Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study

Author:

Bundó Magdalena12,Vlacho Bogdan3452,Llussà Judit6,Bobé Isabel7,Aivar Meritxell8,Ciria Carmen9,Martínez‐Sánchez Ana10,Real Jordi112,Mata‐Cases Manel372,Cos Xavier12132,Dòria Montserrat14,Viade Jordi15,Franch‐Nadal Josep3162ORCID,Mauricio Dídac1431752ORCID

Affiliation:

1. Primary Health Care Center Ronda Prim Gerència d’Àmbit d'Atenció Primària Metropolitana Nord de Barcelona Institut Català de La Salut Mataró Spain

2. DAP‐Cat Group. Unitat de Suport a La Recerca Barcelona Ciutat Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) 375, Entresuelo. 08025 Barcelona Spain

3. CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) Instituto de Salud Carlos III (ISCIII) Barcelona Spain

4. Pharmacology Department Universitat Autònoma de Barcelona (UAB) Cerdanyola del Vallès Spain

5. Institut de Recerca Hospital de La Santa Creu I Sant Pau Barcelona Spain

6. Primary Health Care Centre Sant Roc, Gerència d’Àmbit d'Atenció Primària Metropolitana Nord de Barcelona Institut Català de La Salut, Mataró Spain Catalan Health Institute Badalona Spain

7. Primary Health Care Center La Mina Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat Institut Català de La Salut Sant Adrià de Besòs Spain

8. Primary Health Care Centre Sants, Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat Institut Català de La Salut Barcelona Spain

9. Primary Health Care Centre Ponts. Gerència d’Àmbit d'Atenció Primària Lleida Institut Català de La Salut Lleida Spain

10. Primary Health Care Centre El Carmel. Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat Institut Català de La Salut Barcelona Spain

11. Universitat Internacional de Catalunya Epidemiologia I Salut Pública Sant Cugat Spain

12. Innovation office at Institut Català de La Salut Barcelona Spain

13. Primary Health Care Center Sant Martí de Provençals Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat Institut Català de La Salut Barcelona Spain

14. Department of Endocrinology & Nutrition Hospital de La Santa Creu I Sant Pau Barcelona Spain

15. Department of Endocrinology & Nutrition Hospital Germans Trias I Pujol Badalona Spain

16. Primary Health Care Center Raval Sud Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat Institut Català de La Salut Barcelona Spain

17. Department of Medicine University of Vic ‐ Central University of Catalonia Vic Spain

Abstract

AbstractBackgroundDiabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12‐month follow‐up period.MethodsWe included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow‐up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors.ResultsDuring the follow‐up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively.ConclusionsWe observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU.

Funder

Primary Care Diabetes Europe

Publisher

Wiley

Subject

Orthopedics and Sports Medicine

Reference40 articles.

1. IDF atlas.https://diabetesatlas.org/idfawp/resource‐files/2021/07/IDF_Atlas_10th_Edition_2021.pdf

2. NICE.Diabetic Foot Problems: Inpatient Management of Diabetic Foot Problems. Nice Cg 119. 2011; (March):1–30.http://www.nice.org.uk/guidance/cg119/chapter/guidance.

3. Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer

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