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Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study

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Abstract

Purpose

Predictors of outcome of diabetic foot ulcer (DFU) are important to improve the management of patients. Aim of the study was to find these predictors in type 2 diabetic patients with DFU.

Methods

We recruited 583 patients. They were followed-up by a multidisciplinary team. A holistic and conservative approach was used and all risk factors and co-morbidities were aggressively treated.

Results

During the follow-up period, 79.6% of patients healed in a mean time of 7.6 ± 3.8 months, 6.9% showed DFU persistence, 9.9% had minor amputations, and 3.6% experienced major amputation. Seventeen percent of the patients died. Among patients who healed, 37.1% of them showed DFU recurrence. Impairment of renal function was associated to DFU persistence, amputation, and mortality. Previous cardiovascular disease predicted DFU persistence, DFU recurrence, and mortality. Lower BMI predicted DFU persistence and mortality. Osteomyelitis was a predictor of amputation and death. Markers of peripheral artery disease (PAD) predicted minor amputation and DFU recurrence. Our study shows a relatively low incidence of complications of DFU.

Conclusions

Some predictors of outcome of DFU were confirmed and new predictors, like BMI and markers of PAD, were found. Our new findings suggest future strategies for nutrition support and revascularization. In addition, a holistic and conservative approach may improve the prognosis.

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Authors and Affiliations

  1. Diabetes and Endocrine, Metabolic and Vascular Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo” (Hospital Group San Donato), Corso Pavia 84, 27029, Vigevano, Italy

    Carmine Gazzaruso, Pietro Gallotti & Adriana Coppola

  2. Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Germaneto, Catanzaro, Italy

    Arturo Pujia & Tiziana Montalcini

  3. Unit and Chair of Endocrinology, IRCCS Ospedale San Raffaele and University Vita e Salute, Milan, Italy

    Andrea Giustina

Authors
  1. Carmine Gazzaruso
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  2. Pietro Gallotti
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  3. Arturo Pujia
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  4. Tiziana Montalcini
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  6. Adriana Coppola
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Correspondence to Carmine Gazzaruso.

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Gazzaruso, C., Gallotti, P., Pujia, A. et al. Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study. Endocrine 71, 59–68 (2021). https://doi.org/10.1007/s12020-020-02431-0

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