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Epidemiology
The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study
Choong Hee Kim, Jun Sung Moon, Seung Min Chung, Eun Jung Kong, Chul Hyun Park, Woo Sung Yoon, Tae Gon Kim, Woong Kim, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee
Diabetes Metab J. 2018;42(4):308-319.   Published online April 27, 2018
DOI: https://doi.org/10.4093/dmj.2017.0076
  • 5,369 View
  • 74 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   
Background

This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team.

Methods

In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched.

Results

Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased.

Conclusion

Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.

Citations

Citations to this article as recorded by  
  • Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study
    Thoriso C. Mokoala, Vhusani Sididzha, Etsumang D. Molefe, Thifhelimbilu E. Luvhengo
    The Surgeon.2024; 22(2): e109.     CrossRef
  • Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome
    Marco Meloni, Laura Giurato, Luca Monge, Cesare Miranda, Alessia Scatena, Benedetta Ragghianti, Giovanni Antonio Silverii, Cristiana Vermigli, Alessandro De Cassai, Antonio Volpe, Rodolfo Tramonta, Gerardo Medea, Corrado Bordieri, Marco Falcone, Laura Ste
    Acta Diabetologica.2024; 61(5): 543.     CrossRef
  • Effect of Percutaneous Endovascular Angioplasty Combined with Negative Pressure Drainage on the “One-Stop” Treatment of Ischemic Diabetic Foot Ulcer
    Bo Dong, Xixu Wang, Wei Wang, Biao Hong, Jue Wang, Heng Wang, Yun Gu
    Annals of Vascular Surgery.2023; 92: 272.     CrossRef
  • A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer
    Abdelrahman Zamzam, Ann‐Marie McLaren, Emily Ram, Muzammil H. Syed, Sreenath Rave, Suzanne H. Lu, Mohammed Al‐Omran, Charles de Mestral
    International Wound Journal.2023; 20(8): 3331.     CrossRef
  • Impact of multidisciplinary care of diabetic foot infections for inpatients at Campbelltown Hospital
    Timothy Choi, Uchechukwu Levi Osuagwu, Chau Tran, Krupali Bulsari, David Simmons
    BMC Health Services Research.2023;[Epub]     CrossRef
  • Multigene Panel Testing in Turkish Hereditary Cancer Syndrome Patients
    Esra ARSLAN ATES, Ayberk TURKYILMAZ, Ceren ALAVANDA, Ozlem YILDIRIM, Ahmet Ilter GUNEY
    Medeniyet Medical Journal.2022; 37(2): 150.     CrossRef
  • Prediabetes; Prevention and Management
    Asad Ali Mughal, Syed Taha Abbas, Huma Asad, Muhammed Zubair, Nasir Ali Khan, Shehla Naseem, Muhammad Zaman Shaikh
    Pakistan BioMedical Journal.2022; : 03.     CrossRef
  • A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
    Jackson Musuuza, Bryn L. Sutherland, Suleyman Kurter, Prakash Balasubramanian, Christie M. Bartels, Meghan B. Brennan
    Journal of Vascular Surgery.2020; 71(4): 1433.     CrossRef
