Diabetic foot epidemiology and demographics: Difference between revisions
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==Overview== | ==Overview== | ||
The [[incidence]] of [[diabetic foot | The [[incidence]] of [[diabetic foot]] [[ulcer]] is approximately 1500 per 100,000 [[diabetes|diabetic]] individuals world wide. Among the US veterans the [[incidence]] of active [[diabetic foot]] [[ulcers]] is approximately 500 per 100,000 individuals. On the other hand the [[incidence]] of active [[diabetic foot]] [[ulcers]] in United Kingdom has been estimated 220 per 100,000 individuals. Furthermore it's [[prevalence]] has been reported 170 per 100,000 individuals among the United Kingdom population. The 5 year risk of [[mortality rate|mortality]] in [[diabetes|diabetic]] [[patient|patients]] with a [[foot]] [[ulcer]] is 2.5 times higher than [[diabetes|diabetic individuals]] without a [[foot]] [[ulcer]]. Based on 2 studies with different follow up duration, [[mortality rate]] of [[diabetic foot]] has been estimated as 10% and 24% in 16 months and 5 years follow up, respectively. Based on a [[systematic review]] and [[Meta-analysis|metanalysis]] done on [[diabetes]] [[patients]], [[diabetic foot]] was more common among older [[patients]]. White people develop [[diabetes|diabetic]] [[peripheral neuropathy]] (which is a serious [[risk factor]] for [[diabetic foot]]) more frequently. In 1987, Borch-Johnsen et al. described a [[male]] preponderance for the development of severe [[Microvascular disease|microvascular]] [[Complication (medicine)|complications]] and [[diabetic foot]] [[disease]] is not an exception to this rule. Highest [[prevelance]] of [[diabetic foot]] has been reported in North America. In contrast, Oceania has the lowest reported [[prevelance]] of [[diabetic foot]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
| Line 51: | Line 51: | ||
<br> | <br> | ||
===Mortality=== | ===Mortality Rate=== | ||
*The 5 year risk of mortality in [[diabetes|diabetic]] [[patient|patients]] with a [[foot]] [[ulcer]] is 2.5 times higher than [[diabetes|diabetic individuals]] without a [[foot]] [[ulcer]].<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | *The 5 year risk of [[mortality rate|mortality]] in [[diabetes|diabetic]] [[patient|patients]] with a [[foot]] [[ulcer]] is 2.5 times higher than [[diabetes|diabetic individuals]] without a [[foot]] [[ulcer]].<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | ||
*Based on a study done in Spain [[mortality rate|mortality]] has been reported 28 among 1000 [[patients]] per year and the main cause (31.2%) was cardiovascular [[disease]].<ref name="pmid18779037">{{cite journal| author=Mundet X, Pou A, Piquer N, Sanmartin MI, Tarruella M, Gimbert R | display-authors=etal| title=Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain. | journal=Prim Care Diabetes | year= 2008 | volume= 2 | issue= 3 | pages= 135-40 | pmid=18779037 | doi=10.1016/j.pcd.2008.05.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18779037 }} </ref> | *Based on 2 studies with different follow up duration, [[mortality rate]] of [[diabetic foot]] has been estimated as 10% and 24% in 16 months and 5 years follow up, respectively.<ref name="ChalletonLetanoux1993">{{cite journal|last1=Challeton|first1=JP|last2=Letanoux|first2=M|last3=Melki|first3=JP|last4=Mourad|first4=JJ|last5=Priollet|first5=P|title=Le pied diabétique: pronostic dans une série de 75 patients|journal=La Revue de Médecine Interne|volume=14|issue=10|year=1993|pages=1036|issn=02488663|doi=10.1016/S0248-8663(05)80153-5}}</ref><ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref> | ||
*Another study done in Liverpool [[foot]] clinic reported 44% five year [[mortality rate|mortality]] in [[diabetes|diabetic]] [[patients]] with a new [[foot]] [[ulcer]].<ref name="MoulikMtonga2003">{{cite journal|last1=Moulik|first1=P. K.|last2=Mtonga|first2=R.|last3=Gill|first3=G. V.|title=Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by Etiology|journal=Diabetes Care|volume=26|issue=2|year=2003|pages=491–494|issn=0149-5992|doi=10.2337/diacare.26.2.491}}</ref> | |||
*Based on a study done in Spain [[mortality rate|mortality]] has been reported 28 among 1000 [[patients]] per year and the main cause (31.2%) was cardiovascular [[disease]].<ref name="pmid18779037">{{cite journal| author=Mundet X, Pou A, Piquer N, Sanmartin MI, Tarruella M, Gimbert R | display-authors=etal| title=Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain. | journal=Prim Care Diabetes | year= 2008 | volume= 2 | issue= 3 | pages= 135-40 | pmid=18779037 | doi=10.1016/j.pcd.2008.05.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18779037 }} </ref> Another study done in England demonstrated the cardiovascular [[disease]]s as the main cause of death in [[diabetic foot]] [[patients]] as well.<ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref> | |||
