The Frequency and Risk Factors of Diabetic Foot Ulcer Recurrence Among Jordanian Patients with Diabetes

Author(s): Sinan F. Tabanjeh*, Dana Hyassat, Hashem Jaddou, Nidal A. Younes, Asirvatham A. Robert, Kamel Ajlouni

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 8 , 2020


Become EABM
Become Reviewer
Call for Editor

Abstract:

Background: Diabetic foot is a major public health problem and their complications are an imperative cause of morbidity and mortality in diabetes.

Objective: To evaluate the rate of recurrence of foot ulcers post two years of follow-up, including the associated risk factors in the patients attending the diabetic foot clinic at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Amman, Jordan.

Methods: A historical cohort design was adopted for the patients who presented for the first time to the diabetic foot clinic at the NCDEG. Every patient who came to the clinic was reviewed by using his or her medical files with respect to diabetic foot-related complaints. Patients were classified under four categories: (1) Recurrent foot ulcers (2) chronic foot ulcer (3) free of recurrence, and (4) no foot ulcers. Among the four groups, group 1 (recurrent foot ulcers, n=76) and group 3 (free of recurrence, n=54) were included for the analysis.

Results: Among the 141 patients who presented to the diabetic foot clinic during the two-year study period, 76 (53.9%) of them experienced ulcer recurrences, 54 (38.3%) were recurrence-free, and 11 (7.8%) had chronic ulceration. The two-year recurrence rate was 58.5%. The presence of deformity and osteomyelitis were the statistically significant independent risk factors for recurrent foot ulceration.

Conclusion: This study of recurrences was clearly related to the type and complications of the ulcers rather than to the other variables. Recurrent foot ulceration is linked to the presence of osteomyelitis and/or deformities.

Keywords: Recurrent foot ulcer, diabetic foot, diabetes mellitus, risk factors, foot ulceration, chronic ulceration, deformity.

