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      Foot ulceration and its association with mortality in diabetes mellitus: a meta‐analysis

      1 , 1 , 2 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9
      Diabetic Medicine
      Wiley

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          Abstract

          Diabetic foot ulcers portend an almost twofold increase in all-cause mortality compared with diabetes on its own.

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          Most cited references35

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          Incidence, outcomes, and cost of foot ulcers in patients with diabetes.

          To determine the incidence of foot ulcers in a large cohort of patients with diabetes, the risk of developing serious complications after diagnosis, and the attributable cost of care compared with that in patients without foot ulcers. Retrospective cohort study of patients with diabetes in a large staff-model health maintenance organization from 1993 to 1995. Patients with diabetes were identified by algorithm using administrative, laboratory, and pharmacy records. The data were used to calculate incidence of foot ulcers, risk of osteomyelitis, amputation, and death after diagnosis of foot ulcer, and attributable costs in foot ulcer patients compared with patients without foot ulcers. Among 8,905 patients identified with type 1 or type 2 diabetes, 514 developed a foot ulcer over 3 years of observation (cumulative incidence 5.8%). On or after the time of diagnosis, 77 (15%) patients developed osteomyelitis and 80 (15.6%) required amputation. Survival at 3 years was 72% for the foot ulcer patients versus 87% for a group of age- and sex-matched diabetic patients without foot ulcers (P < 0.001). The attributable cost for a 40- to 65-year-old male with a new foot ulcer was $27,987 for the 2 years after diagnosis. The incidence of foot ulcers in this cohort of patients with diabetes was nearly 2.0% per year. For those who developed ulcers, morbidity, mortality, and excess care costs were substantial compared with those for patients without foot ulcers. The results appear to support the value of foot-ulcer prevention programs for patients with diabetes.
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            The pathologic continuum of diabetic vascular disease.

            Hyperglycemia can promote vascular complications by multiple mechanisms, with formation of advanced glycation end products and increased oxidative stress proposed to contribute to both macrovascular and microvascular complications. Many of the earliest pathologic responses to hyperglycemia are manifest in the vascular cells that directly encounter elevated blood glucose levels. In the macrovasculature, these include endothelial cells and vascular smooth muscle cells. In the microvasculature, these include endothelial cells, pericytes (in retinopathy), and podocytes (in renal disease). Additionally, neovascularization arising from the vasa vasorum may promote atherosclerotic plaque progression and contribute to plaque rupture, thereby interconnecting macroangiopathy and microangiopathy.
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              Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers.

              Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.
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                Author and article information

                Journal
                Diabetic Medicine
                Diabet. Med.
                Wiley
                0742-3071
                1464-5491
                December 02 2019
                December 02 2019
                Affiliations
                [1 ]Division of Cardiovascular Sciences Faculty of Biology, Medicine and Health University of Manchester Manchester UK
                [2 ]George Alleyne Chronic Disease Research Centre University of the West Indies Cavehill Barbados
                [3 ]Diabetes and Endocrine Department Countess of Chester NHS Foundation Trust Chester UK
                [4 ]Department of Blood Sciences Walsall Manor Hospital Walsall UK
                [5 ]Department of Diabetes and Endocrinology Tameside Hospital NHS Foundation Trust Ashton‐under‐Lyne UK
                [6 ]Arthritis Research UK Centre for Epidemiology Centre for Musculoskeletal Research School of Biological Sciences Manchester Academic Health Science Centre University of Manchester Manchester UK
                [7 ]Department of Podiatry East Cheshire NHS Trust Macclesfield UK
                [8 ]School of Medicine and Manchester Academic Health Sciences Centre University of Manchester ManchesterUK
                [9 ]Salford Royal NHS Foundation Trust, Diabetes and Endocrinology Salford UK
                Article
                10.1111/dme.14151
                31613404
                17d915f2-89d2-433f-9e33-d15bb01bd0c1
                © 2019

                http://onlinelibrary.wiley.com/termsAndConditions#vor

                http://doi.wiley.com/10.1002/tdm_license_1.1

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