===Age=== | ===Age=== | ||
Based on a [[systematic review]] and metanalysis done on [[diabetes]] [[patients]], [[diabetic foot]] was more common among older [[patients]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref><ref name="pmid25685277">{{cite journal| author=Yazdanpanah L, Nasiri M, Adarvishi S| title=Literature review on the management of diabetic foot ulcer. | journal=World J Diabetes | year= 2015 | volume= 6 | issue= 1 | pages= 37-53 | pmid=25685277 | doi=10.4239/wjd.v6.i1.37 | pmc=4317316 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25685277 }} </ref> | Based on a [[systematic review]] and [[Meta-analysis|metanalysis]] done on [[diabetes]] [[patients]], [[diabetic foot]] was more common among older [[patients]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref><ref name="pmid25685277">{{cite journal| author=Yazdanpanah L, Nasiri M, Adarvishi S| title=Literature review on the management of diabetic foot ulcer. | journal=World J Diabetes | year= 2015 | volume= 6 | issue= 1 | pages= 37-53 | pmid=25685277 | doi=10.4239/wjd.v6.i1.37 | pmc=4317316 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25685277 }} </ref> | ||
===Race=== | ===Race=== | ||
White people develop [[diabetes|diabetic]] [[peripheral neuropathy]] more frequently.<ref name="pmid21750334">{{cite journal| author=Wang W, Balamurugan A, Biddle J, Rollins KM| title=Diabetic neuropathy status and the concerns in underserved rural communities: challenges and opportunities for diabetes educators. | journal=Diabetes Educ | year= 2011 | volume= 37 | issue= 4 | pages= 536-48 | pmid=21750334 | doi=10.1177/0145721711410717 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21750334 }} </ref> | White people develop [[diabetes|diabetic]] [[peripheral neuropathy]] (which is a serious [[risk factor]] for [[diabetic foot]]) more frequently.<ref name="pmid21750334">{{cite journal| author=Wang W, Balamurugan A, Biddle J, Rollins KM| title=Diabetic neuropathy status and the concerns in underserved rural communities: challenges and opportunities for diabetes educators. | journal=Diabetes Educ | year= 2011 | volume= 37 | issue= 4 | pages= 536-48 | pmid=21750334 | doi=10.1177/0145721711410717 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21750334 }} </ref> | ||
===Gender=== | ===Gender=== | ||
| Line 68: | Line 71: | ||
*Highest [[prevelance]] of [[diabetic foot]] has been reported in North America.<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref> | *Highest [[prevelance]] of [[diabetic foot]] has been reported in North America.<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref> | ||
*Lowest [[prevalence]] of [[diabetic foot]] has been reported in Oceania. | *Lowest [[prevalence]] of [[diabetic foot]] has been reported in Oceania. | ||
*Africa has higher [[prevalence]] of [[diabetic foot]], compared to Asia and Europe. | *Africa has higher [[prevalence]] of [[diabetic foot]], compared to Asia and Europe. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category: | [[Category:Up To Date]] | ||
Latest revision as of 19:28, 17 September 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Vishnu Vardhan Serla M.B.B.S. [3] Usama Talib, BSc, MD [4]
Overview
The incidence of diabetic foot ulcer is approximately 1500 per 100,000 diabetic individuals world wide. Among the US veterans the incidence of active diabetic foot ulcers is approximately 500 per 100,000 individuals. On the other hand the incidence of active diabetic foot ulcers in United Kingdom has been estimated 220 per 100,000 individuals. Furthermore it's prevalence has been reported 170 per 100,000 individuals among the United Kingdom population. The 5 year risk of mortality in diabetic patients with a foot ulcer is 2.5 times higher than diabetic individuals without a foot ulcer. Based on 2 studies with different follow up duration, mortality rate of diabetic foot has been estimated as 10% and 24% in 16 months and 5 years follow up, respectively. Based on a systematic review and metanalysis done on diabetes patients, diabetic foot was more common among older patients. White people develop diabetic peripheral neuropathy (which is a serious risk factor for diabetic foot) more frequently. In 1987, Borch-Johnsen et al. described a male preponderance for the development of severe microvascular complications and diabetic foot disease is not an exception to this rule. Highest prevelance of diabetic foot has been reported in North America. In contrast, Oceania has the lowest reported prevelance of diabetic foot.
