Validity of diagnostic codes and estimation of prevalence of diabetic foot ulcers using a large electronic medical record database (original) (raw)
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Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
The incidence of a diabetic foot ulcer (DFU) is increasing over the previous decade with an increasing prevalence of diabetes mellitus (DM). Despite the increasing incidence of DFU, there is limited information about the problem in Ethiopia. Hence, this study aimed to investigate the incidence of DFU and its predictors among newly diagnosed DM patients who were on follow-up at Felege Hiwot Referral Hospital. Methods: Institution-based retrospective follow-up study was conducted at Felege Hiwot Referral Hospital among newly diagnosed DM patients from January 1, 2009, to December 31, 2018. A simple random sampling method was used to select 401 study participants from a total of 723 eligible population. Data was entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was estimated using person-years of observation and Nelson-Aalen cumulative hazard function, showing the cumulative probability of diabetic foot ulcer, was done. The best model (Gompertz) was selected using the AIC and log-likelihood method. Hazard ratio (HR) with its 95% confidence interval was computed and variables having a p-value less than 0.05 in the multivariable model were considered to be significantly associated with DFU. Results: A total of 387 patients were followed retrospectively for a median follow-up time of 95 months. Out of all, 66 (17.05%) patients developed DFU with an incidence rate of 4 cases per 100 person-years of observation. Diabetic nephropathy (adjusted hazard ratio (AHR) = 2.37, 95% CI: 1.33-54.24), diabetic retinopathy (AHR = 5.56, 95% CI: 2.64-11.74), and increased body mass index (AHR = 1.13, 95% CI: 1.01-1.27) were found to increase the hazard of DFU. Conclusion: The incidence of DFU was relatively high. Diabetic nephropathy, diabetic retinopathy, and body mass index were its significant predictors. Therefore, close monitoring of patients with co-morbidities and increased body mass index should be considered to reduce DFU.
Jurnal Keperawatan
Background: Diabetic Foot Ulcer (DFU) is common problem in Diabetes Mellitus (DM) patients in which early detection of DFU is very important. The screening tool for DFU had been developed by researcher previously in 2016. Purpose: This study aimed to test validities and reliabilities of the tool. Methods: The method in this study which included content validity by 4 experts, construct validity with 180 patients, internal consistency in 60 patients and intra-rater reliability. Results: The results showed that: 1) content validity was acceptable, I-CVI was 1.00 and S-CVI was 1.00; 2) internal consistency used Kuder-Richardson (KR – 20) was 0.806; 3) Intra-rater reliability used Intra-class Coefficient Correlation (ICC) for total score was 0.996 and Kappa 1.00 for duration of DM, history of ulceration, history of claudication, neuropathy sensory, abnormal skin, foot care, Kappa 0.93 for foot deformities, Kappa 0.92 for history of amputation, and Kappa 0.89 for peripheral vascular dis...
Knowledge of the Warning Signs of Foot Ulcer Deterioration Among Patients With Diabetes
Journal of Nursing Research, 2017
Diabetic foot ulcer (DFU) is one of the common complications of diabetes and a common precursor to lower limb amputation, with an associated lower-limb amputation rate as high as 25%Y28% (Bakheit et al., 2012; Zubair, Malik, & Ahmad, 2012). Fortunately, most subsequent lower limb amputations may be avoided. Specifically, 80% of subsequent lower limb amputations may be avoided by aggressive treatment of DFU as well as treatment seeking on a timely basis (Wounds International, 2013). According to the DFU management guidelines, patients should seek treatment for their foot ulcers as soon as possible after finding the ulcer, preferably within 24 hours (National Institute for Health and Care Excellence, 2015; Wounds International, 2013). Nevertheless, previous studies have revealed that only 4.4% patients seek treatment for their DFU within 24 hours after ulcer occurrence (Yan, Liu, Zhou, & Sun, 2014). On the basis of the accessibility of medical facilities, most patients with DFUs should be able to seek medical treatment within 3 days. In Sanders et al.'s (2013) study, however, only approximately half of the patients sought treatment for their DFU within 3 days of ulcer occurrence. Furthermore, the time between the onset of their ulcer and first treatment seeking was up to 243 days, with a median time of 3 days (Sanders et al., 2013). The longer the delay in seeking treatment, the higher the risk of lower limb amputation and mortality (Yan et al., 2014). Although knowledge only is not sufficient to improve the prognosis for DFU, knowledge of the warning signs of DFU deterioration is known to promote the timely treatment seeking necessary to achieve a good prognosis for DFU. Knowledge regarding the warning signs is one important factor that relates to the timely seeking of treatment by patients with DFU (Yan et al., 2014). On the basis of the limited number of prior studies, however, it appears that patients with diabetes may have insufficient knowledge of the warning signs of DFU deterioration. Yan et al. found
Who are diabetic foot patients? A descriptive study on 873 patients
Journal of Diabetes & Metabolic Disorders, 2013