  • The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey
    Elisabetta Salutini, Enrico Brocco, Roberto Da Ros, Luca Monge, Luigi Uccioli, Roberto Anichini
    The International Journal of Lower Extremity Wounds.2020; 19(1): 34.     CrossRef
  • The effect of a multidisciplinary outpatient team approach on outcomes in diabetic foot care: a single center study
    Eline Huizing, Michiel A. Schreve, Willemijn Kortmann, Jan P. Bakker, Jean-Paul P. M. de Vries, Çağdaş Ünlü
    The Journal of Cardiovascular Surgery.2020;[Epub]     CrossRef
Incidence of Diabetic Foot and Associated Risk Factors in Type 2 Diabetic Patients: A Five-year Observational Study.
Shin Ae Park, Seung Hyun Ko, Seung Hwan Lee, Jae Hyoung Cho, Sung Dae Moon, Sang A Jang, Hyun Shik Son, Ki Ho Song, Bong Yun Cha, Ho Young Son, Yu Bae Ahn
Korean Diabetes J. 2009;33(4):315-323.   Published online August 1, 2009
DOI: https://doi.org/10.4093/kdj.2009.33.4.315
  • 2,555 View
  • 42 Download
  • 14 Crossref
AbstractAbstract PDF
BACKGROUND
The frequency of lower extremity amputation due to diabetic foot has been increasing in type 2 diabetic patients. The aim of this study was to observe the incidence, clinical aspects and associated risk factors for diabetic foot. METHODS: We evaluated the incidence of diabetic foot through a five-year observation of type 2 diabetic patients who presented to St. vincent's Hospital between January and December 2003. To identify the risk factors for diabetic foot, we evaluated mean glycosylated hemoglobin A1c (HbA1c) every six months and assessed renal function based on the existence of proteinuria and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation. Patients were also evaluated for retinopathy, peripheral neuropathy and autonomic neuropathy using Ewing's method. RESULTS: From an initial pool of 613 patients, the observational study of 508 patients (82.9%) was completed. The mean age, duration of diabetes and HbA1c were 50.3 +/- 10.6 yrs, 7.2 +/- 6.5 yrs and 8.8 +/- 2.1%, respectively. Diabetic foot occurred in 32 patients (6.3%). The incidence of diabetic foot increased when diabetic retinopathy (OR = 6.707, 2.314~19.439), peripheral neuropathy (OR = 2.949, 1.075~8.090), and autonomic neuropathy (OR = 3.967, 1.476~10.660) were present and when the MDRD GFR (OR = 5.089, 1.712~15.130) decreased. Mean HbA1c (OR = 12.013, 1.470~98.179) was found to be an independent risk factor for diabetic foot. CONCLUSION: The present study confirmed the importance of intensive glycemic control and the role of autonomic dysfunction in the development of diabetic foot. In addition, diabetic retinopathy and impaired renal function proved to be factors associated with the occurrence of diabetic foot. Therefore, intensive glycemic control, as well as periodic examination of renal function, are essential for the prevention of diabetic foot.