Epidemiology and Demographics
Incidence
- The incidence of diabetic foot ulcer is approximately 630 per 100,000 diabetic individuals world wide.[1][2][3][4]
- According to an other estimate the incidence of diabetic foot ulcer is approximately 1500 per 100,000 individuals worldwide.[5]
- The incidence of active diabetic foot ulcers in the US veterans is approximately 500 per 100,000 individuals.[1][2][3][4]
- The incidence of active diabetic foot ulcers in United Kingdom is approximately 220 per 100,000 individuals.[1][2]
- Based on another study, up to 25% of diabetic patients develop diabetic foot within their disease period.[6]
- It is estimated that 2% to 3% of diabetic patients experience diabetic foot every year.[7][8]
- Between 15 to 20 percent of diabetic patients in the United States will be hospitalized due to diabetic foot and it's complications at one point in their life.[9]
Prevalence
- The prevalence of active diabetic foot ulcers in United Kingdom is approximately 170 per 100,000 individuals.[1][2]
- Based on a cohort study which studied 310 patients with type 2 diabetes, diabetic foot prevelance was found to be 18.1%.[10]
- In a study done on a diabetic population in Ethiopia, prevalence of diabetic foot ulcer has been estimated 13.6% with a 95% confidence interval (9.3-17.2) among 279 diabetic patients who attend a diabetic clinic.[11]
- Prevalence of diabetic foot have been reported 51.8% based on a community based cross-sectional study which evaluated 620 diabetic patients in rural areas of India.[12]
- The following table is a summary of prevalence of diabetic foot globally and in different regions:[3]
| Region | Prevalence of diabetic foot | 95% Confidence interval |
|---|---|---|
| Global | 6.3% | 5.4–7.3% |
| North America | 13.0% | 10.0–15.9% |
| Asia | 5.5% | 4.6–6.4% |
| Europe | 5.1% | 4.1–6.0% |
| Africa | 7.2% | 5.1–9.3% |
| Oceania | 3.0% | 0.9–5.0% |
Mortality Rate
- The 5 year risk of mortality in diabetic patients with a foot ulcer is 2.5 times higher than diabetic individuals without a foot ulcer.[1]
- Based on 2 studies with different follow up duration, mortality rate of diabetic foot has been estimated as 10% and 24% in 16 months and 5 years follow up, respectively.[13][14]
- Another study done in Liverpool foot clinic reported 44% five year mortality in diabetic patients with a new foot ulcer.[15]
- Based on a study done in Spain mortality has been reported 28 among 1000 patients per year and the main cause (31.2%) was cardiovascular disease.[16] Another study done in England demonstrated the cardiovascular diseases as the main cause of death in diabetic foot patients as well.[14]
Age
Based on a systematic review and metanalysis done on diabetes patients, diabetic foot was more common among older patients.[3][17]
Race
White people develop diabetic peripheral neuropathy (which is a serious risk factor for diabetic foot) more frequently.[18]
Gender
- In 1987, Borch-Johnsen et al. described a male preponderance for the development of severe microvascular complications and diabetic foot disease is not an exception to this rule.[19] [20]
- For unknown reasons, men have a higher risk of diabetic foot disease compared to women.[17][21]
- Few possible explanations could be the higher bioavailability of nitric oxide (NO), higher responsiveness to NO and the protective role of estrogen in women. [22]. However the beneficial effect of these factors could be reversed by diabetes itself and irrespective of the menopausal status of female patients.
Region
- Highest prevelance of diabetic foot has been reported in North America.[3]
- Lowest prevalence of diabetic foot has been reported in Oceania.
- Africa has higher prevalence of diabetic foot, compared to Asia and Europe.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
- ↑ 2.0 2.1 2.2 2.3 Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J; et al. (2002). "The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort". Diabet Med. 19 (5): 377–84. PMID 12027925.
- ↑ 3.0 3.1 3.2 3.3 3.4 Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y (2017). "Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (†)". Ann Med. 49 (2): 106–116. doi:10.1080/07853890.2016.1231932. PMID 27585063.
- ↑ 4.0 4.1 Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ (2006). "Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study". Diabetes Care. 29 (6): 1202–7. doi:10.2337/dc05-2031. PMID 16731996.
