Diabetic foot natural history, complications and prognosis: Difference between revisions
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*[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref><ref name="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278 }} </ref> | *[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref><ref name="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278 }} </ref> | ||
*[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]] develop [[diabetic foot]], which then may get infected. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]].<ref name="pmid16740006">{{cite journal| author=Edmonds M| title=Diabetic foot ulcers: practical treatment recommendations. | journal=Drugs | year= 2006 | volume= 66 | issue= 7 | pages= 913-29 | pmid=16740006 | doi=10.2165/00003495-200666070-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740006 }} </ref> | *[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]] develop [[diabetic foot]], which then may get infected. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]].<ref name="pmid16740006">{{cite journal| author=Edmonds M| title=Diabetic foot ulcers: practical treatment recommendations. | journal=Drugs | year= 2006 | volume= 66 | issue= 7 | pages= 913-29 | pmid=16740006 | doi=10.2165/00003495-200666070-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740006 }} </ref> | ||
*Based on a study, factors such as elevated [[body mass index]] and [[osteomyelitis]] prolong the [[wound healing]] process.<ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue= | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658 }} </ref> | |||
*If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | *If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref> | ||
==Complications== | ==Complications== | ||
*Diabetic foot ulcer can cause many complications including:<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref><ref name="pmid18647759">{{cite journal| author=Gardner SE, Frantz RA| title=Wound bioburden and infection-related complications in diabetic foot ulcers. | journal=Biol Res Nurs | year= 2008 | volume= 10 | issue= 1 | pages= 44-53 | pmid=18647759 | doi=10.1177/1099800408319056 | pmc=3777233 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18647759 }} </ref><ref name="pmid22890823">{{cite journal| author=Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK et al.| title=The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. | journal=Diabetologia | year= 2012 | volume= 55 | issue= 11 | pages= 2906-12 | pmid=22890823 | doi=10.1007/s00125-012-2673-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890823 }} </ref><ref name="pmid17276208">{{cite journal| author=Rathur HM, Boulton AJ| title=The diabetic foot. | journal=Clin Dermatol | year= 2007 | volume= 25 | issue= 1 | pages= 109-20 | pmid=17276208 | doi=10.1016/j.clindermatol.2006.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17276208 }} </ref> | *Diabetic foot ulcer can cause many complications including:<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref><ref name="pmid18647759">{{cite journal| author=Gardner SE, Frantz RA| title=Wound bioburden and infection-related complications in diabetic foot ulcers. | journal=Biol Res Nurs | year= 2008 | volume= 10 | issue= 1 | pages= 44-53 | pmid=18647759 | doi=10.1177/1099800408319056 | pmc=3777233 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18647759 }} </ref><ref name="pmid22890823">{{cite journal| author=Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK et al.| title=The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. | journal=Diabetologia | year= 2012 | volume= 55 | issue= 11 | pages= 2906-12 | pmid=22890823 | doi=10.1007/s00125-012-2673-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890823 }} </ref><ref name="pmid17276208">{{cite journal| author=Rathur HM, Boulton AJ| title=The diabetic foot. | journal=Clin Dermatol | year= 2007 | volume= 25 | issue= 1 | pages= 109-20 | pmid=17276208 | doi=10.1016/j.clindermatol.2006.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17276208 }} </ref><ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue= | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658 }} </ref> | ||
**[[Infection]]: | **[[Infection]]: | ||
***[[Diabetes|Diabetic foot]] [[infection]] is the most common cause of [[Hospital|hospitalization]] in [[diabetes|diabetic]] [[patients]]. | ***[[Diabetes|Diabetic foot]] [[infection]] is the most common cause of [[Hospital|hospitalization]] in [[diabetes|diabetic]] [[patients]]. | ||
| Line 20: | Line 21: | ||
**Lower [[Limb (anatomy)|limb]] [[amputation]] | **Lower [[Limb (anatomy)|limb]] [[amputation]] | ||
***It is estimated that roughly half of non [[Physical trauma|traumatic]] [[Limb (anatomy)|lower limb]] [[amputation]] is due to [[diabetic foot]] in North America and Europe. | ***It is estimated that roughly half of non [[Physical trauma|traumatic]] [[Limb (anatomy)|lower limb]] [[amputation]] is due to [[diabetic foot]] in North America and Europe. | ||
***Factors such as [[Ageing|old age]], [[peripheral vascular disease]], transcutaneous [[oxygen]] reduction, poor [[Diabetes management|glycemic control]] and [[smoking]] increase the risk of [[amputation]] in [[diabetic foot]] [[patients]]. | ***Factors such as [[Ageing|old age]], [[peripheral vascular disease]], transcutaneous [[oxygen]] reduction, poor [[Diabetes management|glycemic control]], [[osteomyelitis]] and [[smoking]] increase the risk of [[amputation]] in [[diabetic foot]] [[patients]]. | ||
**Death | **Death | ||
***[[Patients]] with [[diabetic foot]] have an increased risk of all-cause [[mortality rate|mortality]], especially [[Cardiovascular disease|cardiovascular disorders]], compared with [[patients]] with [[diabetes]] without a history of [[diabetic foot]] [[ulcer]]. | ***[[Patients]] with [[diabetic foot]] have an increased risk of all-cause [[mortality rate|mortality]], especially [[Cardiovascular disease|cardiovascular disorders]], compared with [[patients]] with [[diabetes]] without a history of [[diabetic foot]] [[ulcer]]. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Vishnu Vardhan Serla M.B.B.S. [3] Usama Talib, BSc, MD [4]
Overview
The complications of diabetic foot ulcers include infection, sepsis, osteomyelitis and death.
