DIABETIC FOOT ULCERATION

Analysis Of Risk Factors For Diabetic Foot Ulceration And Their Clinical Implication



Table of Contents

Central Research Question3

Aim3

Objectives3

Rationale For Research3

Study Design4

Patient selection7

Method8

Statistical analysis10

LITERATURE REVIEW12

Introduction12

Diabetic Nephropathy17

Glycaemic Control19

UK Prospective Diabetes Study and Diabetes control and Complication Trail21

Callus24

Peripheral Vascular Disease27

Risk Factors And Their Clinical Implications30

Summary and Conclusion35

REFERENCES37

Research Proposal- Analysis Of Risk Factors For Diabetic Foot Ulceration And Their Clinical Implication

Central Research Question

What are the risk factors for diabetic foot ulceration and their clinical implication?

Aim

To determine the incidence of, and clinically relevant risk factors for, new foot ulceration in a large cohort of diabetic patients in the community healthcare setting.

Objectives

We aimed to determine:

The incidence of foot ulceration in diabetic patients;

Which of the simple clinical foot screening methods widely used in clinical practice are most effective for predicting the risk of diabetic foot ulceration in the community.

Rationale For Research

Some of the risk factors found to relate to improved healing such as smaller wound size and lack of infection are not surprising; they have been reported in previous DFU studies.12,13 Several risk factors found to relate to healing in other DFU studies were not found to affect healing in this study. The duration of ulceration before study enrolment has been described as an important risk factor previously, with ulcers of longer duration having poor healing rates.13,14 However, only patients with ulcers of duration >6 weeks were enrolled, which may have affected analysis of this risk factor. Ulcer duration related to healing usually depends on the type of treatment the wound has received over time. An ulcer may have been present for years but treatment neglected pressure relief and debridement or involved the use of toxic agents. With proper therapy, healing may proceed rapidly.

Study Design

At baseline, the following variables will be recorded for all patients: gender, age, ethnic origin (based upon patients' appearance and grandparental origin), socioeconomic classification (based upon the Registrar General's classification ), and whether or not the patient lived alone. A medical history will be taken, including duration and treatment of diabetes, and patients' social history included details of smoking history and evidence of regular alcohol consumption (> 7 units/week).

Medical records will be examined to determine if patients will be registered blind/partially sighted, or had impaired vision so that they will be unable to see their own feet clearly. Patients will be also questioned as to whether they had previously attended a podiatrist for a routine visit, treatment and/or foot care advice. Repeated evidence of protein in urine, ongoing haemodialysis or continuous ambulatory peritoneal dialysis, or previous kidney transplant indicated nephropathy. Details of past or present foot ulcers will be documented via examination and accessing the podiatry/medical notes. A foot ulcer will be defined as a full thickness skin break at least to Wagner Stage 1, occurring distal to the malleoli. Patients will be assigned a footwear risk category, dependent on which type of shoe will be worn most often: low risk = trainers, lace-ups, boots (low heel), extra depth/surgical shoes; moderate risk = 'slip-ons'/casual shoes, bar or buckle fastened ...