Time in range in relation to amputation and all‐cause mortality in hospitalised patients with diabetic foot ulcers

Xie, Puguang; Deng, Bo; Xi, Zhang; Li, Yuyao; Du, Chenzhen; Rui, Shunli; Deng, Wen; Boey, Johnson; Armstrong, David G.; Ma, Yu; Deng, Wuquan

doi:10.1002/dmrr.3498

Cited by 15 publications

(17 citation statements)

References 40 publications

(73 reference statements)

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“…The important role of local or systemic infection in DFU for mortality has also been identified. 28,29 It is challenging to identify the biggest threat to a patient's life simply by relying on a nonspecialist of DFU. However, it is difficult to achieve multidisciplinary consultation due to the shortage of medical resources during the COVID-19 epidemic.…”

Section: Discussionmentioning

confidence: 99%

The amputation and mortality of inpatients with diabetic foot ulceration in the COVID‐19 pandemic and postpandemic era: A machine learning study

Xie

et al. 2021

International Wound Journal

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This study aimed to explore the clinical characteristic and outcomes of inpatients with diabetic foot ulceration (DFU) in 2019 (prelockdown) and 2020 (postlockdown) due to the COVID-19 pandemic, at an emergency medical service unit. Prediction models for mortality and amputation were developed to describe the risk factors using a machine learning-based approach. Hospitalized DFU patients (N = 23) were recruited after the lockdown in 2020 and matched with corresponding inpatients (N = 23) before lockdown in 2019. Six widely used machine learning models were built and internally validated using 3-fold cross-validation to predict the risk of amputation and death in DFU inpatients under the COVID-19 pandemic. Previous DF ulcers, prehospital delay, and mortality were significantly higher in 2020 compared to 2019. Diabetic foot patients in 2020 had higher hs-CRP levels (P = .037) but lower hemoglobin levels (P = .017). The extreme gradient boosting (XGBoost) performed best in all models for predicting amputation and mortality with the highest area under the curve (0.86 and 0.94), accuracy (0.80 and 0.90), sensitivity (0.67 and 1.00), and negative predictive value (0.86 and 1.00). A long delay in admission and a higher risk of mortality was observed in patients with DFU who attended the emergency center during the COVID-19 post lockdown. The XGBoost model can provide evidence-based risk information for patients with DFU regarding their amputation and mortality. The prediction models would benefit DFU patients during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

The amputation and mortality of inpatients with diabetic foot ulceration in the COVID‐19 pandemic and postpandemic era: A machine learning study

Xie

et al. 2021

International Wound Journal

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“…Our analysis also suggests that HbA1c is a contributing factor to mortality in patients with a DFU and cognitive impairment. Among hospitalized patients with a DFU, the duration of glycemic control was found to be inversely associated with greater risk for amputation and all-cause mortality [ 43 ]. In another study, higher HbA1c was associated with reduced cognitive scores of patients with diabetes and lacunar stroke [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between cognitive function in individuals with diabetic foot ulcer and mortality

Sela

Grinberg

Natovich

2022

Diabetol Metab Syndr

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Background Diabetic foot ulcer (DFU) is a common diabetes mellitus (DM) complication. Individuals with DM and a DFU achieved significantly lower scores in cognitive tests than those without a DFU. We investigated whether baseline cognitive function in individuals with a DFU is a determinant of mortality. Methods A prospective study using data collected during a case–control study conducted in 2010–2012 whereby 90 participants with a DFU (mean age at baseline 58.28 ± 6.95 years, 75.6% male) took the paper and pencil and the NeuroTrax battery of cognitive tests. Depression was assessed, and the DFU status was evaluated. In 2020, information pertaining to participants’ vital status (dead/alive) was collected and the relationship between baseline cognitive status and vital status was assessed. Results During a median follow-up of 6.8 years (range 0.2–9.5), 39 participants died (43.3%). Individuals alive vs. those who had died during follow-up had a higher global cognitive score at baseline (92.16 ± 10.95 vs. 87.18 ± 12.24, p = 0.045), but increased risk was not found. Individuals who were alive vs. those who had died during follow-up had statistically significantly higher baseline executive function, reaction time and digit symbol substitution test results. However, after adjustment for glycosylated hemoglobin (HbA1c), microvascular and macrovascular complications, no relationship between cognitive tests and mortality remained significant. Conclusions The higher mortality rate among people with type 2 DM and a DFU was not significant after adjustment for HbA1c, micro- and macrovascular complications. There may be common pathophysiological pathways to both DM complications and cognitive impairment, which may contribute to increased mortality. Further studies are warranted.

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“…The association of TIR with amputation and all-cause mortality was assessed retrospectively among 303 hospitalised patients with DFUs. The amputation rate and all-cause mortality was found to decline with increasing TIR [ 34 ]. Logistic regression analysis showed an inverse association of TIR with both amputation ( p = 0.034) and all-cause mortality ( p = 0.013) after controlling for multiple confounders [ 34 ].…”

Section: Cgm and Diabetic Footmentioning

confidence: 99%

The Emerging Role of Continuous Glucose Monitoring in the Management of Diabetic Peripheral Neuropathy: A Narrative Review

Gouveri

Παπάνας

2022

Diabetes Ther

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The aim of this narrative review is to present data on the role of continuous glucose monitoring (CGM) in the management of peripheral diabetic neuropathy (DPN) among individuals with type 1 and type 2 diabetes mellitus. Adequate glycaemic control is crucial to prevent the development or progression of DPN. CGM systems are valuable tools for improving glycaemic control and reducing glycaemic variability (GV). Chronic hyperglycaemia is known to be a risk factor for the development of diabetic microvascular complications, including DPN. In addition, there is now evidence that GV, evaluated by mean amplitude of glycaemic excursions, may be a novel factor in the pathogenesis of diabetic complications. Increased GV appears to be an independent risk factor for DPN and correlates with painful neuropathy. Similarly, time-in-range correlates positively with peripheral nerve function and negatively with sudomotor dysfunction. However, relevant studies are rather limited in scope, and the vast majority are cross-sectional and use different methodologies for the assessment of DPN. Therefore, the causal relationship between CGM-derived data and the development of DPN cannot be firmly established at the present time. It also remains to be elucidated whether CGM measures can be considered the new therapeutic targets for DPN management.

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Time in range in relation to amputation and all‐cause mortality in hospitalised patients with diabetic foot ulcers

Cited by 15 publications

References 40 publications

The amputation and mortality of inpatients with diabetic foot ulceration in the COVID‐19 pandemic and postpandemic era: A machine learning study

The amputation and mortality of inpatients with diabetic foot ulceration in the COVID‐19 pandemic and postpandemic era: A machine learning study

Relationship between cognitive function in individuals with diabetic foot ulcer and mortality

The Emerging Role of Continuous Glucose Monitoring in the Management of Diabetic Peripheral Neuropathy: A Narrative Review

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