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      Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team : Team care effectively manages patients with diabetes foot ulcers

      1 , 2 , 3 , 4

      International Wound Journal

      Wiley

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          Most cited references 23

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          Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995-2005: a population-based study.

          The prevalence of diabetes has been increasing greatly, but WHO's predicted 39% rise in the global rate of diabetes from 2000 to 2030 might be an underestimate. We aimed to assess diabetes trends in Ontario, Canada. Using population-based data, including a validated diabetes database from the province of Ontario, Canada, we examined trends in diabetes prevalence and mortality from 1995 to 2005, and incidence from 1997 to 2003, in adults aged 20 years or older. Age-adjusted and sex-adjusted diabetes prevalence increased by 69%, from 5.2% in a population of 7,908,562 in 1995 to 8.8% of 9,276,945 in 2005. Prevalence increased by 27% from 6.9% in a population of 8,457,720 in 2000 to 8.8% of 9,276,945 in 2005. Although prevalence rates have remained higher in people aged 50 years or older (7.1% of 3,675,554) than in those aged 20-49 years (3.5% of 5 601 391), rates increased to a greater extent in the younger population (94%vs 63%, p<0.0001). A 31% increase occurred in yearly incidence over 6 years, from 6.6 per 1000 in 1997 to 8.2 per 1000 in 2003. The adjusted mortality rate in people with diabetes fell by 25% from 1995 to 2005. The prevalence of diabetes in Ontario, Canada increased substantially during the past 10 years, and by 2005 already exceeded the global rate that was predicted for 2030. This increase in prevalence is attributable to both rising incidence and declining mortality. Effective public-health interventions aimed at diabetes prevention are needed, as well as improved resources to manage the greater number of people living longer with the disease.
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            Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

            Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
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              Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit.

              To assess changes in diabetic lower-extremity amputation rates in a defined relatively static population over an 11-year period following the introduction of a multidisciplinary foot team. All diabetic patients with foot problems admitted to Ipswich Hospital, a large district general hospital, were identified by twice-weekly surveillance of all relevant in-patient areas and outcomes including amputations recorded. The incidence of major amputations fell 62%, from 7.4 to 2.8 per 100,000 of the general population. Total amputation rates also decreased (40.3%) but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10,000 people with diabetes, total amputations fell 70%, from 53.2 to 16.0, and major amputations fell 82%, from 36.4 to 6.7. Significant reductions in total and major amputation rates occurred over the 11-year period following improvements in foot care services including multidisciplinary team work.
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                Author and article information

                Journal
                International Wound Journal
                Int Wound J
                Wiley
                17424801
                August 2015
                August 2015
                July 09 2013
                : 12
                : 4
                : 377-386
                Affiliations
                [1 ]School of Physical Therapy; University of Western Ontario; London ON Canada
                [2 ]Centre of Wound Management, Royal District Nursing Service Institute; St Kilda VIC Australia
                [3 ]Faculty of Health Sciences; University of Western Ontario; London ON Canada
                [4 ]Department of Internal Medicine, Schulich School of Medicine and Dentistry; University of Western Ontario; London ON Canada
                Article
                10.1111/iwj.12119
                © 2013
                Product
                Self URI (article page): http://doi.wiley.com/10.1111/iwj.12119

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