Patients with healed diabetic foot ulcer represent a cohort at highest risk for future fatal events

Abstract

Patients with previous diabetic foot ulcer are prone to re-ulceration and (re)amputation, to various comorbidities, have significantly impaired quality of life and increased mortality. We aimed to evaluate the risk of foot related complications and mortality in a high-risk population of patients with healed diabetic foot syndrome over a decade. 91 patients with recently healed diabetic foot ulcer were invited for follow-up at 1, 6 and 11 years after inclusion. Patient characteristics at inclusion were: 40 women, 65 ± 11 years, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 ± 4.4 kg/m 2 , and HbA1c 68 ± 17 mmol/mol. Comorbidities included neuropathy (n = 91), peripheral artery disease (PAD), history of minor (n = 25) or major (n = 5, 5.5%) amputation, nephropathy (n = 40) and retinopathy (n = 53). Ulceration recurred in 71 (65%) patients, time to first recurrence was 1.8 ± 2.4 years (mean ± SD). 21 patients had to undergo (re)amputation (minor n = 19, major n = 2), time to amputation was 3.6 ± 1.9 years. Over time, 3 further major amputations were required in patients with an initial minor amputation. Thirty-three (36%) of the initially included patients completed the follow-up period of 11.0 ± 0.6 years. 58 patients (64%) died during the observational period, time to death was 5 ± 3 years in this group. We found overall high mortality of 64% throughout the follow-up period of 11 years in high-risk patients with healed diabetic foot syndrome. Presence of PAD, prior amputation and nephropathy as well as poor glycemic control were significantly predictive for death.

Microbial Content Recovered From Diabetic Foot Infections: A Cross-Sectional Study in Brazil / Conteúdo Microbiano Recuperado Em Infecções De Pé Diabético: Um Estudo Transversal No Brasil

“…Anaerobe bacteria were recovered from 15 patients (50%), and similar numbers were obtained by Omar et al[18]. The most frequently recovered strict anaerobic genus was Peptostreptococcus spp.…”

“…The number of recovered species per sample ranged from one to nine (mean of four). Other studies [16,18] [6,19]. Fungal species were recovered from 10.0% of the patients, and Candida parapsilosis was the most prevalent.…”

“…to β-lactamase). Other authors [18] also reported an increase in the resistance profile of Pseudomonas aeruginosa and the presence of multidrug resistance (MDR) among isolates of this species. In our study, it was possible to recover three microorganisms that were β-lactamase producers, including one E. coli and two Proteus mirabilis isolates.…”

“…According to Omar et al [18], β-lactamase inducers among members of the Enterobacteriacea family are an universal concern. AMI 0 0 0 1 0 0 0 1 0 ASB 0 4 6 3 0 0 1 0 0 AMP 2 5 8 6 2 0 4 0 1 AZT 1 1 0 2 0 1 0 4 0 CFZ 1 5 8 5 2 0 2 0 0 CPM 1 0 0 2 0 0 0 4 0 CTX 0 1 0 2 0 0 0 5 0 CAZ 0 1 0 1 0 0 0 4…”

The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease

“…People with DFD have an increased risk of all-cause mortality (relative risk (RR) 1.89, 95% confidence intervals (CI) 1.60, 2.23) and fatal myocardial infarction (RR 2.22, 95% CI 1.09, 4.53) compared to people with diabetes without DFD [57]. In people with a history of diabetes-related foot ulcers, the risk of cardiovascular mortality is about 50% over 10 years and the annual mortality rate is estimated to be about 6% [58]. This emphasizes the importance of optimizing medical management in this population.…”