Citations

Citations to this article as recorded by  
  • The Risk of the Aggravation of Diabetic Foot According to Air Quality Factors in the Republic of Korea: A Nationwide Population-Based Study
    Saintpee Kim, Sungho Won, Young Yi
    International Journal of Environmental Research and Public Health.2024; 21(6): 775.     CrossRef
  • Microbiological, Clinical and Radiological Aspects of Diabetic Foot Ulcers Infected with Methicillin-Resistant and -Sensitive Staphylococcus aureus
    Maria Stańkowska, Katarzyna Garbacz, Anna Korzon-Burakowska, Marek Bronk, Monika Skotarczak, Anna Szymańska-Dubowik
    Pathogens.2022; 11(6): 701.     CrossRef
  • Potential of Nanoencapsulated Quercetin Topical Formulations in the Management of Diabetic Foot Ulcer
    Shashank Chaturvedi, Shruti Agrawal, Anuj Garg, Vaibhav Rastogi
    Revista Brasileira de Farmacognosia.2022; 33(3): 484.     CrossRef
  • Development of a Diabetic Foot Ulceration Prediction Model and Nomogram
    Eun Joo Lee, Ihn Sook Jeong, Seung Hun Woo, Hyuk Jae Jung, Eun Jin Han, Chang Wan Kang, Sookyung Hyun
    Journal of Korean Academy of Nursing.2021; 51(3): 280.     CrossRef
  • Regional Variation in the Incidence of Diabetes-Related Lower Limb Amputations and Its Relationship with the Regional Factors
    Sung Hun Won, Jahyung Kim, Dong-Il Chun, Young Yi, Suyeon Park, Kwang-Young Jung, Gun-Hyun Park, Jaeho Cho
    Journal of Korean Foot and Ankle Society.2019; 23(3): 121.     CrossRef
  • The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study
    Choong Hee Kim, Jun Sung Moon, Seung Min Chung, Eun Jung Kong, Chul Hyun Park, Woo Sung Yoon, Tae Gon Kim, Woong Kim, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee
    Diabetes & Metabolism Journal.2018; 42(4): 308.     CrossRef
  • The Relationship between Body Mass Index and Diabetic Foot Ulcer, Sensory, Blood Circulation of Foot on Type II Diabetes Mellitus Patients
    Yi Kyu Park, Jun Young Lee, Sung Jung, Kang Hyeon Ryu
    Journal of the Korean Orthopaedic Association.2018; 53(2): 136.     CrossRef
  • Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
    Seo Jin Park, Taeyoung Yang, Jun Young Lee, Jinhee Kim
    Korean Journal of Adult Nursing.2018; 30(1): 106.     CrossRef
  • A Report on Diabetic Foot and Amputation from the Korean Health Insurance Review & Assessment Service Data
    Jong-Kil Kim, Young-Ran Jung, Kyung-Tae Kim, Chung-Shik Shin, Kwang-Bok Lee
    Journal of Korean Foot and Ankle Society.2017; 21(2): 66.     CrossRef
  • Prevalence and Current Status of Treatment of Diabetic Foot in South Korea
    Jae-Ik Bae, Je Hwan Won, Jun Su Kim, Man Deuk Kim, Chang Jin Yoon, Yun Ku Cho
    Journal of the Korean Society of Radiology.2016; 74(3): 169.     CrossRef
  • Diabetic Foot Disease—Incidence and Risk Factors: A Clinical Study
    Rajesh Kapila, Rakesh Sharma, Ashwani K Sharma, Jagsir Mann
    Journal of Foot and Ankle Surgery (Asia Pacific).2016; 3(1): 41.     CrossRef
  • Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus in Korea
    Seung-Hyun Ko, Bong-Yun Cha
    Diabetes & Metabolism Journal.2012; 36(1): 6.     CrossRef
  • Diabetics' Preference in the Design Factors and Performance Requirements of Diabetic Socks
    Ji-Eun Lee, Young-Ah Kwon
    Journal of the Korean Society of Clothing and Textiles.2011; 35(5): 527.     CrossRef
  • Epidemiology of Diabetic Foot Disease
    Kyu Jeung Ahn
    Journal of Korean Diabetes.2011; 12(2): 72.     CrossRef
A Clinical Study on the Diabetic Foot Wound.
J Young Kim, Kyung Tai Lee, Ki Won Young, Seung Keun Hwang
Korean Diabetes J. 2007;31(1):89-95.   Published online January 1, 2007
DOI: https://doi.org/10.4093/jkda.2007.31.1.89
  • 1,959 View
  • 23 Download
  • 5 Crossref
AbstractAbstract PDF
PURPOSE: To make protocol on diabetic foot ulcer, with making use of this protocol, investigate hospitalized patients who have had diabetic foot wound and define pattern, characteristics and problems of diabetic foot in hospitalized patients MATERIALS AND METHODS: From Oct. 2002 to Sep. 2003, Seventy-two patients who had been admitted to our hospital due to treatment of diabetic foot wound studied with use of the protocol designed by the authors. RESULTS: The mean age of patients was 64.3 years and male patients were twice as many as female. The most common cause of hospitalization was infection of diabetic foot (77.7%). As a basic pathology of diabetic foot, the main pathology of diabetic foot was the neuropathy that is four times more than vasculopathy. The causations of wound were infection with no specific cause (40.0%). No statistical difference was found between timing of hospitalization and the results of treatment in vasculopathic group but in neuropathic ulcer group, the major procedure such as amputation, and the times of debridement in operation room and are more common in patients who were hospitalized after 3rd days of beginning of symptoms than within 3rd day. CONCLUSION: The education that the patient having a foot symptom have to visit the hospital as soon as possible on patients is important to prevent morbidity of diabetic foot wound, long hospitalization and amputation. The protocol that we are presenting can be modified for other study related to diabetic foot.