- ↑ Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR; et al. (2006). "Diabetic foot disorders. A clinical practice guideline (2006 revision)". J Foot Ankle Surg. 45 (5 Suppl): S1–66. doi:10.1016/S1067-2516(07)60001-5. PMID 17280936.
- ↑ Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG; et al. (2014). "Diabetic foot ulcers: Part I. Pathophysiology and prevention". J Am Acad Dermatol. 70 (1): 1.e1–18, quiz 19-20. doi:10.1016/j.jaad.2013.06.055. PMID 24355275.
- ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
- ↑ Borssén B, Bergenheim T, Lithner F (1990). "The epidemiology of foot lesions in diabetic patients aged 15-50 years". Diabet Med. 7 (5): 438–44. doi:10.1111/j.1464-5491.1990.tb01420.x. PMID 2142042.
- ↑ Hunt D (2009). "Diabetes: foot ulcers and amputations". BMJ Clin Evid. 2009. PMC 2907821. PMID 19445774.
- ↑ Almobarak AO, Awadalla H, Osman M, Ahmed MH (2017). "Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?". Ann Transl Med. 5 (17): 340. doi:10.21037/atm.2017.07.01. PMC 5599292. PMID 28936434.
- ↑ Mariam TG, Alemayehu A, Tesfaye E, Mequannt W, Temesgen K, Yetwale F; et al. (2017). "Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study". J Diabetes Res. 2017: 2879249. doi:10.1155/2017/2879249. PMC 5534295. PMID 28791310.
- ↑ Vibha SP, Kulkarni MM, Kirthinath Ballala AB, Kamath A, Maiya GA (2018). "Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus". BMC Endocr Disord. 18 (1): 43. doi:10.1186/s12902-018-0270-2. PMC 6020220. PMID 29940924.
- ↑ Challeton, JP; Letanoux, M; Melki, JP; Mourad, JJ; Priollet, P (1993). "Le pied diabétique: pronostic dans une série de 75 patients". La Revue de Médecine Interne. 14 (10): 1036. doi:10.1016/S0248-8663(05)80153-5. ISSN 0248-8663.
- ↑ 14.0 14.1 Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E. (2016). "Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type". Journal of Diabetes Research. 2016: 1–7. doi:10.1155/2016/2879809. ISSN 2314-6745.
- ↑ Moulik, P. K.; Mtonga, R.; Gill, G. V. (2003). "Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by Etiology". Diabetes Care. 26 (2): 491–494. doi:10.2337/diacare.26.2.491. ISSN 0149-5992.
- ↑ Mundet X, Pou A, Piquer N, Sanmartin MI, Tarruella M, Gimbert R; et al. (2008). "Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain". Prim Care Diabetes. 2 (3): 135–40. doi:10.1016/j.pcd.2008.05.001. PMID 18779037.
- ↑ 17.0 17.1 Yazdanpanah L, Nasiri M, Adarvishi S (2015). "Literature review on the management of diabetic foot ulcer". World J Diabetes. 6 (1): 37–53. doi:10.4239/wjd.v6.i1.37. PMC 4317316. PMID 25685277.
- ↑ Wang W, Balamurugan A, Biddle J, Rollins KM (2011). "Diabetic neuropathy status and the concerns in underserved rural communities: challenges and opportunities for diabetes educators". Diabetes Educ. 37 (4): 536–48. doi:10.1177/0145721711410717. PMID 21750334.
- ↑ Borch-Johnsen K, Nissen H, Salling N, Henriksen E, Kreiner S, Deckert T; et al. (1987). "The natural history of insulin-dependent diabetes in Denmark: 2. Long-term survival--who and why". Diabet Med. 4 (3): 211–6. PMID 2956021.
- ↑ Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG (1998). "Practical criteria for screening patients at high risk for diabetic foot ulceration". Arch Intern Med. 158 (2): 157–62. doi:10.1001/archinte.158.2.157. PMID 9448554.
- ↑ Assaad-Khalil SH, Zaki A, Abdel Rehim A, Megallaa MH, Gaber N, Gamal H; et al. (2015). "Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes". Prim Care Diabetes. 9 (4): 297–303. doi:10.1016/j.pcd.2014.10.010. PMID 25543864.
- ↑ Gladwin MT, Schechter AN, Ognibene FP, Coles WA, Reiter CD, Schenke WH; et al. (2003). "Divergent nitric oxide bioavailability in men and women with sickle cell disease". Circulation. 107 (2): 271–8. PMID 12538427.