Background: Diabetic foot ulcer (DFU) as the leading cause of lower limb amputation is one of the most important complications of diabetes mellitus (DM). Patient and physician's education plays a significant role in DFU prevention. While effective treatment and formulation of prevention guidelines for DFU require a thorough understanding of characteristics of DFU patients and their ulcers, there are reports that not only patients' but also physicians' information about these characteristics is inadequate. So we conducted this study to investigate these characteristics. Methods: Necessary data was collected from medical archives of DFU patients admitted between 2002 and 2008 in two university hospitals. Results: 873 patients were included. Mean age was 59.3 ± 11.2 years and most of the patients developed DFU in 5th and 6th decades of their life. 58.1% were men. 28.8% had family history of DM. Mean duration of DM was 172.2 months. Mean duration of DFU was 79.8 days. Only 14.4% of the patients had Hemoglobin A1C < 7%. 69.6% of the patients had history of previous hospitalization due to DM complications. The most prevalent co-morbidities were renal, cardiovascular and ophthalmic ones. Most patients had "ischemic DFU" and DFU in their "right" limb. The most prevalent location of DFU was patients' toes, with most of them being in the big toe. 28.2% of the patients underwent lower-limb amputations. The amputation rate in the hospital where the "multidisciplinary approach" has been used was lower (23.7% vs. 30.1%). Conclusions: Number of patients with DFU is increasing. DFU is most likely to develop in middle-aged diabetic patients with a long duration of DM and poor blood sugar control who have other co-morbidities of DM. Male patients are at more risk. Recurrence of DFU is a major point of concern which underscores the importance of patient education to prevent secondary ulcers. As a result, educating medical and nursing personnel, applying screening and prevention guidelines, and allocating more resources are of great importance regarding treatment of DFU patients. Application of the "multidisciplinary approach" can reduce the rate of amputations. Primary care physicians might be furnished with the information presented in the present study.
Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital, Eastern Indonesia
Open Journal of Nursing, 2016
Indonesia is one of the top ten diabetes mellittus (DM) countries. However as the main complication of DM, there was lack of studies related to diabetic foot ulcer (DFU). Thus, the aim of this study was to survey the prevalence of DFU risk factors and DFU among type 2 diabetes mellitus (T2DM) patients. An epidemiological study was conducted at an outpatient endocrine clinic in a regional hospital, eastern Indonesia. All T2DM participants attending research setting that were ≥ 18 years were included. Demographic and foot care behavior were assessed using minimum data sheet (MDS). Meanwhile, presence of risk factors was evaluated by using 5.07/10 g Semmes-Weinsten Monofilament (SWM) for neuropathy and presence of angiopathy was evaluated with Ankle Brachial Index (ABI) by using a hand held Doppler (Bidop ES-100V3, Hadeco-Kawasaki, Japan) both dorsal and posterior tibialis foot. At the end of study, 249 T2DM participants were enrolled. The prevalence of DFU risk factors was 55.4% (95% CI: 53.7%-57.0%), and prevalence of DFU was 12% (95% CI: 10.3%-13.6%). Based on a logistic regression, predictors for DFU risk factors included age (OR: 1.04; 95% CI: 1.005-1.074) and daily foot inspection (OR: 0.36; 95% CI: 0.186-0.703). Meanwhile, the predictors for presence of DFU were insulin (OR: 9.37; 95% CI: 2.240-39.182), shoes (OR: 0.05; 95% CI: 0.007-0.294), spiritual belief that DM was a disease (OR: 0.04; 95% CI: 0.004-0.326) and belief that DM was a temptation from God (OR: 0.13; 95% CI: 0.027-0.598). In conclusion, we recommend to educate high risk patients to understand positive foot care behavior as essentially preventive strategies to prevent presence risk and DFU.
Shiraz E-Medical Journal, 2019
Background: Diabetic Foot Ulcer (DFU) as one of the main complications of diabetes mellitus has serious outcomes such as infection, foot amputation, low quality of life, and premature death. Objectives: This study was conducted to assess the DFU prevalence and its related factors among diabetic patients. Methods: The population of this cross-sectional study included adult diabetic patients in the Diabetes Center of Kerman University of Medical Sciences. The data were recorded in a questionnaire using patients' medical records, interviews with them, and physical examination. The collected data were imported to SPSS version 22 software and analyzed. Results: Of 400 diabetic patients enrolled in the study, 69% (n = 276) were female. The mean (± SD) of their age was 57.1 (± 11.9) years and 72% (n = 288) were younger than 65. The frequency of DFU during the total course of the disease and its annual prevalence were 17.3% (n = 69) and 11.8% (n = 49) among diabetic patients, respectively. More than one-third (37.7%) of the DFU patients and 6.6% of all the patients were admitted to a hospital due to DFU. Major or minor amputation was performed for 14.5% (n = 10) of the total DFU patients and 2.5% of the total patients. Having diabetes-related complications was determined as the strongest predictor of DFU (OR = 7.016, 95% CI = 2.67-18.38), followed by smoking (OR = 3. 80, 95% CI = 2.06-6.99) and age over 64 years (OR = 3.70, 95% CI = 1.299-10.568). Conclusions: The frequency of DFU was high among diabetic patients attending the Diabetes Center of Kerman University of Medical Sciences. Also, hospital admission and foot amputation due to DFU had a considerable frequency. Therefore, there is a crucial need to improve the quality of foot care services and emphasize foot self-care as essential components of diabetes self-management at all levels of the health service delivery system to decrease the risk of DFU.