[1]
Forde H, Wrigley S, O’Murchadha LT, et al. Five-year outcomes of patients attending a diabetic foot clinic in a tertiary referral centre. Ir J Med Sci 2019.
[http://dx.doi.org/10.1007/s11845-019-02108-2] [PMID: 31650450]
[2]
Saluja S, Anderson SG, Hambleton I, et al. Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabet Med 2019.
[http://dx.doi.org/10.1111/dme.14151] [PMID: 31613404]
[3]
Shi H. A health needs assessment of adults with diabetic foot disease in the US. Diabetes Metab Syndr 2019; 13(3): 2152-7.
[http://dx.doi.org/10.1016/j.dsx.2019.05.008] [PMID: 31235150]
[4]
Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 2017; 376(24): 2367-75.
[http://dx.doi.org/10.1056/NEJMra1615439] [PMID: 28614678]
[5]
Molines-Barroso RJ, Lazaro-Martinez JL. Predictors of Diabetic Foot Reulceration beneath the Hallux 2019.
[http://dx.doi.org/10.1155/2019/9038171]
[6]
Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med 2016; 33(11): 1493-8.
[http://dx.doi.org/10.1111/dme.13054] [PMID: 26666583]
[7]
Larsson J, Agardh CD, Apelqvist J, Stenström A. Long-term prognosis after healed amputation in patients with diabetes. Clin Orthop Relat Res 1998; (350): 149-58.
[http://dx.doi.org/10.1097/00003086-199805000-00021] [PMID: 9602814]
[8]
Howarth D. Preventing foot complications in people with diabetes mellitus. Nurs Stand 2019; 34(7): 69-74.
[http://dx.doi.org/10.7748/ns.2019.e11432] [PMID: 31468824]
[9]
Marathe PH, Gao HX, Close KL. American diabetes association standards of medical care in diabetes 2017. J Diabetes 2017; 9(4): 320-4.
[http://dx.doi.org/10.1111/1753-0407.12524] [PMID: 28070960]
[10]
Lavery LA, Peters EJ, Williams JR, Murdoch DP, Hudson A, Lavery DC. International Working Group on the Diabetic Foot. Reevaluating the way we classify the diabetic foot: restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care 2008; 31(1): 154-6.
[http://dx.doi.org/10.2337/dc07-1302] [PMID: 17934155]
[11]
Barshes NR, Grant CL. Advances in the management of peripheral artery disease. Curr Diab Rep 2019; 19(7): 36.
[http://dx.doi.org/10.1007/s11892-019-1155-0] [PMID: 31115702]
[12]
Kurup R, Ansari AA. A study to identify bacteriological profile and other risk factors among diabetic and non-diabetic foot ulcer patients in a Guyanese hospital setting. Diabetes Metab Syndr 2019; 13(3): 1871-6.
[http://dx.doi.org/10.1016/j.dsx.2019.04.024] [PMID: 31235108]
[13]
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. J Foot Ankle Res 2019; 12: 34.
[http://dx.doi.org/10.1186/s13047-019-0345-y] [PMID: 31223342]
[14]
Font-Jiménez I, Llaurado-Serra M, Roig-Garcia M, De Los Mozos-Perez B, Acebedo-Urdiales S. Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation. Prim Care Diabetes 2016; 10(6): 434-41.
[http://dx.doi.org/10.1016/j.pcd.2016.04.001] [PMID: 27184825]
[15]
Nijenhuis-Rosien L, Hendriks SH, Kleefstra N, Bilo HJ, Landman GW. Nationwide diabetes-related lower extremity amputation rates in secondary care treated patients with diabetes in the Netherlands (DUDE-7). J Diabetes Complications 2017; 31(4): 675-8.
[http://dx.doi.org/10.1016/j.jdiacomp.2017.01.015] [PMID: 28214067]
[16]
Schmidt BM, Wrobel JS, Munson M, Rothenberg G, Holmes CM. Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study. Diabetes Res Clin Pract 2017; 126: 272-7.
[http://dx.doi.org/10.1016/j.diabres.2017.02.008] [PMID: 28288437]
[17]
Khalifa WA. Risk factors for diabetic foot ulcer recurrence: A prospective 2-year follow-up study in Egypt. Foot 2018; 35: 11-5.
[http://dx.doi.org/10.1016/j.foot.2017.12.004] [PMID: 29753996]
[18]
Fu XL, Ding H, Miao WW, Mao CX, Zhan MQ, Chen HL. Global recurrence rates in diabetic foot ulcers: A systematic review and meta-analysis (2019); 35(6)
[http://dx.doi.org/10.1002/dmrr.3160]
[19]
Engberg S, Kirketerp-Møller K, Ullits Andersen H, Rasmussen A. Incidence and predictors of recurrent and other new diabetic foot ulcers: a retrospective cohort study. Diabet Med 2019; 36(11): 1417-23.
[http://dx.doi.org/10.1111/dme.13964] [PMID: 30972797]
[20]
Apelqvist J, Bitzen PO, Larsson J, Nyberg P, Schersten P. Prevalence of foot ulcer and utilization of preventive care 1998; 47( ((suppl 1))): 167.
[21]
Huang ZH, Li SQ, Kou Y, Huang L, Yu T, Hu A. Risk factors for the recurrence of diabetic foot ulcers among diabetic patients: a meta-analysis. Int Wound J 2019; 16(6): 1373-82.
[http://dx.doi.org/10.1111/iwj.13200] [PMID: 31489774]
[22]
Edmonds ME, Blundell MP, Morris ME, Thomas EM, Cotton LT, Watkins PJ. Improved survival of the diabetic foot: the role of a specialized foot clinic. Q J Med 1986; 60(232): 763-71.
[PMID: 3774959]
[23]
Premkumar R, Rajan P, Rima J, Richard J. Footwear in the causation and prevention of foot ulcers in diabetes mellitus. Natl Med J India 2017; 30(5): 255-61.
[http://dx.doi.org/10.4103/0970-258X.234391] [PMID: 29916424]
[24]
Bus SA, van Netten JJ, Lavery LA, et al. International Working Group on the Diabetic Foot. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev 2016; 32(Suppl. 1): 16-24.
[http://dx.doi.org/10.1002/dmrr.2696] [PMID: 26334001]
[25]
Igiri BE, Tagang JI, Okoduwa SIR, Adeyi AO, Okeh A. An integrative review of therapeutic footwear for neuropathic foot due to diabetes mellitus. Diabetes Metab Syndr 2019; 13(2): 913-23.
[http://dx.doi.org/10.1016/j.dsx.2018.12.011] [PMID: 31336545]
[26]
Lee JS, Lu M, Lee VS, Russell D, Bahr C, Lee ET. Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. Diabetes 1993; 42(6): 876-82.
[http://dx.doi.org/10.2337/diab.42.6.876] [PMID: 8495811]
[27]
Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med 1992; 117(2): 97-105.
[http://dx.doi.org/10.7326/0003-4819-117-2-97] [PMID: 1605439]
[28]
Dubský M, Jirkovská A, Bem R, et al. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. Int Wound J 2013; 10(5): 555-61.
[http://dx.doi.org/10.1111/j.1742-481X.2012.01022.x] [PMID: 22712631]
[29]
Mantey I, Foster AV, Spencer S, Edmonds ME. Why do foot ulcers recur in diabetic patients? Diabet Med 1999; 16(3): 245-9.
[http://dx.doi.org/10.1046/j.1464-5491.1999.00032.x] [PMID: 10227571]
[30]
Moss SE, Klein R, Klein BE. The prevalence and incidence of lower extremity amputation in a diabetic population. Arch Intern Med 1992; 152(3): 610-6.
[http://dx.doi.org/10.1001/archinte.1992.00400150120022] [PMID: 1546925]
[31]
Walsh CH, Soler NG, Fitzgerald MG, Malins JM. Association of foot lesions with retinopathy in patients with newly diagnosed diabetes. Lancet 1975; 1(7912): 878-80.
[http://dx.doi.org/10.1016/S0140-6736(75)91682-7] [PMID: 47532]
[32]
Lipsky BA, Pecoraro RE, Wheat LJ. The diabetic foot. Soft tissue and bone infection. Infect Dis Clin North Am 1990; 4(3): 409-32.
[PMID: 2212597]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 8
Year: 2020
Page: [910 - 915]
Pages: 6
DOI: 10.2174/1573399816666200109094329
Price: $65

Article Metrics

PDF: 21
HTML: 2