Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3‐year follow‐up study

Zhang, Li; Fu, Guifen; Deng, Yongqing; Nong, Yibing; Huang, Jianhao; Huang, Xiulu; Wei, Fenglian; Yu, Yong; Huang, Linke; Zhang, Wenjiao; Tang, Meizhu; Deng, Licai; Han, Jiaxia; Zhou, Xing; Wang, Qiu; Lu, Wensheng

doi:10.1111/iwj.13861

Cited by 12 publications

(7 citation statements)

References 56 publications

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“…Growing body evidence has shown that TyG index is related to diabetic macrovascular and microvascular complications, [29][30][31] which is directly related to the pathological mechanisms of diabetic foot. 32,33 As a result, physically and clinically, the association between the TyG index and the prognosis of the diabetic foot makes sense. Kaplan-Meier survival curve analysis in this study also revealed that all-cause mortality in patients with DFUs increased with the TyG index (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…This fact demonstrated that the control of blood lipids and blood glucose was worse with a higher TyG index, which was evidently harmful to the prognosis of diabetic foot. Growing body evidence has shown that TyG index is related to diabetic macrovascular and microvascular complications, 29–31 which is directly related to the pathological mechanisms of diabetic foot 32,33 . As a result, physically and clinically, the association between the TyG index and the prognosis of the diabetic foot makes sense.…”

Section: Discussionmentioning

confidence: 99%

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Triglyceride‐glucose index is strongly associated with all‐cause mortality in elderly females with diabetic foot ulcers: A 9‐year follow‐up study

Huang

Han

Nong

et al. 2023

International Wound Journal

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This study aims to explore the association between the triglyceride‐glucose (TyG) index and all‐cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63‐month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low‐level (≤8.75, n = 185), moderate‐level (8.76–9.33, n = 185) and high‐level (≥9.34, n = 185). The association between the TyG index and all‐cause mortality in patients with DFUs was then assessed. During the follow‐up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all‐cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341–2.241; p < 0.001). Compared with the low‐level TyG index, the moderate‐level TyG index (HR = 1.685; 95% CI = 1.011–2.810; p = 0.045) and the high‐level TyG index (HR = 2.769; 95% CI = 1.678–4.568; p < 0.001) were positively correlated with all‐cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250–2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240–2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008–2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339–2.791; p < 0.001) showed a positive correlation between TyG index and all‐cause mortality rate in patients with DFUs. Furthermore, in the high‐level TyG index group compared, males (HR = 2.699; 95% CI = 1.457–4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972–4.242), with the TyG index level increase by 1.0, the risk for all‐cause mortality increased 3.277‐fold in females (HR = 4.277; 95% CI = 1.645–11.124) and 1.909‐fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486–5.695), respectively. Kaplan–Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all‐cause mortality in patients with DFUs (log‐rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all‐cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all‐cause mortality than other populations in daily clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Triglyceride‐glucose index is strongly associated with all‐cause mortality in elderly females with diabetic foot ulcers: A 9‐year follow‐up study

Huang

Han

Nong

et al. 2023

International Wound Journal

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“…DFU are one of the major health issues worldwide that causes signi cant economic burden and affects not only the patients but also the society as a whole [12]. In patients with DFU associated with osteomyelitis and diabetic nephropathy, microcirculation disorders rather than macrovascular complications play a major role in causing a delay in healing or recurrence of foot ulcers [13] which may not improve by revascularization of larger vessels alone. Surgical revascularization is the present procedure of choice in most cases of critical limb ischemia with non-healing ulcers which includes angioplasty with or without stenting and bypass or hybrid procedures or a combination of both.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Medical Cocktail Therapy for Non-healing Refractory Ischemic Diabetic Foot Ulcers- Case Reports

