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[Risk factors associated to hospitalization in diabetic patients with foot ulcers]
1Unidad de Referencia de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Spain.
Insights
Hospitalization for diabetic foot ulcers is linked to larger ulcer size and advanced diabetic retinopathy. Strengthening preventive care for these patients can reduce hospital admissions.
Area of Science:
- Diabetology
- Vascular Surgery
- Podiatry
Context:
- Diabetic foot ulcers are a significant cause of morbidity and healthcare costs.
- In-patient care for diabetic foot complications represents a substantial financial burden.
- Identifying risk factors for hospitalization is crucial for effective resource allocation and patient management.
Purpose:
- To identify clinical and biochemical risk factors associated with hospitalization in diabetic patients with foot ulcers.
- To analyze predictors of admission to reduce healthcare costs and improve patient outcomes.
- To inform preventive strategies aimed at avoiding hospitalization for diabetic foot care.
Summary:
- A study of 108 diabetic patients with foot ulcers found that larger ulcer diameter and advanced diabetic retinopathy were independent predictors of hospitalization.
- Other risk factors included higher ulcer grade, cellulitis, poorer metabolic control (HbA1c), and polyneuropathy.
- Hospitalization occurred in 28% of patients, highlighting the need for targeted interventions.
Impact:
- Findings emphasize the need to intensify therapeutic and preventive measures for diabetic patients with larger ulcers and retinopathy.
- Early detection and management of these risk factors can potentially decrease hospitalization rates.
- This research contributes to optimizing diabetic foot care protocols and reducing the economic impact of diabetic foot disease.
Background:
To analyse the risk factors associated with admissions of diabetic patients with foot ulcers, in order to prevent hospitalization. In-patient care supposes the greatest cost of the diabetic foot care.
Subjects And Method:
We studied 108 diabetic patients (male n = 59, mean age 68 [11] years, 100 type 2 diabetics, disease duration 16.4 [10.3]) who attended the diabetic foot unit between January 1996 and September 1997. Clinical and biochemical risk parameters were recorded in a clinical protocol. Patients were followed up for a mean period of 200.2 (121.3) days. Admission was needed for 30 diabetic patients (28%).
Results:
Risk factors for hospitalization were: higher ulcer diameter (1.9 [1.6] vs 3.4 [2.3] cm, p < 0.05), higher ulceration grade according to Wagner's classification (p = 0.005), presence of > 2 cm cellulitis (p < 0.001), worse metabolic control (HbA1c 7.6 [1.3] vs 8.6 [1.1], p < 0.05), and greater degree of retinopathy (p < 0.005). Odds ratios (OR) for admission were: advanced diabetic retinopathy: OR 1.9 (CI 95% 1.3-2.9; p = 0.02); presence of moderate to severe polyneuropathy: OR 1.6 (CI 95% 1.3-2.1; p = 0.05); upper HbA1c tertile: OR 2.4 (CI 95% 1.2-4.2; p = 0.004). In the logistic regression model, both foot ulcer diameter and advanced diabetic retinopathy were significantly independent.
Conclusions:
In diabetic subjects with foot ulcers, hospitalization is independently related to the diameter of the ulcer and the degree of diabetic retinopathy. Therapeutic and preventive approaches should be strengthened in this subgroup of diabetic patients to prevent their hospitalization.