Ulcer‐free survival following management of foot ulcers in diabetes

Pound, Nicholas; Chipchase, Susan; Treece, K. A.; Game, Frances; Jeffcoate, William

doi:10.1111/j.1464-5491.2005.01640.x

Cited by 174 publications

(144 citation statements)

References 8 publications

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“…These differences might reflect a major difference in population selection, clinical practice or both. Nevertheless, the incidence of new ulceration observed is very similar to that reported earlier by both ourselves [22,27] and others [21,28]. It is also possible that the earlier study involved a patient population which had not previously had access to expert diabetes care and that the quality of education and support provided for those in the control group may have differed from the usual care available (almost 20 years later) for those attending specialist clinics in UK.…”

Section: Discussionsupporting

confidence: 85%

“…In a Swedish cohort study of 558 people managed between 1983 and 1990 ulcers recurred in 34, 61 and 70% at 1, 3 and 5 years, and major amputation in 3, 10 and 12% [21]. Of 226 patients with healed ulcers who were managed in the UK, 91 (40.3%) developed a recurrent or new ulcer after a median 126 days (range 14-903) [22]. However, only one study of education has specifically targeted patients who had a previous lesion [23].…”

mentioning

confidence: 99%

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Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

et al. 2008

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Aims/hypothesis This observer-blind, randomised controlled trial was designed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers. Methods People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted, one-to-one education or usual care, using a computer-generated random allocation sequence that had been prepared in advance but which was concealed from the clinical researcher. The primary outcome was ulcer incidence at 12 months. Secondary outcomes were ulcer incidence at 6 months and incidence of amputation, mood (Hospital Anxiety and Depression Scale) and quality of life (Diabetic Foot Ulcer Scale) at 6 and 12 months. Protective foot care behaviours (Nottingham Assessment of Functional Footcare) were assessed at 12 months. Results There were 87 (mean [SD] age 63.5 [12.1] years) patients in the intervention group and 85 control patients (mean [SD] age 64.9 [10.9] years). The groups were comparable at baseline. No significant differences (p> 0.05) were observed between groups in ulcer incidence at either 6 months (intervention 30%, control 21%) or 12 months (intervention 41%, control 41%). Recommended foot care behaviours at 12 months were better in the intervention than in the control group (p=0.03), but education had no significant (p>0.05) effect on mood, quality of life or amputations. Conclusions/interpretation Even though the intervention was associated with improved foot care behaviour, there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care. The usefulness and optimal delivery of education to such a high-risk group requires further evaluation.

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

et al. 2008

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“…Primary healing was achieved in 69 of 89 patients (77.5%) ( Even though the rate of amputation was higher in the group of patients with a previous history of amputation (15 …”

Section: Primary Healingmentioning

confidence: 96%

Long-Term Outcome and Disability of Diabetic Patients Hospitalized for Diabetic Foot Ulcers

Ghanassia

Villon²,

Dieudonné³

et al. 2008

Diabetes Care

174

120

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OBJECTIVE -The long-term outcome and functional status of subjects hospitalized for diabetic foot ulcers have been poorly studied and thus are the topics of this study.RESEARCH DESIGN AND METHODS -Ninety-four consecutive diabetic subjects hospitalized for diabetic foot ulcers between January 1998 and December 2000 were prospectively followed for mean Ϯ SD 79.5 Ϯ 13.3 months. We calculated rates of primary healing, new ulcers, amputations, mortality, and disability and evaluated the global therapeutic success (GTS) of foot care management as defined by the association of primary healing without recurrence or disability at the end of follow-up.RESULTS -Follow-up was successful in 89 of 94 subjects (63 men and 31 women; age 63.7 Ϯ 10.8 years). Of these, 69 (77.5%) experienced primary healing without major amputation, 39 (43.8%) underwent amputation (24 minor and 15 major), and 46 died (51.7%), including 23 from cardiovascular events. Forty-two of 69 patients who experienced primary healing (60.9%) had ulcer recurrence. At the end of the follow-up period, 25 patients (28.1%) were dependent and 40 subjects (44.9%) had achieved GTS. Multivariate analysis showed the role of age as an independent predictor of GTS (P Ͻ 0.05) and of impaired renal function/ albuminuria as independent predictors of healing failure, first amputation, and mortality (P Ͻ 0.01).CONCLUSIONS -Despite a satisfactory initial healing rate, the global long-term outcome of patients hospitalized for diabetic foot ulcers was poor. Nephropathy appears to be an important predictor of long-term outcome. Further studies are needed to establish recognized criteria for therapeutic success going beyond just the evaluation of healing rate in the management of diabetic foot ulcers.

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“…1 Outcome of foot ulceration is often poor: healing is slow, a high proportion of ulcers do not heal in spite of intensive treatment, [2][3][4] and up to 17% of foot ulcers result in minor or major amputation. [3][4][5][6] Treatment of diabetic foot complications is a major financial burden on the healthcare system. [7][8] Foot ulcers are, in most cases, caused by a combination of risk factors associated with chronic complications of diabetes.…”

Section: Introductionmentioning

confidence: 99%

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

Gale

Vedhara²,

Searle³

et al. 2008

Br J Gen Pract

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Ulcer‐free survival following management of foot ulcers in diabetes

Abstract: The use of ulcer-free survival can be used as an indication of the effectiveness of foot ulcer management. It could be adopted as a measure to compare performance between different specialist units.

Cited by 174 publications

References 8 publications

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

Long-Term Outcome and Disability of Diabetic Patients Hospitalized for Diabetic Foot Ulcers

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

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