1. bookVolume 54 (2020): Issue 3 (July 2020)
Journal Details
License
Format
Journal
eISSN
1336-0329
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
access type Open Access

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study

Published Online: 27 Aug 2020
Volume & Issue: Volume 54 (2020) - Issue 3 (July 2020)
Page range: 207 - 216
Journal Details
License
Format
Journal
eISSN
1336-0329
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
Abstract

Objective. The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.

Methods. The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.

Results. The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004–0.332). This was followed by PAD (OR 0.093; 95% CI 0.028–0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030–0.395), anemia (OR 0.179; 95% CI 0.056–0.571).

Conclusion. Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

Keywords

Adeleye JO. Diabetic foot disease: The perspective of a Nigerian tertiary health care centre. Pract Diabetes Int 22, 211–214, 2005.10.1002/pdi.819Search in Google Scholar

Alvin CP. Diabetes Mellitus: Aetiological classification In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (eds). Harrison’s principles of Internal Medicine. 16th edition. Mc Graw Hill (Medical Publishing division), 323, 2168–2169, 2005.Search in Google Scholar

Apelqvist J, Larsson J, Agardh CD. Medical risk factors in diabetic patients with foot ulcers and severe peripheral vascular disease and their influence on outcome. J Diabetes Complications 6, 167–174, 1992.10.1016/1056-8727(92)90032-GSearch in Google Scholar

Atosona A, Larbie C. Prevalence and determinants of diabetic foot ulcers and lower extremity amputations in three selected tertiary hospitals in Ghana. J Diabetes Res 2019, 7132861, 2019.10.1155/2019/7132861638833630886869Search in Google Scholar

Centers for Disease Control and Prevention (CDC). Geographic disparities in diabetes-related amputations--Texas-Mexico border, 2003. MMWR Morb Mortal Wkly Rep 55, 1251–1253, 2006.Search in Google Scholar

Choi SK, Kim CK, Jo DI, Lee MC, Kim JN, Choi HG, Shin DH, Kim SH. Factors associated with a prolonged length of hospital stay in patients with diabetic foot: a single-center retrospective study. Arch Plast Surg 44, 539–544, 2017.10.5999/aps.2017.01207580179429121708Search in Google Scholar

Chuan F, Zhang M, Yao Y, Tian W, He X, Zhou B. Anemia in patients with diabetic foot ulcer: prevalence, clinical characteristics, and outcome. Int J Low Extrem Wounds 15, 220–226, 2016.10.1177/153473461666022427440798Search in Google Scholar

Baltzis D, Eleftheriadou I, Veves A. Pathogenesis and treatment of impaired wound healing in diabetes mellitus: new insights. Adv Ther 31, 817–836, 2014.10.1007/s12325-014-0140-x25069580Search in Google Scholar

Djibril AM, Mossi EK, Djagadou AK, Balaka A, Tchamdja T, Moukaila R. [Epidemiological, diagnostic, therapeutic and evolutionary features of diabetic foot: a study conducted at the Medico-surgical Clinic, University Hospital Sylvanus Olympio in Lomé]. Pan Afr Med J 30, 4, 2018.10.11604/pamj.2018.30.4.14765609359030123407Search in Google Scholar

Elgzyri T, Larsson J, Thorne J, Eriksson KF, Apelqvist J. Outcome of ischemic foot ulcer in diabetic patients who had no invasive vascular intervention. Eur J Vasc Endovasc Surg 46, 110–117, 2013.10.1016/j.ejvs.2013.04.01323642521Search in Google Scholar

Feldman-Idov Y, Melamed Y, Linn S, Ore L. Prognostic factors predicting ischemic wound healing following hyper-baric oxygenation therapy. Wound Repair Regen 21, 418–427, 2013.10.1111/wrr.1203823590699Search in Google Scholar

Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J Diabetes 8, 135–142, 2017.10.4239/wjd.v8.i4.135539473328465790Search in Google Scholar

Grigoropoulou P, Eleftheriadou I, Jude EB, Tentolouris N. Diabetic foot infections: an update in diagnosis and management. Curr Diab Rep 17, 3. 2017.10.1007/s11892-017-0831-1Search in Google Scholar

Harrington C, Zagari MJ, Corea J, Klitenic J. A cost analysis of diabetic lower-extremity ulcers. Diabetes Care 23, 1333–1338, 2000.10.2337/diacare.23.9.1333Search in Google Scholar

Hartemann-Heutier A, Ha Van G, Danan JP. Outcome of severe diabetic foot ulcers after standardized management in a specialized unit. Diabetes Metab (Paris) 28, 477–484, 2002.Search in Google Scholar

