Predictors of Outcomes of Foot Ulcers among Individuals with Type 2 Diabetes Mellitus in an Outpatient Foot Clinic.

OBJECTIVES: To determine the risk factors for recurrence and persistence of non-healing foot ulcers resulting in minor and major amputations. METHODOLOGY: This was an ambispective cohort analysis of persons with diabetic foot ulcers consulting at the diabetic foot clinic of East Avenue Medical Center. Data were analyzed through multiple logistic regression. RESULT: Two hundred sixteen patients with Type 2 Diabetes Mellitus and diabetic foot ulcers were included in the analysis; 50.9% were males and the mean age of the cohort was 55.8 ± 9.9 years. Outcomes of foot ulcers were: healed 44.5% (healed with no recurrence 30%, healed but with recurrence 14.5%) and not healed 55.5% (major amputation 11%, minor amputation, 21.5%, and persistently non-healing 23%). Multivariate logistic regression showed the following were independent risk factors for persistent non-healing ulcer: osteomyelitis (OR 66.5; CI 19.7, 217.8), smoking (OR 28.9; CI 6.8, 129.3, and peripheral arterial disease (PAD) (OR 56.8; CI 2.5, 877.2). Independent risk factors for ulcer recurrence were: plantar location of ulcer (OR 16.8; CI 6.8, 89.4), presence of more than one ulcer (OR 7.8; CI 3.6,31.6), and neuropathy (OR 11.2; CI 7.2, 19.9). For healed foot ulcers, mean healing time was 14 ± 3 weeks. Healing time was significantly reduced from 12 weeks to 4.5 weeks (p<0.001) if patients consulted earlier (within 4 weeks from sustaining an ulcer). CONCLUSION: Only half (55%) of patients with diabetic foot ulcers consulting in a dedicated outpatient foot clinic had an adverse outcome of foot ulcers (major amputation 11%, minor amputation, 21.5%, and persistently non-healing ulcer 23%) while a small portion (14.5%) of patients had recurrent foot ulcers. Arterial obstruction, smoking, low hemoglobin, neuropathy, and osteomyelitis increase the likelihood of healing failure while the presence of multiple ulcers, plantar location of ulcers, and neuropathy increase the risk of ulcer recurrence.

Differences between national and international guidelines for the management of diabetic foot disease.

AIM: No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. METHODS: The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as "similar," "partially similar," "not similar," or "different" when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. RESULTS: Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. CONCLUSIONS: National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.

Long term outcome of type 2 diabetic patients with critical limb ischemia

INTRODUCTION: Diabetes Mellitus is associated with vascular disease. One of its macrovascular complications is peripheral arterial disease (PAD), which can present as critical limb ischemia (CLI) that can eventually lead to amputation and death.OBJECTIVE: Determine the long-term outcome of Type 2 diabetic patients with critical limb ischemia in National Kidney and Transplant Institute (NKTI).METHODS: Computerized search of NKTI Medical Records Section was done using the Docuview. Type 2 diabetic patients with critical limb ischemia of the lower extremities were included in the study. Patients were grouped according to the intervention received (No intervention, Bypass Graft or Peripheral Angioplasty). Endpoints such as amputation and mortality were ascertained on readmissions and on outpatient records. Data processing and analyses were performed using SPSS v20. Kaplan-Meier Survival Analysis was used to examine days to amputation and days to mortality between groups.RESULTS: Twenty-three (23) patients were included in the study. There was no significant difference on the baseline characteristics of those who received revascularization and those who did not have revascularization. Amputation rate was 31% while mortality rate was 30% for the whole population. Patients who had revascularization seemed to have greater probability of amputation and lesser probability of dying, but these were not statistically significant based on Kaplan - Meier Survival Curves p values of 0.918 and 0.433, respectively.CONCLUSION: Diabetic patients with CLI still carries a high risk of amputation and mortality even with revascularization but the time to amputation is longer for those who were revascularized.