Sureshkumar¹,

Kumar²

2023

Preprint

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INTRODUCTION: Diabetic foot ulcers (DFU) are a serious complication of diabetes mellitus that can have significant medical and socioeconomic impact as well as increase in mortality rates. Healing of ischemic or neuro ischemic foot ulcers is most challenging as conventional therapies often fail to achieve adequate vascularity. Ulcers of the heel area can be very severe and strenuous to treat and can eventually end up in the amputation of the limb due to poor vascularity. So optimization of therapies to improve vascularity should be a major objective in successfully treating such cases. CASE PRESENTATION: Here we report two cases of chronic non-healing ischemic ulcers of the heel area of the foot. Patients approached us after the conventional medical treatments had failed to achieve healing. We treated them with a cocktail (Diabcare protocol) that we formulated using existing medications along with appropriate wound care and antibiotics. Diabcare protocol comprises plaque regression agents (statins), antiplatelet drugs (Aspirin), novel oral anticoagulant (Rivaroxaban) and vasoactive agents [PDE3 inhibitor (Cilostazol) and PDE5 inhibitor (Tadalafil)]. On Serial measurements, ulcers showed progressive healing and wound contraction. Vascularity improved significantly and fresh granulation appeared within days to weeks of initiation of therapy. Ulcers healed completely, with spontaneous epithelialization in the first case and after SSG in the second case, within a mean period of three months. CONCLUSION The ‘Diabcare protocol’ is found to be effective in healing difficult-to-heal ischemic foot ulcers where conventional treatment fails.

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“…Therefore, the mechanism of MAFLD affecting vascular disease in diabetes can be explained through relevant research on NAFLD. However, diabetic foot is related to macrovascular disease and microvascular disease, 30,31 so it can be speculated that MAFLD is related to the occurrence and development of the diabetic foot. This study showed that MAFLD was a risk factor for ulcer recurrence in elderly patients with DFUs based on the stratified analysis by age.…”

Section: Discussionmentioning

confidence: 99%

Metabolic dysfunction‐associated fatty liver disease in the elderly with diabetic foot ulcers: A longitudinal cohort study

Zhang,

Lin,

Huang

et al. 2023

International Wound Journal

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This study aimed to explore the association between metabolic‐associated fatty liver disease (MAFLD) and ulcer recurrence risk in patients with diabetic foot ulcers (DFUs) through an ambispective longitudinal cohort. From December 2013 to December 2022, a total of 482 inpatients with DFUs (PEDIS grade 3 and above with a severe infection) were eligible for inclusion in this study. This was an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 36 months. According to whether having MAFLD or not, all subjects were placed into two groups: non‐MAFLD (n = 351) and MAFLD (n = 131). The association between MAFLD and ulcer recurrence in patients with DFUs was then evaluated through multivariate Cox regression analysis, stratified analyses and Kaplan–Meier survival analysis. Throughout the follow‐up period, out of 482 subjects with DFUs, 68 had ulcer recurrence (14.1%). Three Cox regression models were established for data analyses. In the model I (unadjusted), MAFLD was significantly associated with the ulcer recurrence rate in patients with DFUs (HR = 1.79; 95% CI = 1.097–2.92; p = 0.02). Model II (adjusted model I with gender and age) (HR = 1.781; 95% CI = 1.09–2.912; p = 0.021) and model III (adjusted model II with CVD, duration of diabetes and Cr.) (HR = 1.743; 95% CI = 1.065–2.855; p = 0.027) also showed that MAFLD was significantly related to the ulcer recurrence risk in patients with DFUs, respectively. Stratified analysis indicated that subjects aged ≥60 had a greater risk of ulcer recurrence in MAFLD than in non‐MAFLD (HR = 2.31; 95% CI = 1.268–4.206; p = 0.006). Kaplan–Meier survival curve analysis showed that ulcer recurrence rate had a significant association with MAFLD (log‐rank, p = 0.018). This study indicated a close association between ulcer recurrence risk and MAFLD in patients with DFUs, especially in the elderly (aged ≥60). Therefore, special attention should be paid to the elderly with both DFUs and MAFLD because they have a higher ulcer recurrence rate than other general populations in routine clinical practice.

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Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3‐year follow‐up study

Cited by 12 publications

References 56 publications

Triglyceride‐glucose index is strongly associated with all‐cause mortality in elderly females with diabetic foot ulcers: A 9‐year follow‐up study

Triglyceride‐glucose index is strongly associated with all‐cause mortality in elderly females with diabetic foot ulcers: A 9‐year follow‐up study

The Effectiveness of a Medical Cocktail Therapy for Non-healing Refractory Ischemic Diabetic Foot Ulcers- Case Reports

Metabolic dysfunction‐associated fatty liver disease in the elderly with diabetic foot ulcers: A longitudinal cohort study

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