Iraj B, Khorvash F, Ebneshahidi A, Askari G. Prevention of diabetic foot ulcer. Int J Prev Med 4, 373–376, 2013.Search in Google Scholar

Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg 35, 528–531, 1996.10.1016/S1067-2516(96)80125-6Search in Google Scholar

Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care 29, 1288–1293, 2006.10.2337/dc05-242516732010Search in Google Scholar

Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic foot ulcers receiving standard treatment: a meta-analysis. Diabetes Care 22, 692–695, 1999.10.2337/diacare.22.5.69210332667Search in Google Scholar

Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol 136, 1531–1535, 2000.10.1001/archderm.136.12.153111115166Search in Google Scholar

Marston WA; Dermagraft Diabetic Foot Ulcer Study Group. Risk factors associated with healing chronic diabetic foot ulcers: the importance of hyperglycemia. Ostomy Wound Manage 52, 26–32, 2006.Search in Google Scholar

Mbanya JC, Sobngwi E. Diabetes in Africa. Diabetes Microvascular and Macrovascular Disease in Africa. J Cardiovasc Risk 10, 97–102, 2003.10.1177/174182670301000204Search in Google Scholar

Mehmood K, Akhtar ST, Talib A, Talib A, Abbasi B, Siraj-ul-Salekeen, Naqvi IH. Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital. J Coll Physicians Surg Pak 18, 408–412, 2008.Search in Google Scholar

Monami M, Longo R, Desideri CM, Masotti G, Marchionni N, Mannucci E. The diabetic person beyond a foot ulcer healing, recurrence, and depressive symptoms. J Am Podiatr Med Assoc 98, 130–136, 2008.10.7547/098013018347122Search in Google Scholar

Otu AA, Umoh VA, Essien OE, Enang OE, Okpa HO, Mbu PN. Profile, bacteriology, and risk factors for foot ulcers among diabetics in a tertiary hospital in Calabar, Nigeria. Ulcers 2013, 820468, 2013.10.1155/2013/820468Search in Google Scholar

Ozkara A, Delibasi T, Selcoki Y. The major clinical outcomes of diabetic foot infections: one center experience. Cent Eur J Med 3, 464–469, 2008.10.2478/s11536-008-0018-xSearch in Google Scholar

Piaggesi A, Schipani E, Campi F. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomised trial. Diabet Med 15, 412–417, 1998.10.1002/(SICI)1096-9136(199805)15:5<412::AID-DIA584>3.0.CO;2-1Search in Google Scholar

Pemayun TGD, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabetic Foot Ankle 6, 29629, 2015.10.3402/dfa.v6.29629Search in Google Scholar

Pemayun TGD, Naibaho RM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Indonesia. Diabet Foot Ankle 8, 1312974, 2017.10.1080/2000625X.2017.1312974Search in Google Scholar

Saleem S, Hayat N, Ahmed I, Ahmed T, Rehan AG. Risk factors associated with poor outcome in diabetic foot ulcer patients. Turk J Med Sci 47, 826–831, 2017.10.3906/sag-1602-119Search in Google Scholar

Thewjitcharoen Y, Krittiyawong S, Porramatikul S, Parksook W, Chatapat L, Watchareejirachot O, Sripatpong J, Himathongkam T. Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand’s experience. J Clin Transl Endocrinol 1, 187–191, 2014.10.1016/j.jcte.2014.10.002Search in Google Scholar

Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Burden of diabetic foot ulcer in Nigeria: current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria. World J Diabetes 10, 200–211, 2019.10.4239/wjd.v10.i3.200Search in Google Scholar

Wagner FW. The diabetic foot. Orthopedics 10, 163–172, 1987.10.3928/0147-7447-19870101-28Search in Google Scholar

Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yapar N, Atabey A, Kucukyavas Y, Comlekci A, Eraslan S. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones 8, 286–295, 2009.10.14310/horm.2002.1245Search in Google Scholar

Young EE, Anyim OB, Onyenekwe BM, Nwatu CB, Anyim OB, Okafor CI, Ofoegbu EN. Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu, Nigeria. Int J Diabetes Dev Ctries 36, 220–227, 2016.10.1007/s13410-015-0413-1Search in Google Scholar

Zimny S, Schatz H, Pfohl M. Determinants and estimation of healing times in diabetic foot ulcers. J Diabetes Complications 16, 327–332, 2002.10.1016/S1056-8727(01)00217-3Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo