeutic success (GTS) of foot care management as defined by the association of primary healing without recurrence or disability at the end of follow-up.RESULTS -Follow-up was successful in 89 of 94 subjects (63 men and 31 women; age 63.7 Ϯ 10.8 years). Of these, 69 (77.5%) experienced primary healing without major amputation, 39 (43.8%) underwent amputation (24 minor and 15 major), and 46 died (51.7%), including 23 from cardiovascular events. Forty-two of 69 patients who experienced primary healing (60.9%) had ulcer recurrence. At the end of the follow-up period, 25 patients (28.1%) were dependent and 40 subjects (44.9%) had achieved GTS. Multivariate analysis showed the role of age as an independent predictor of GTS (P Ͻ 0.05) and of impaired renal function/ albuminuria as independent predictors of healing failure, first amputation, and mortality (P Ͻ 0.01).CONCLUSIONS -Despite a satisfactory initial healing rate, the global long-term outcome of patients hospitalized for diabetic foot ulcers was poor. Nephropathy appears to be an important predictor of long-term outcome. Further studies are needed to establish recognized criteria for therapeutic success going beyond just the evaluation of healing rate in the management of diabetic foot ulcers.

Depression predicts first but not recurrent diabetic foot ulcers

“…Control variables While indicators of neuropathy severity were our primary controls for biological risk associated with ulcers, we also considered a number of additional variables that have been reported to predict ulceration in patients with diabetes: age [29]; sex [30,31]; duration of diabetes [30,31]; nephropathy [4,30]; retinopathy/poor vision [23,24,30]; and macrovascular complications [29]. Each of these variables was assessed by self-report at the baseline evaluation.…”

“…Persons with diabetes have a 12-25% lifetime risk of developing a foot ulcer [2,3], and those with established diabetic peripheral neuropathy (DPN), a key risk factor for foot ulceration, have an annual first ulcer incidence of 5-7% [3]. Recurrence rates among those with successfully treated foot ulcers may be as high as 60% [4]. Foot ulcers are the most important risk factor for lower-extremity amputations [5,6] and are associated with substantial treatment costs [7].…”

Activity of mesenchymal stem cells in therapies for chronic skin wound healing

“…48,49 This need has generated a large interest in new treatments for improving patient outcomes in chronic wound therapies. Mesenchymal stem cells, given their immunomodulatory and angiogenic properties, have therefore been studied extensively with regards to cell therapy to supplement wound dressings.…”

Instrumento para avaliação da integridade tissular dos pés de portadores de diabetes melittus

“…(5) Pedal and tibial pulses should be palpated aiming at verifying the perception, as well as the reduction of both. (3,5,(8)(9)(10) Godet sign (pitting), characterizing the presence of edema, should be assessed concerning its depth. (4,(11)(12)(13) The presence of varicose veins, whether in only one of the limbs or both, represents an aggravating factor to condition of the feet of patients with diabetes mellitus.…”