Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

Meloni, Marco; Izzo, Valentina; Giurato, Laura; Lázaro‐Martínez, José Luis; Uccioli, Luigi

doi:10.3390/jcm9061780

Cited by 55 publications

(48 citation statements)

References 37 publications

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“…This strain was the most commonly isolated, especially from the respiratory tract in the ICU, and resistant to all the β-lactam antibiotics, including carbapenems [47,48]. The same characteristics were present in the strains isolated from diabetic foot lesions, which raised treatment difficulties [49,50].…”

Section: Discussionmentioning

confidence: 86%

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

et al. 2020

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Background and objectives: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, being related to frequent and long-term hospitalisation, reduced quality of life of the patient, amputations, a high rate of morbidity and mortality. The bacterial aetiology is complex, sometimes involving more than one pathogen, playing a major role in the infection prognosis and development of microbial resistance. This study evaluated the current state of the aetiology, clinical and pathological characteristics of DFU in a single diabetes centre in order to provide some specific measures to prevent it. Materials and Methods: This retrospective study was conducted on patients with diabetes mellitus (252 individuals diagnosed with DFU) between January 2018–December 2019. All participants were assessed based on their clinical characteristics, including complications of diabetes and pathological and microbiological evaluations. Results: The present research revealed that diabetic foot ulcer prevalence was higher in males than in females and higher in type 2 diabetic patients than in type 1 diabetic patients. The patients with diabetic foot ulcer were older, had a higher body mass index (BMI), longer diabetic duration and had more diabetic complications, such as retinopathy, diabetic polyneuropathy and diabetic kidney disease, than patients without diabetic foot ulceration. Conclusions: Taking into account all factors involved, including the aetiology and the antibiotic susceptibility pattern of these isolates, planning the suitable treatment options of patients is possible.

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Section: Discussionmentioning

confidence: 86%

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

et al. 2020

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“…The number of arterial lesions [ 14 ] is considered a specific parameter of PAD severity, as well as the involvement of BTA arteries, which identifies a complex pattern of PAD in diabetic patients, justifying the high rate of revascularization failure as already described [ 4 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, in clinical practice, several cases of technical revascularization failure, defined as the inability to overcome vessel obstruction and/or absence of blood flow to the foot, are still reported [ 3 , 4 ]. Patients with untreatable critical limb ischemia (CLI), termed no-option critical limb ischemia (NO-CLI), are currently a clinical challenge for all clinicians involved in the management of ischemic DFUs, due to the fact that failed or missing revascularization is a predictor of nonhealing, amputation, and mortality [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia

Meloni

Izzo

Ros

et al. 2020

JCM

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The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, p = 0.008), heart failure (63.3 vs. 32.4%, p < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, p < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, p = 0.006), anterior tibial (93.3 vs. 82.7, p = 0.03), posterior tibial (93.3 vs. 73.7%, p = 0.0005), peroneal (70 vs. 48%, p = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, p < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, p < 0.0001), amputation (30 vs. 4.5%, p = 0.0001), and mortality (50 vs. 8.9%, p < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.

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“…Statins improve the lipid profile and exerted pleiotropic effects including plaque stabilization, regression of atheroma and anti-inflammatory effects able to minimizing cardiovascular risk in high risk subjects; however, the role of lipid-lowering drugs in PAD patients requires further studies [28]. Cardiovascular prevention guidelines recommend reaching the LDL-cholesterol target < 70 mg/dL in high-risk subjects and a target of < 55 mg/dL in very high-risk subjects with cardiovascular disease and/or multiple cardiovascular risk factors [29,30]. Patients with diabetic foot ulcer (DFU), especially if PAD or other relevant co-pathologies such as CKD are present, should be considered at very high risk [31,32].…”

Section: Deranged Cardiometabolic Control and Insulin Therapymentioning

confidence: 99%

“…In consideration of the available evidence, comorbidities reflect severity of diabetes, unhealthy lifestyle habits and failure to achieve cardiovascular prevention targets [6,30].…”

Section: Co-morbiditiesmentioning

confidence: 99%

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

Maurantonio

Gabrielli

Castellano

et al. 2021

Exploration of Medicine

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Aim: Diabetic foot syndrome (DFS) is a complication of diabetes in which the presence of infections, ulceration and/or destruction of deep tissue associated with neuropathy, peripheral atherosclerosis and comorbidity affect the prognosis, the need for limb amputation and quality of life. Purpose of the present study is to report the features of patients with acute DFS admitted to our Diabetic Foot Unit tertiary Center in 2019. Methods: In all patients admitted, the approach was performed through a multidisciplinary team (Diabetic Foot Care Team) and described in a specific diagnostic-therapeutic-assistance program. Criteria of inclusion were presence of sepsis and/or suspected osteomyelitis and/or critical limb ischemia. Clinical features and interventions performed were registered. Primary endpoints were mortality and amputation (major, minor). Secondary endpoints were length of hospitalization, type of revascularization and duration of antibiotic therapy. Results: Among 75 consecutive patients (mean age 70.9 years) enrolled, prevalence of acute DFS was higher among men (M/F 3:1). Poor glycemic control [mean hemoglobin A1c (HbA1c) 67.9 ± 22.3 mmol/mol], long duration of diabetes (mean 19 ± 16.3 years), high low-density lipoprotein-cholesterol (mean 89.5 ± 45.1 mg/ dL) and obesity (mean Body Mass Index 30.2 ± 7.6 kg/m2) were common. Diabetes-related complications as peripheral arterial disease (PAD) (76%), ischemic heart disease (48%), retinopathy (40.5%), hepatic steatosis (50%), heart failure (17.8%) were present. During hospitalization, 21 subjects (28.4%) underwent lower limb amputations (overall rate of major amputation 4%), and 41.3% underwent percutaneous angioplasty. Long period of hospitalization (18.4 ± 7.9 days) and prolonged antibiotic therapy (23.9 ± 15.9 days) were observed. Major amputation was associated with C-reactive protein > 6.5 mg/dL (P = 0.03), osteomyelitis (P = 0.001), prior insulin therapy (P = 0.015). Conclusions: Male sex, co-morbidity, PAD, systemic inflammation and poor glycemic control are major features of acute hospitalized DFS. An approach through a multidisciplinary team is recommended in order to treat vascular and extra-vascular complications aimed at reducing mortality and at improving quality of life.

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Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

Cited by 55 publications

References 37 publications

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia

Risk factors in acute diabetic foot syndrome: analysis of 75 consecutive patients referred to a tertiary center in Modena, Italy

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