References

Richard JL, Lavigne JP, Got I Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab. 2011; 37:(3)208-215 https://doi.org/10.1016/j.diabet.2010.10.003

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005; 366:(9498)1719-1724 https://doi.org/10.1016/S0140-6736(05)67698-2

Ghanassia E, Villon L, Thuan dit Dieudonné JF Long-term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5-year follow-up study. Diabetes Care. 2008; 31:(7)1288-1292 https://doi.org/10.2337/dc07-2145

Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes Metab Res Rev. 2016; 32:7-15 https://doi.org/10.1002/dmrr.2695

Basit A. Setting up a diabetic foot service. In: Hinchliffe RJ, Thompson MM, Schaper NC, Tripathi RK, Timaran C. London, UK: JP medical Ltd;

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003; 361:(9368)1545-1551 https://doi.org/10.1016/S0140-6736(03)13169-8

Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005; 366:(9498)1725-1735 https://doi.org/10.1016/S0140-6736(05)67699-4

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293:(2)217-228 https://doi.org/10.1001/jama.293.2.217

Wukich DK, Armstrong DG, Attinger CE Inpatient management of diabetic foot disorders: a clinical guide. Diabetes Care. 2013; 36:(9)2862-2871 https://doi.org/10.2337/dc12-2712

Les hospitalisations pour complications podologiques chez les personnes diabétiques traitées pharmacologiquement, en France en 2013 [Article in French]. 2015. http://www.invs.sante.fr/beh/2015/34-35/2015_34-35_4.html (accessed 3 June 2020)

Prompers L, Schaper N, Apelqvist J Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008; 51:(5)747-755 https://doi.org/10.1007/s00125-008-0940-0

Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004; 20:S90-S95 https://doi.org/10.1002/dmrr.464

Lipsky BA, Aragón-Sánchez J, Diggle M IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016; 32:45-74 https://doi.org/10.1002/dmrr.2699

Ha Van G, Michaux C, Parquet H Treatment of chronic plantar ulcer of the diabetic foot using an irremovable windowed fibreglass cast boot: prospective study of 177 patients. Diabetes Metab Res Rev. 2015; 31:(7)691-698 https://doi.org/10.1002/dmrr.2657

Ha Van G, Siney H, Danan JP, Sachon C, Grimaldi A. Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery. Diabetes Care. 1996; 19:(11)1257-1260 https://doi.org/10.2337/diacare.19.11.1257

Aragón-Sánchez FJ, Cabrera-Galván JJ, Quintana-Marrero Y Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement. Diabetologia. 2008; 51:(11)1962-1970 https://doi.org/10.1007/s00125-008-1131-8

Lázaro-Martínez JL, Aragón-Sánchez J, García-Morales E. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes Care. 2014; 37:(3)789-795 https://doi.org/10.2337/dc13-1526

Hartemann-Heurtier A, Ha Van G, Danan JP Outcome of severe diabetic foot ulcers after standardised management in a specialised unit. Diabetes Metab. 2002; 28:(6 Pt 1)477-484

Beckert S, Witte M, Wicke C A new wound-based severity score for diabetic foot ulcers: a prospective analysis of 1,000 patients. Diabetes Care. 2006; 29:(5)988-992 https://doi.org/10.2337/dc05-2431

Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers and amputation. Wound Repair Regen. 2005; 13:(3)230-236 https://doi.org/10.1111/j.1067-1927.2005.130303.x

Holstein P, Ellitsgaard N, Bornefeldt Olsen B, Ellitsgaard V. Decreasing incidence of major amputations in people with diabetes. Diabetologia. 2000; 43:(7)844-847 https://doi.org/10.1007/s001250051459

Apelqvist J. Wound healing in diabetes: outcome and costs. Clin Podiatr Med Surg. 1998; 15:(1)21-39

Jeffcoate WJ, Chipchase SY, Ince P, Game FL. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care. 2006; 29:(8)1784-1787 https://doi.org/10.2337/dc06-0306

Morbach S, Furchert H, Gröblinghoff U Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care. 2012; 35:(10)2021-2027 https://doi.org/10.2337/dc12-0200

Young MJ, McCardle JE, Randall LE, Barclay JI. Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. Diabetes Care. 2008; 31:(11)2143-2147 https://doi.org/10.2337/dc08-1242

Santilli SM, Kronson JW, Payne WD. Cigarette smoking alters the rabbit transarterial wall oxygen gradient. Ann Vasc Surg. 1998; 12:(2)174-181 https://doi.org/10.1007/s100169900137

Diabetic foot ulcers

Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

01 June 2021
Practice

Abstract

Objective:

To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS).

Method:

A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method.

Results:

Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age.

Conclusion:

This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

Diabetic foot ulcers (DFU) are characterised by slow healing and a high risk of amputation in patients who are likely to have many comorbidities, and mortality rates are high.1,2,3 International guidelines recommend rapid access to expertise in a multidisciplinary diabetic foot service (DFS) in order to decrease the risk of major amputation.4,5,6,7,8 Treatment in this type of care structure might be essential in the control of infection, metabolic disorder and peripheral vascular disease, in addition to optimising offloading and wound care.4,9 In France, the amputation rate in patients with diabetes is still high and a recent epidemiological study has shown considerable differences between regions.10

Register now to continue reading

Thank you for visiting Journal of Wound Care's World Union of Wound Healing Supplement and reading some of our peer-reviewed resources for healthcare professionals. To read more, please register today.

Register
Or continue by

Signing in with your registered email address

amputation
diabetic foot ulcer
healing rate
mortality