Diabetic foot natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
*[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<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="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278 }} </ref> | *[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<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="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278 }} </ref> | ||
*[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]] develop [[diabetic foot]] | *[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]], develop [[diabetic foot]] which may get infected later. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]].<ref name="pmid16740006">{{cite journal| author=Edmonds M| title=Diabetic foot ulcers: practical treatment recommendations. | journal=Drugs | year= 2006 | volume= 66 | issue= 7 | pages= 913-29 | pmid=16740006 | doi=10.2165/00003495-200666070-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740006 }} </ref> | ||
*Based on a study, factors such as elevated [[body mass index]] and [[osteomyelitis]] prolong the [[wound healing]] process.<ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue= | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658 }} </ref> | *Based on a study, factors such as elevated [[body mass index]] and [[osteomyelitis]] prolong the [[wound healing]] process.<ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue= | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658 }} </ref> | ||
*If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.<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> | *If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.<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> | ||
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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 complications of diabetic foot ulcers include infection, sepsis, osteomyelitis and death.
Natural History
- Diabetic foot as a known complication of diabetes is more related to diabetes mellitus type 2, compared to type 1 diabetes.[1][2]
- Diabetic patients who are at risk of foot ulceration, develop diabetic foot which may get infected later. The final state of diabetic foot is a necrotic foot.[3]
- Based on a study, factors such as elevated body mass index and osteomyelitis prolong the wound healing process.[4]
- If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.[5]
Complications
- Diabetic foot ulcer can cause numerous complications including:[5][6][7][8][4][9][10]
- Infection:
- Diabetic foot infection is the most common cause of hospitalization in diabetic patients.
- Sepsis
- Osteomyelitis
- Gangrene
- Lower limb amputation
- It is estimated that roughly half of non traumatic lower limb amputation is due to diabetic foot in North America and Europe.
- The following factors increase the risk of amputation in diabetic foot patients:
- Old age
- Peripheral vascular disease (PAD)
- Transcutaneous oxygen reduction
- Poor glycemic control
- Osteomyelitis
- Smoking
- Dialysis
- Death
- Patients with diabetic foot have an increased risk of all-cause mortality, especially cardiovascular disorders, compared with diabetic patients without a history of diabetic foot ulcer.
- The following risk factors have been associated with higher rate of mortality:
- Infection:
- Complications of diabetic foot have been more common in male patients and patients older than 60 years old.[8]
Prognosis
- If left untreated prognosis could be very bad and it eventually can lead to death.[5]
- 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.[5]
- The presence of a single ulcer is associated with a particularly good prognosis among patients with diabetic foot, compared to multiple ulcers.[11]
- Modification of specific risk factors (such as improving glycemic control, treatment of neuropathy and immediate treatment of ulcers) improves the prognosis in a significant manner.[12]
- Three year mortality has been estimated 35-50% after amputation of the diabetic foot.[13]
References
- ↑ 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.
- ↑ Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC (2013). "Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients". Endocrine. 44 (1): 119–24. doi:10.1007/s12020-012-9829-2. PMID 23124278.
- ↑ Edmonds M (2006). "Diabetic foot ulcers: practical treatment recommendations". Drugs. 66 (7): 913–29. doi:10.2165/00003495-200666070-00003. PMID 16740006.
- ↑ 4.0 4.1 Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN; et al. (2019). "Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care". J Multidiscip Healthc. 12: 349–359. doi:10.2147/JMDH.S194969. PMC 6506632 Check
|pmc=value (help). PMID 31118658. - ↑ 5.0 5.1 5.2 5.3 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.
- ↑ Gardner SE, Frantz RA (2008). "Wound bioburden and infection-related complications in diabetic foot ulcers". Biol Res Nurs. 10 (1): 44–53. doi:10.1177/1099800408319056. PMC 3777233. PMID 18647759.
- ↑ Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK; et al. (2012). "The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis". Diabetologia. 55 (11): 2906–12. doi:10.1007/s00125-012-2673-3. PMID 22890823.
- ↑ 8.0 8.1 Rathur HM, Boulton AJ (2007). "The diabetic foot". Clin Dermatol. 25 (1): 109–20. doi:10.1016/j.clindermatol.2006.09.015. PMID 17276208.
- ↑ Chammas NK, Hill RL, Edmonds ME (2016). "Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type". J Diabetes Res. 2016: 2879809. doi:10.1155/2016/2879809. PMC 4860228. PMID 27213157.
- ↑ Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT; et al. (2012). "Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade". Diabetes Care. 35 (10): 2021–7. doi:10.2337/dc12-0200. PMC 3447849. PMID 22815299.
- ↑ Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M; et al. (2018). "Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study". Diabet Med. 35 (1): 78–88. doi:10.1111/dme.13537. PMC 5765512. PMID 29083500.
- ↑ ""Group therapy for schizophrenia: A meta-analysis": Correction to Burlingame et al. (2020)". Psychotherapy (Chic). 57 (4): 597. 2020. doi:10.1037/pst0000354. PMID 33301344 Check
|pmid=value (help). - ↑ Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I (2019). "Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study". J Foot Ankle Res. 12: 34. doi:10.1186/s13047-019-0345-y. PMC 6570910 Check
|pmc=value (help). PMID 31223342.