Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study.

BACKGROUND: Diabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12-month follow-up period. METHODS: We included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow-up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors. RESULTS: During the follow-up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively. CONCLUSIONS: We observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU.

Correction: Martinez-Gonzalez et al. Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form in Spanish Subjects. J. Clin. Med. 2020, 9, 2497.

In the original publication [...].

Psychometric Validation of the Cardiff Wound Impact Schedule Questionnaire in a Spanish Population with Diabetic Foot Ulcer.

Diabetic foot ulcers (DFU) negatively affect the quality of life (QoL) of people with diabetes. The Cardiff Wound Impact Schedule (CWIS) questionnaire has been designed to measure the QoL of people with chronic foot wounds. However, no studies have been specifically designed to validate this instrument in a Spanish population. In this prospective study, a total of 141 subjects with DFU were recruited. DFU was determined by performing physical examinations. Medical records were exhaustively reviewed to collect clinical variables. The CWIS was transculturally adapted by a group of experts and a group of patients with DFU. The SF-36 and EQ-5D generic instruments were used as reference tools. The questionnaires were administered at 7 days and 4, 12, and 26 weeks after the baseline assessment by personal interview with each of the study subjects. The psychometric properties of the instrument were assessed using statistical methods. The content validity had an average of 3.63 (90.7% of the maximum score of 4). The internal consistency of the CWIS subscales had a standardized Cronbach's alpha range from 0.715 to 0.797. The reproducibility was moderate with an intraclass correlation coefficient (ICC) range from 0.606 to 0.868. Significant correlations between CWIS domains and SF-36 and EQ-5D subscales were observed, demonstrating a good criterion validity of the CWIS questionnaire (p < 0.001). However, the construct validity of the CWIS was not validated with a comparative fit index (CFI) of 0.69, a root mean square error of approximation (RMSEA) of 0.09, and a standardized root mean square residual (SRMR) of 0.10. The sensitivity to changes over time was optimal in the three domains (i.e., social life, well-being, and physical symptoms) (p < 0.001). In conclusion, the Spanish version of the CWIS shows acceptable psychometric properties to assess the QoL of subjects with DFU, except for its construct validity.

High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain.

BACKGROUND: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. METHODS: Retrospective, observational study in 220 subjects followed for six years. We calculated and compared the frequency and 5-year cumulative incidence of all-cause mortality, cardiovascular (CV) mortality, CV events, major adverse CV events (MACE), and new foot ulcer (FU) or amputation. We also examined prognostic factors of all-cause and CV mortality based on baseline characteristics. RESULTS: DM patients had a 1.98 times higher probability of all-cause mortality than those without DM (p = 0.001) and 2.42 times higher likelihood of CV mortality and new FU or amputation (p = 0.002 and p = 0.008, respectively). In the DM cohort, only the risk of a new FU or amputation was 2.69 times higher among those with previous DFS (p = 0.021). In patients with DM, older age was the only predictor of all-cause and CV mortality (p = 0.001 and p = 0.014, respectively). CONCLUSIONS: Although all-cause and CV mortality were increased on HD subjects with DM, the presence of DFS did not modify the excess risk. Additional studies are warranted to further explore the impact of DFS in subjects with DM undergoing HD.

Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain / Complicaciones a corto plazo en el pie en la neuroartropatía de Charcot: estudio retrospectivo en centros de atención terciaria en España

Objectives: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. Patients and methods: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. Results: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). Conclusions: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy

Objetivos: Determinar las características clínicas de pacientes con neuroartropatía de Charcot (NC) en España e identificar predictores de complicaciones relacionadas. Materiales y métodos: Estudio retrospectivo llevado a cabo en 5 hospitales terciarios de España con unidad de pie diabético. Se recopilaron datos de 83 pacientes incluyendo perfil demográfico, datos provenientes de la exploración podológica, características de la diabetes y presencia de comorbilidad micro y macro vascular. Para determinar los predictores significativos de acontecimientos clínicos predefinidos se utilizaron análisis de regresión logística. Resultados: Casi todos los pacientes (98,9%) tenían signos de neuropatía diabética en la evaluación inicial, aproximadamente la mitad tenían retinopatía o nefropatía diabética (61,5 y 51,8%, respectivamente) y la enfermedad arterial periférica era infrecuente (8,6%). Treinta y ocho pacientes (47,5%) experimentaron uno o más acontecimientos clínicos relevantes: 22 (27,5%) una nueva úlcera en el pie, 7 (8,7%) una amputación mayor, 20 (25%) fueron hospitalizados y 4 (5%) murieron. Solamente la presencia de nefropatía diabética se encontró independientemente asociada al desarrollo de alguna de las complicaciones estudiadas (p = 0,009; odds ratio = 3,37; 95% CI: 1,12-10,1). Conclusiones: Casi la mitad de los pacientes con NC atendidos en unidades de cuidado del pie diabético en hospitales terciarios experimentaron complicaciones asociadas a NC a corto plazo, y el riesgo entre aquellos sujetos con historia de úlcera previa era 3 veces mayor

Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain.

OBJECTIVES: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.

Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain.

Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

Las congelaciones: caso clínico / No disponible

El artículo que se presenta a continuación quieredar a conocer la patología de las congelaciones através de un caso clínico. Además, pretende informara los profesionales de la salud de la actuaciónde los podólogos, bien sea en la fase preventiva,dando recomendaciones para evitarlas, en la fasecurativa, curando o compensando las secuelas.Proponemos un sencillo protocolo de prevenciónque incluye una exploración y estudio biomecánicodel pié, una revisión de las alteraciones de lapiel y de las uñas, consejos y revisión del calzadoy calcetines en base a la actividad a realizar. Comoconclusión podemos afirmar que la mejor manerade evitarlas es mentalizar e informar a todos loscolectivos expuestos(AU)

The next text get to know the frostbite patologyby a clinic case. Also, this report wants to informanother health professionals about the podiatricsactuations, in a preventive phase: giving heathcare,or in a recover phase: treating injuries andcompensating consequences. We propose an easyprevention protocol that’s includes: biomecanicstudy and exploration of the feet, skin and nailsdisorders, revision and care about footwear andsocks linked by the activity to do. Finishing, wewould to say that the best way to prevent it’s theinformation and to make abore all implicatedcollectives(AU)