Citations

Citations to this article as recorded by  
  • Educational Needs Associated with the Level of Complication and Comparative Risk Perceptions in People with Type 2 Diabetes
    Youngji Hwang, Dongsuk Lee, Yeon Sook Kim
    Osong Public Health and Research Perspectives.2020; 11(4): 170.     CrossRef
  • The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study
    Choong Hee Kim, Jun Sung Moon, Seung Min Chung, Eun Jung Kong, Chul Hyun Park, Woo Sung Yoon, Tae Gon Kim, Woong Kim, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee
    Diabetes & Metabolism Journal.2018; 42(4): 308.     CrossRef
  • Factors Contributing to Diabetic Foot Ulcer among Patients with Type 2 Diabetes Mellitus
    Seo Jin Park, Taeyoung Yang, Jun Young Lee, Jinhee Kim
    Korean Journal of Adult Nursing.2018; 30(1): 106.     CrossRef
  • Prevalence and Current Status of Treatment of Diabetic Foot in South Korea
    Jae-Ik Bae, Je Hwan Won, Jun Su Kim, Man Deuk Kim, Chang Jin Yoon, Yun Ku Cho
    Journal of the Korean Society of Radiology.2016; 74(3): 169.     CrossRef
  • Diabetic Foot
    Kwang-Won Kim
    Journal of the Korean Medical Association.2007; 50(5): 447.     CrossRef
Current Status of Diabetic Foot in Korean Patients Using National Health Insurance Database.
Choon Hee Chung, Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Kyung Mook Choi, Injeoung Choi, Ie Byung Park
Korean Diabetes J. 2006;30(5):372-376.   Published online September 1, 2006
DOI: https://doi.org/10.4093/jkda.2006.30.5.372
  • 2,871 View
  • 38 Download
  • 18 Crossref
AbstractAbstract PDF
BACKGROUND
Foot ulcer diseases are more prevalent in diabetic patients than that those of non-diabetic patients. Several reports showed the risk of amputation and the medical cost were increased when foot ulcer developed. Therefore, strict glycemic control from the initial period of diabetes is necessary. Since there is no enough epidemiologic data, large scaled studies for medical and economic consequences about diabetic foot ulcer are needed. METHODS: This study was based on health insurance claims submitted to the National Health Insurance Review Agency during the period from December 1994 through December 2002. We investigated the incidence and medical cost of foot disorders in Korean population using the disease-classification codes on the health insurance claim forms. RESULTS: The incidences of foot disorders (per 100,000 of population) were 49.7 for amputations, 99.7 for ulcers, and 1,051 for injuries in diabetic patients, and 4.2 for amputations, 10.3 for ulcers, and 943 for injuries in non-diabetic patients. Relative risk of the incidences of foot amputation, ulcer, and injury in diabetic patients comparing with non-diabetic patients were 11.7, 9.7, and 1.1, respectively. Total medical costs (per capita) of foot amputation, ulcer, and injury in diabetic patients were 2.0, 1.7, and 2.1 times higher, respectively, than those of non-diabetic patients. Mean hospital stay of foot amputation, ulcer, and injury in diabetic patients were 1.6, 1.3, and 1.7 times more, respectively, than those of non-diabetic patients. CONCLUSION: In diabetic patients, the incidences of foot amputation and ulcer are higher than those of non-diabetic patients. To reduce those incidences, we need to early strict glycemic control as well as government based management.