Journal of International Medical Research, 2022
Objective Diabetes affected 463 million people globally in 2019, and this number is anticipated to reach 700 million by 2045. Diabetes results in lower limb amputation every 30 seconds. Egypt has a high prevalence of diabetic foot disease among patients with type 2 diabetes mellitus (T2DM). We aimed to identify high-risk patients for diabetic foot ulcers (DFUs) in Egypt. Methods We designed a cross-sectional study among adult patients with diabetes at Asyut University Hospital. Inlow’s 60-second diabetic foot screening tool was used to assess the risk of DFU. Neuropathy was assessed using the 10g monofilament test, and laboratory testing was performed to assess glycosylated hemoglobin (HbA1c) and diabetes control levels. Results Participants were aged 46.11 ± 9.18 years; 56% had T2DM and HbA1c levels >7%. In total, 47.9% of participants were at risk for DFUs. This risk was higher in patients who were older, male, widowed, working, illiterate, living in rural areas, and patients w...
Determinants of the Risk for Diabetic Foot Ulceration in Sohag University Hospital
Journal of High Institute of Public Health
Background: One of the most common complications of diabetes in the lower extremity is the diabetic foot ulceration (DFU). Objective: To identify the determinants of the risk for diabetic foot ulceration (DFU) in terms of peripheral neuropathy (PN) or peripheral vascular disease (PVD) among a sample of diabetic foot patients. Methods: A cross sectional study included 100 diabetic foot patients attending Sohag University complete medical history taking and thorough clinical examination. Diabetic Neuropathy Symptoms (DNS) along with the Diabetic Neuropathy Examination (DNE) scores were used together to define and assess PN. PVD diagnosis was based on identification of claudication pain symptoms; absent or weak foot pulses on palpation of the dorsalis pedis and/or the tibialis posterior arteries; coldness of skin; and finally confirmed by arterial doppler of lower limbs. Results: The mean age of the patients was 57.92 ± 9.2 years; 65% were males and 79% lived in rural areas. The majority (79%) had type 2 DM with mean disease-duration of 13.4 ± 6.9 years. Fifty percent of the study patients were smokers and ex-smokers, 33% were hypertensive and 24% had previous history of foot ulceration or amputation. Male gender, old age, low socioeconomic status, smoking, hypertension, type 2 DM, long duration of DM, uncontrolled DM, and previous history of foot ulceration, amputation or other diabetic complications were all significant determinants of PN and PVD; two major risk factors of DFU.
Introduction: Diabetes Mellitus (DM) is the 7 th leading cause of death and 1 st leading cause of blindness, amputation and kidney failure. DFI is the main cause not only for hospitalization, but also for prolonged hospitalization among diabetics, owing to 82, 000 amputations/year worldwide. The risk factors for complicated and severe DFIs are grade of diabetic foot ulcer, overall glycaemic control, previous hospitalizations, and infection with Multidrug Resistant Organisms (MDRO). Our objective was to elaborate the influence of demographic factors on DFI and study the rates of MDRO and poly microbial infections in relation to outcome of DFI. Material and methods: In this hospital based, longitudinal, observational study done in NRIIMS, Sangivalasa, Visakhapatnam for 2 months (June-July2015), as a part of 2015 ICMR-STS project, out of 54 DFI patients attended our OPD, 48 patients were enrolled in our study. Results: There was significant influence of previous hospitalizations (p<0.01), size of the ulcer (p<0.05), smoking (p<0.05) and alcoholic intake (p<0.05), male gender (p<0.001) on DFI. Isolates/ patient ratio increased from Grade 2 (1.1: 1) to grade 5 (1.6: 1). There is highest ratio of Isolate: patient noticed in DFI Patients who were diagnosed as Diabetic for the first –time i.e. 1.7:1 when compared to others. In our study, 73% prolonged hospitalization, 92% surgical debridements and 91% amputations were due to MDR DFIs. Conclusion: A well-documented past clinical, treatment history and a systemic uniform method of evaluating patients for diabetic complications by physical examination is required to assess the severity, risk and prognosis of DFIs.
Journal of Foot and Ankle Research, 2010
Background: As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method. Methods: Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003. Their electronic medical records were reviewed to verify whether the medical records positively indicate presence of a diabetic foot ulcer in diagnoses, medical assessments, or consults. For each method, five measures of accuracy and agreement were evaluated using data from medical records as the gold standard.