Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults

Armstrong, D. G.; Lavery, Lawrence A.; Quebedeaux, Terri L.; Walker, Steven C.

doi:10.7547/87507315-87-7-321

Cited by 60 publications

(39 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a previous case-control study (43) of patients with an infected puncture wound of the foot, we found that visual cues of inflammation, rather than the pain, were the most frequent presenting complaints in the people with diabetes. The interval from the puncture injury to surgery was also significantly longer in the diabetic individuals, suggesting that their lack of pain perception might delay recognition of a limb-threatening problem (44). The types of traumatic wounds in this study included burns, puncture wounds, blunt trauma, lacerations, and ingrown toenails.…”

Section: Statistical Analysesmentioning

confidence: 99%

Risk Factors for Foot Infections in Individuals With Diabetes

Lavery

Armstrong

Wunderlich³

et al. 2006

Diabetes Care

622

414

View full text Add to dashboard Cite

OBJECTIVE -To prospectively determine risk factors for foot infection in a cohort of people with diabetes.RESEARCH DESIGN AND METHODS -We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.RESULTS -During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture-proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3-102.2; P Ͻ 0.001) and the risk of amputation was 154.5 times greater (58.5-468.5; P Ͻ 0.001). Foot wounds preceded all but one infection. Significant (P Ͻ 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration Ͼ30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).CONCLUSIONS -Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.

show abstract

Section: Statistical Analysesmentioning

confidence: 99%

Risk Factors for Foot Infections in Individuals With Diabetes

Lavery

Armstrong

Wunderlich³

et al. 2006

Diabetes Care

622

414

View full text Add to dashboard Cite

show abstract

“…T h e s e reulceration estimates are based on a previous randomized trial (20) and reports of reulceration in high-risk patients (3)(4)(5). We expected that 9% of subjects in the enhanced treatment group would develop ulcers during the evaluation period (P o ϭ 0.09) and that 30% of subjects who received standard therapy would develop foot ulcers.…”

Section: Outcomes and Clinical Assessmentmentioning

confidence: 99%

“…Pain is one of the primary natural warning systems that alerts individuals to take action and seek medical care (3). Because this early warning system is faulty, individuals with diabetic neuropathy can sustain injuries that are not recognized until they are so severe that full-thickness wounds result (4). In the "diabetic foot" patient, involvement to identify early warning signs of the disease process is imperative to reduce the incidence of complications.…”

mentioning

confidence: 99%

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients

Lavery

Higgins²,

Lanctot³

et al. 2007

Diabetes Care

367

402

View full text Add to dashboard Cite

OBJECTIVE -The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications.RESEARCH DESIGN AND METHODS -In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences Ͼ4°F (Ͼ2.2°C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.RESULTS -The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P ϭ 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P ϭ 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group.CONCLUSIONS -Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.

show abstract

“…Because DM is a lifelong disease and causes signifi cant complications, it substantially reduces the victim's lifespan and quality of life [5,6]. In order to prevent complications such as retinopathy, nephropathy, neuropathy, end-stage renal disease and non-traumatic lower extremity amputations associated with this disease, patients must change their way of life and maintain those changes [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of a Home-Based Diabetes Management Program on Diabetes Control

Karatay¹,

Akkuş²,

Öztürk³

et al. 2016

Arch Prev Med

View full text Add to dashboard Cite

Background: Diabetes is a lifelong disease and reduces the victim's lifespan and quality of life. Diabetes management is a continuing life-long endeavor requiring cognitive, attitudinal and behavioral changes.The purpose of the study: To evaluate the effectiveness of home based diabetes management programme on diabetes control conducted by health team. Methods:This study which was designed as a one-group pretest-posttest pattern. Home visits were carried out once a week for nine weeks for 52 patients. The obtained data were evaluated by using percentages, t-test and the McNemar signifi cance test.Results: At the completion of the intervention, life-style changes, such as the frequency of controlling blood glucose, glycemic control, exercise, and increasing vegetable and fruit consumption all produced changes which proved statistically signifi cant and positive. Similarly, in comparison to before the intervention, the results after completion of the intervention showed that the values of patients ' weight (86.28 ± 13.50, 80.40 ± 23:13), systolic blood pressure (139.75 ± 17.53, 135.31 ± 17.91), and postprandial blood glucose (265.63 ± 128.63, 215.48 ± 69.71) had all statistically and signifi cantly decreased (p <0.05). Conclusion:This team study created a positive change in terms of managing patients' diabetes.

show abstract

Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults

Cited by 60 publications

References 0 publications

Risk Factors for Foot Infections in Individuals With Diabetes

Risk Factors for Foot Infections in Individuals With Diabetes

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients

The Effectiveness of a Home-Based Diabetes Management Program on Diabetes Control

Contact Info

Product

Resources

About