Citations

Citations to this article as recorded by  
  • The Risk of the Aggravation of Diabetic Foot According to Air Quality Factors in the Republic of Korea: A Nationwide Population-Based Study
    Saintpee Kim, Sungho Won, Young Yi
    International Journal of Environmental Research and Public Health.2024; 21(6): 775.     CrossRef
  • Efficacy of a povidone‐iodine foam dressing (Betafoam) on diabetic foot ulcer
    Heui C. Gwak, Seung H. Han, Jinwoo Lee, Sejin Park, Ki‐Sun Sung, Hak‐Jun Kim, Dongil Chun, Kyungmin Lee, Jae‐Hoon Ahn, Kyunghee Kwak, Hyung‐Jin Chung
    International Wound Journal.2020; 17(1): 91.     CrossRef
  • Regional Variation in the Incidence of Diabetes-Related Lower Limb Amputations and Its Relationship with the Regional Factors
    Sung Hun Won, Jahyung Kim, Dong-Il Chun, Young Yi, Suyeon Park, Kwang-Young Jung, Gun-Hyun Park, Jaeho Cho
    Journal of Korean Foot and Ankle Society.2019; 23(3): 121.     CrossRef
  • Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients
    Eun-Gyo Jeong, Sung Shim Cho, Sang-Hoon Lee, Kang-Min Lee, Seo-Kyung Woo, Yoongoo Kang, Jae-Seung Yun, Seon-Ah Cha, Yoon-Jung Kim, Yu-Bae Ahn, Seung-Hyun Ko, Jung-Min Lee
    The Korean Journal of Internal Medicine.2018; 33(5): 952.     CrossRef
  • Risk factors for diabetic foot ulcer recurrence: A prospective 2-year follow-up study in Egypt
    Walaa A. Khalifa
    The Foot.2018; 35: 11.     CrossRef
  • Microbiology and Antimicrobial Therapy for Diabetic Foot Infections
    Ki Tae Kwon, David G. Armstrong
    Infection & Chemotherapy.2018; 50(1): 11.     CrossRef
  • Diagnosis and Management of Diabetic Foot
    Chang Won Lee
    The Journal of Korean Diabetes.2018; 19(3): 168.     CrossRef
  • Effects of foot complications in patients with Type 2 diabetes mellitus on public healthcare: An analysis based on the Korea National Diabetes Program Cohort
    So Young Park, Sang Youl Rhee, Suk Chon, Kyu Jeung Ahn, Sung-Hoon Kim, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Jeong-taek Woo, Ki Hong Chun, Young Seol Kim
    Journal of Diabetes and its Complications.2017; 31(2): 375.     CrossRef
  • Prevalence and Current Status of Treatment of Diabetic Foot in South Korea
    Jae-Ik Bae, Je Hwan Won, Jun Su Kim, Man Deuk Kim, Chang Jin Yoon, Yun Ku Cho
    Journal of the Korean Society of Radiology.2016; 74(3): 169.     CrossRef
  • Lifestyle, Diet, Self-care, and Diabetes Fatalism of Diabetic Patients with and without Diabetic Foot
    Jungha Choi, Juhee Kang, Hongmie Lee
    Korean Journal of Community Nutrition.2014; 19(3): 241.     CrossRef
  • The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities
    Sun Hee Beom, Moo Kyung Oh, Chul Woo Ahn
    Korean Journal of Medicine.2014; 86(5): 585.     CrossRef
  • Advanced Glycation End Products and Management of Diabetes Diet
    Hyun-Sun Lee
    The Journal of Korean Diabetes.2013; 14(2): 90.     CrossRef
  • Cost-effectiveness Analysis of Home Care Services for Patients with Diabetic Foot
    Chong Rye Song, Yong Soon Kim, Jin Hyun Kim
    Journal of Korean Academy of Nursing Administration.2013; 19(4): 437.     CrossRef
  • Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
    Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
    Diabetes & Metabolism Journal.2013; 37(4): 233.     CrossRef
  • Treatment of Diabetic Foot Ulcer Using Matriderm In Comparison with a Skin Graft
    Hyojin Jeon, Junhyung Kim, Hyeonjung Yeo, Hoijoon Jeong, Daegu Son, Kihwan Han
    Archives of Plastic Surgery.2013; 40(04): 403.     CrossRef
  • Three Cases of Auricular Pressure Ulcer in Ambulatory Leprotic Patients
    Nam Soo Han, Hyung-Cheol Park
    Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2013; 56(9): 588.     CrossRef
  • Diabetic Foot: Past and Present
    Ji Ho Lee, Choon Hee Chung
    Journal of Korean Diabetes.2011; 12(2): 69.     CrossRef
  • Epidemiology of Diabetic Foot Disease
    Kyu Jeung Ahn
    Journal of Korean Diabetes.2011; 12(2): 72.     CrossRef

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