Diabetes & Metabolism Journal

Original Articles

Epidemiology
The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study: Choong Hee Kim, Jun Sung Moon, Seung Min Chung, Eun Jung Kong, Chul Hyun Park, Woo Sung Yoon, Tae Gon Kim, Woong Kim, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee; Diabetes Metab J. 2018;42(4):308-319. Published online April 27, 2018; DOI: https://doi.org/10.4093/dmj.2017.0076

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Background

This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team.

Methods

In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched.

Results

Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased.

Conclusion

Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.

Citations

Citations to this article as recorded by

Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study
Thoriso C. Mokoala, Vhusani Sididzha, Etsumang D. Molefe, Thifhelimbilu E. Luvhengo
The Surgeon.2024; 22(2): e109. CrossRef
Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome
Marco Meloni, Laura Giurato, Luca Monge, Cesare Miranda, Alessia Scatena, Benedetta Ragghianti, Giovanni Antonio Silverii, Cristiana Vermigli, Alessandro De Cassai, Antonio Volpe, Rodolfo Tramonta, Gerardo Medea, Corrado Bordieri, Marco Falcone, Laura Ste
Acta Diabetologica.2024; 61(5): 543. CrossRef
Effect of Percutaneous Endovascular Angioplasty Combined with Negative Pressure Drainage on the “One-Stop” Treatment of Ischemic Diabetic Foot Ulcer
Bo Dong, Xixu Wang, Wei Wang, Biao Hong, Jue Wang, Heng Wang, Yun Gu
Annals of Vascular Surgery.2023; 92: 272. CrossRef
A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer
Abdelrahman Zamzam, Ann‐Marie McLaren, Emily Ram, Muzammil H. Syed, Sreenath Rave, Suzanne H. Lu, Mohammed Al‐Omran, Charles de Mestral
International Wound Journal.2023; 20(8): 3331. CrossRef
Impact of multidisciplinary care of diabetic foot infections for inpatients at Campbelltown Hospital
Timothy Choi, Uchechukwu Levi Osuagwu, Chau Tran, Krupali Bulsari, David Simmons
BMC Health Services Research.2023;[Epub] CrossRef
Multigene Panel Testing in Turkish Hereditary Cancer Syndrome Patients
Esra ARSLAN ATES, Ayberk TURKYILMAZ, Ceren ALAVANDA, Ozlem YILDIRIM, Ahmet Ilter GUNEY
Medeniyet Medical Journal.2022; 37(2): 150. CrossRef
Prediabetes; Prevention and Management
Asad Ali Mughal, Syed Taha Abbas, Huma Asad, Muhammed Zubair, Nasir Ali Khan, Shehla Naseem, Muhammad Zaman Shaikh
Pakistan BioMedical Journal.2022; : 03. CrossRef
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
Jackson Musuuza, Bryn L. Sutherland, Suleyman Kurter, Prakash Balasubramanian, Christie M. Bartels, Meghan B. Brennan
Journal of Vascular Surgery.2020; 71(4): 1433. CrossRef
The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey
Elisabetta Salutini, Enrico Brocco, Roberto Da Ros, Luca Monge, Luigi Uccioli, Roberto Anichini
The International Journal of Lower Extremity Wounds.2020; 19(1): 34. CrossRef
The effect of a multidisciplinary outpatient team approach on outcomes in diabetic foot care: a single center study
Eline Huizing, Michiel A. Schreve, Willemijn Kortmann, Jan P. Bakker, Jean-Paul P. M. de Vries, Çağdaş Ünlü
The Journal of Cardiovascular Surgery.2020;[Epub] CrossRef

Poor Prognosis Factors and Risk Factors of Amputation in Foot ulcers in Diabetes.: Mi Jung Eun, Jung Hoon Lee, Jin Ho Kim, Ji Eun Lee, Jae Hong Kim, Kyu Chang Won, In Ho Jo, Hyoung Woo Lee; Korean Diabetes J. 2004;28(4):304-314. Published online August 1, 2004

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Abstract PDF: BACKGROUND
Foot ulcers are a common complication of diabetes mellitus, and their prevalence is increased relative to those without diabetes. Foot ulcers and related complications represent an important cause of morbidity among patients with diabetes mellitus. Most of the poor prognosis factors and amputation risk factors of diabetic foot ulcers have been found to be largely affected by male sex, inadequate blood glucose control, vascular disease, neuropathy, end organ defects, and the depth and size of ulcers, prior ulcer history, infection and ischemia. Currently, the poor prognosis factors and amputation risk factors of diabetic foot ulcers in the Korean diabetic population are unknown. The purpose of this study was to identify and quantify the poor prognosis factors of diabetic foot ulcers and the risk factors of lower extremity amputation. METHODS: This study comprised of involved 37 male and 14 female diabetics with foot ulcers aged 23 to 83 years. According to the results of treatment, the patients were divided into 4 groups; complete healing (CH), partial healing (PH), unhealing (UH), and amputation (AM) groups. The baseline characteristics of the study subjects (gender, age, duration of diabetes, BMI, drinking, smoking, insulin therapy, blood pressure, whole blood count, renal function test and the size and depth of ulcer, prior ulcer history, osteomyelitis, infection, ischemia, neuropathy and retinopathy) were examined. RESULTS: The following characteristics were not significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: age, duration of diabetes, BMI; drinking, smoking, insulin therapy, blood pressure, whole blood count and renal function test. The following characteristics were significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: male (p=0.021), ischemia (p<0.05), infection (p<0.01), osteomyelitis (p<0.01), prior ulcer history (p<0.05), retinopathy (p<0.05), size of ulcer (p<0.001) and depth of ulcer (p<0.001). The size and depth of an ulcer, prior ulcer history, ischemia and infection were found to be associated with poor prognosis factors of treatment and risk factors of amputation in diabetic foot ulcer patients by a multiple regression test (P<0.05). CONCLUSION: This study shows that the size and depth of an ulcer, prior ulcer history, ischemia and infection are poor prognosis factors of diabetic foot ulcer and amputation risk factors However, further studies will be required due to the smaill size of our study population.

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