ABSTRACT
In Nov 2019, " The Journal of Clinical Endocrinology & Metabolism" published an article " Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot" [Peled S, Pollack R, Elishoov O, et al. J Clin Endocrinol Metab, 2019, 104(11): 5445-5452. DOI: 10.1210/jc.2019-00774], with the permission of the original journal, we translated it into Chinese. This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot. The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017. Information on demographic characteristics, medical history, laboratory tests, and point-of-care glucose measurements were collected. The primary outcomes were any or major amputation during hospitalization. 45 496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot. Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization. High glycemic variability was associated with major amputations. Peripheral vascular disease, high Wagner score, and hypoglycemia were independent predictors of amputations. Older age, peripheral vascular disease, previous amputation, elevated white blood cell, high Wagner score, and hypoglycemia were independent predictors of major amputations. Hypoglycemia appeared to be an independent risk factor for any and major amputations. While it is unclear whether hypoglycemia directly contributes to adverse outcomes, efforts to minimize in-hospital hypoglycemic events are needed.
ABSTRACT
In June 2019, "The Journal of Clinical Endocrinology & Metabolism" published an article"Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot"[Peled S, Pollack R, Elishoov O, et al. J Clin Endocrinol Metab, 2019,104(11):5445-5452. DOI: 10.1210/jc.2019-00774] , with the permission of the original journal, we translated it into Chinese. This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot. The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017. Information on demographic characteristics, medical history, laboratory tests, and point-of-care glucose measurements were collected. The primary outcomes were any or major amputation during hospitalization. 45496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot. Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization. High glycemic variability was associated with major amputations. Peripheral vascular disease, high Wagner score, and hypoglycemia were independent predictors of amputations. Older age, peripheral vascular disease, previous amputation, elevated white blood cell, high Wagner score, and hypoglycemia were independent predictors of major amputations. Hypoglycemia appeared to be an independent risk factor for any and major amputations. While it is unclear whether hypoglycemia directly contributes to adverse outcomes, efforts to minimize in-hospital hypoglycemic events are needed.
ABSTRACT
Objective Secondary infection with pseudomonas aeruginosa( PA) in diabetic foot ulcer( DFU) was analyzed to investigate the related risk factor, antibiotic resistance, and prognoses of the infection. Methods Pathogen cultures were carried out in 966 DFU patients with their clinical data collected. All of the patients were followed-up for two years to observe the outcomes, including ulcer healing, amputation, recurrence of ulcers, non-fatal cardiovascular events, and death. The antibiotic susceptibility, risk factors and associated outcome of secondary PA infection were analyzed. Results Total incidence of PA infection was 13. 0％ in DFU patients, of which 38. 1％was secondary. The susceptibility rates of secondary infected PA to tobramycin, meropenem, eftazidime, levofloxacin, cefepime, and cefepime were similar to those in primary infected PA. However, the susceptibility rates of secondary infected PA to piperacillin, piperacillin/tazobactam, ciprofloxacin, imipenen, gentamicin, aztreonam, and amikacin decreased by 12％ to 22％ as compared with primary infected PA. The healing rate was much lower in patients with secondary PA infection compared with those with primary PA infection, and the accumulated healing rates at2yearswere44.44％ and70.4％ (P=0.01) respectively. Theriskofulcerhealingfailurewithintwoyears increased by 3 folds in patients with secondary PA infection. After adjusting for age, sex, Wagner grade, infection grade, and duration of DFU, plasma albumin level was an independent risk factor for secondary PA infection in patients with DFU(P=0. 001). Conclusions The antibiotics susceptibility rates of secondary infected PA were lower than those of primary infected PA. Secondary PA infection in DFU was less likely to be healed. Plasma albumin level was a risk factor for secondary PA infection.