Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission

Abstract

IntroductionFoot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation.Research design and methodsWe aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) recurrence coincided with typical intervals between routine preventive care appointments, which would suggest that delays exist between ulcer development and identification. We completed an analysis of existing data from two multicenter studies in 300 total participants. We analyzed unadjusted counts of DFU binned in weekly intervals and defined ‘exam periods’ as intervals from 2 to 4 weeks, from 6 to 8 weeks, within 1 week of 3 months and within 1 week of 6 months. We tested whether recurrence rates during exam periods were equivalent to rates outside exam periods. We estimated the delay between DFU development and DFU identification such that the rate of development would have been constant.ResultsDuring exam periods, a total of 43 DFUs were identified (43/86=50%) despite the fact that these periods represent only 23.5% of follow-up in aggregate. Accounting for censoring, the annualized incidence during exam periods was 0.68 DFU/year (CI 0.48 to 0.89) in contrast to 0.25 DFU/year (CI 0.18 to 0.32) outside exam periods (incidence ratio=2.8, CI 1.8 to 4.3). We estimated delays between DFU occurrence and identification to average 15.3 days (IQR 7.4–23.7 days).ConclusionsThese findings have potential implications for practice, particularly related to the value of telehealth and in-home monitoring of patients in diabetic foot remission. Additionally, there are implications for study design, which should consider the impact of interval censoring and attempt to control for confounders related to frequency and timing of exams.

Update on functional imaging in the evaluation of diabetic foot infection

“…Delays in treatment can result in impaired healing, infection, hospitalization, minor and major nontraumatic lower limb amputations and mortality. 5 Hence early diagnosis and effective treatment are essential for the prevention of amputation. Planned therapeutic strategy is based on a multidisciplinary and multifactorial approach.…”

Three years progress chronic limb-threatening ischemia case with simultaneous surgery

“…CLTI and DFU patients performed major amputation have a low activites of daily living (ADL), and their mortality rate are also high [8] , [9] . In addition, the adherence of DFU and CLTI is not so high, hence their recurrence rate is high [10] , [11] . Recently, treatment results of CLTI have gradually improved [12] .…”

Digital Biomarkers of Poor Gait and Balance in Diabetic Foot, Measurable by Wearables: A Review of Literature

“…These two issues can lead to a subsequent question of generalizability of the findings. In terms of participant characteristics included in this review, the vast majority recruited people with diabetic peripheral neuropathy, the most common underlying etiology causing a diabetic foot ulcer [52], but reports are needed for different diabetic foot problems such as Charcot foot and diabetic foot in remission [53,54].…”