Risk factors for recurrence of diabetic foot ulcers: prospective follow‐up analysis in the Eurodiale subgroup

Dubský, Michal; Jirkovská, Alexandra; Bém, Robert; Fejfarová, Vladimı́ra; Skibová, J; Schaper, Nicolaas C.; Lipsky, Benjamin A.

doi:10.1111/j.1742-481x.2012.01022.x

Cited by 167 publications

(155 citation statements)

References 32 publications

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“…Total incremental costs in the year postindex date increase from $11,710 to $18,756 for Medicare and from $16,883 to $31,851 for private insurance when these severely sick or costly patients are retained (data not shown). Third, the objective of this analysis was to estimate the annual burden associated with DFU; however, it should be noted that prior research has found that many patients remain unhealed after 12 months (16) and/or experience reulceration (17). As a result, the estimates of this study understate the true incremental costs associated with a DFU episode, and further research is warranted to examine the potentially large costs of DFU beyond the first year.…”

Section: Discussionmentioning

confidence: 65%

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers

et al. 2014

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OBJECTIVE To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS DFU patients and non-DFU patients with diabetes (controls) were selected using two deidentified databases: ages 65+ years from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, January 2007–December 2010) and ages 18–64 years from a privately insured population (OptumInsight, January 2007–September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts. RESULTS Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having $11,710 in incremental annual health care costs for Medicare, and $16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of $3,259. CONCLUSIONS These findings document that DFU imposes substantial burden on public and private payers, ranging from $9–13 billion in addition to the costs associated with diabetes itself.

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Section: Discussionmentioning

confidence: 65%

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers

et al. 2014

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“…However, our annual incidence is higher than that observed in developed countries, where a dramatic reduction in the rate of diabetic foot has been recorded over the past two decades [8,25,26]. The North-West and West of Ireland diabetic foot studies conducted in the United Kingdom and the Republic of Ireland reported diabetic foot incidence of 2.2% and 2.6%, respectively [8,27]. Similarly, Muller et al and de Sonnaville et al both from the Netherlands indicated an incidence of 2.1% and 1.8%, respectively [28,29].…”

Section: Discussionmentioning

confidence: 89%

Diabetes-related foot disorders among adult Ghanaians

Sarfo‐Kantanka

Kyei

Mbanya

et al. 2018

Diabetic Foot & Ankle

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Background: Diabetic foot remains a challenge in most low-middle-income countries (LMICs). A severe deficit in data exists on them in sub-Saharan Africa (SSA). Up-to-date data on the longitudinal trajectories and determinants can provide a benchmark for reducing diabetic foot complications in SSA. Objective: The primary objective of this study was to estimate trends in the incidence of diabetic foot and determine predictors in an adult Ghanaian diabetes cohort. Design: The study is a retrospective longitudinal study over a 12 year period. Methods: We applied Poisson regression analysis and Cox proportional hazard models to demographic and clinical information obtained from patients who enrolled in a diabetes specialist clinic in Ghana from 2005 to 2016 to identify longitudinal trends in incidence and predictors of diabetic foot. Results: The study comprised 7383 patients (63.8% female, mean follow-up duration: 8.6 years). The mean incidence of foot disorders was 8.39% (5.27% males and 3.12% females). An increase in the incidence of diabetic foot ranging from 3.25% in 2005 to 12.57% in 2016, p < 0.001, was determined. Diabetic foot, with adjusted hazard ratio (HR; 95% confidence interval (CI)), was predicted by disease duration, that is, for every 5-year increase in diabetes duration: 2.56 (1.41–3.06); male gender: 3.51 (1.41–3.06); increased body mass index (BMI), that is, for every 5 kg/m2: 3.20 (2.51–7.52); poor glycaemic control, that is, for every percentage increase in HbA1c: 1.11 (1.05–2.25), hypertension: 1.14 (1.12–3.21); nephropathy: 1.15 (1.12–3.21); and previous foot disorders: 3.24 (2.12–7.21). Conclusions: We have found a trend towards an increased incidence of diabetic foot in an outpatient tertiary diabetes setting in Ghana. Systemic and individual-level factors aimed at preventive foot screening as well as vascular risk factor control should be intensified in diabetic patients in Ghana and other LMICs. Abbreviations: BMI: Body Mass Index, BP: Blood Pressure, CI: Confidence Interval, HR: Hazard Ratio, HbA1c: Glycated Hemoglobin, PAD: Peripheral Arterial Disease, NCDs: Non Communicable Disease, SSA: Sub Saharan Africa.

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“…The end result of these disrupted repair networks is the defective quality of repaired tissue (as validated with histologic, molecular, and biomechanical testing), which may underlie the propensity for chronic wound recidivism. 45,46,48 Importantly, this study provides a molecular basis for excessive dermal proteolysis in chronic wounds and indicates the importance of ongoing efforts to target the mechanical environment to aid in wound repair. 39,49,50 Copyright © 2013 Lippincott Williams & Wilkins.…”

Section: Discussionmentioning

confidence: 97%