Natural History
- Diabetic foot as a known complication of diabetes is more related to diabetes mellitus type 2, compared to type 1 diabetes.[1][2]
- Diabetic patients who are at risk of foot ulceration develop diabetic foot, which then may get infected. The final state of diabetic foot is a necrotic foot.[3]
- Based on a study, factors such as elevated body mass index and osteomyelitis prolong the wound healing process.[4]
- If left untreated diabetic ulcer may progress to infection, sepsis, or osteomyelitis. According to an estimate 20% of significant diabetic foot ulcers end up requiring an amputation. Untreated diabetic foot ulcer cab lead to death of the affected individual.[5]
Complications
- Diabetic foot ulcer can cause many complications including:[5][6][7][8][4]
- Infection:
- Diabetic foot infection is the most common cause of hospitalization in diabetic patients.
- Sepsis
- Osteomyelitis
- Gangrene
- Lower limb amputation
- It is estimated that roughly half of non traumatic lower limb amputation is due to diabetic foot in North America and Europe.
- Factors such as old age, peripheral vascular disease, transcutaneous oxygen reduction, poor glycemic control, osteomyelitis and smoking increase the risk of amputation in diabetic foot patients.
- Death
- Patients with diabetic foot have an increased risk of all-cause mortality, especially cardiovascular disorders, compared with patients with diabetes without a history of diabetic foot ulcer.
- Infection:
- Complications of diabetic foot have been more common in male patients and individuals older than 60 years old.[8]
Prognosis
- If left untreated prognosis could be very bad and it eventually can lead to death.[5]
- The 5 year risk of mortality in diabetic patients with a foot ulcer is 2.5 times higher than diabetic individuals without a foot ulcer.[5]
References
- ↑ Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y (2017). "Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †". Ann Med. 49 (2): 106–116. doi:10.1080/07853890.2016.1231932. PMID 27585063.
- ↑ Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC (2013). "Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients". Endocrine. 44 (1): 119–24. doi:10.1007/s12020-012-9829-2. PMID 23124278.
- ↑ Edmonds M (2006). "Diabetic foot ulcers: practical treatment recommendations". Drugs. 66 (7): 913–29. doi:10.2165/00003495-200666070-00003. PMID 16740006.
- ↑ 4.0 4.1 Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN; et al. (2019). "Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care". J Multidiscip Healthc. 12: 349–359. doi:10.2147/JMDH.S194969. PMC 6506632 Check
|pmc=value (help). PMID 31118658. - ↑ 5.0 5.1 5.2 5.3 Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
- ↑ Gardner SE, Frantz RA (2008). "Wound bioburden and infection-related complications in diabetic foot ulcers". Biol Res Nurs. 10 (1): 44–53. doi:10.1177/1099800408319056. PMC 3777233. PMID 18647759.
- ↑ Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK; et al. (2012). "The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis". Diabetologia. 55 (11): 2906–12. doi:10.1007/s00125-012-2673-3. PMID 22890823.
- ↑ 8.0 8.1 Rathur HM, Boulton AJ (2007). "The diabetic foot". Clin Dermatol. 25 (1): 109–20. doi:10.1016/j.clindermatol.2006.09.015. PMID 17276208.