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Fulltext Malaysian clinical practice guidelines for management of diabetic foot: A synopsis for the primary care physician

Tharumaraja T, Che-Ahmad A, Wong PF, Ahmad Hamid AH, Hasan MI, Bajuri MY, et al.

Malays Fam Physician, 2021 Mar 25;16(1):103-113.
PMID: 33948148 DOI: 10.51866/cpg0001

Diabetic foot requires careful attention and coordinated management by a dedicated team. Screening, prevention, adequate assessment, and appropriate referral are crucial to prevent complications. Multimodal treatment and rehabilitation are recommended to ensure a better quality of life and reduction of amputation rate in people with diabetic foot.

Matched MeSH terms: Diabetic Foot
Fulltext Kajian analisa kos pembekal perkhidmatan kesihatan bagi rawatan diabetic foot wad ortopedik Pusat Perubatan Universiti Kebangsaan Malaysia dalam tahun 2006

Amin, S.A., Ali, M., Aniza, I., Rizal, A.M., Saperi, S., Amrizal, M., et al.

Malaysian Journal of Community Health, 2009;15(1):32-38.
MyJurnal

Introduction : Diabetes mellitus is recognized as a major public health problem worldwide. The burden of diabetes to society are morbidity, mortality and extensive usage of health care services.
Methodology : This study aimed to determine the provider’s cost in treating diabetic foot patient per day in orthopaedic ward, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in year 2006. Result : A total of 54 patients fulfilled the inclusion and exclusion criteria, only 29 were eligible for analysis. The cost of health care providers derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating diabetic foot patient per day is RM 634.57. Recurrent costs contributed 75.3% of the total diabetic foot treatment and Intensive Care Unit costs was the biggest percentage (40.5%).
Discussion : The results were comparable with findings by Case-Mix Unit of UKMMC. Treatment cost of diabetic foot is substantial and therefore avoidance of this complication must be emphasized to all diabetic patients.

Matched MeSH terms: Diabetic Foot
The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

Lai HY, Foo LL, Lim SM, Yong CF, Loh PS, Chaw SH, et al.

Clin Auton Res, 2020 Feb;30(1):53-60.
PMID: 29196938 DOI: 10.1007/s10286-017-0485-8

PURPOSE: Comparison of hemodynamic profiles and pain scores in diabetic patients undergoing diabetic foot surgery receiving peripheral nerve block (PNB) or spinal anesthesia [subarachnoid block (SAB)].
METHODS: This was a prospective, randomised controlled trial. We recruited diabetic patients aged > 18 years, American Society of Anesthesiologists class II-III, who were scheduled for unilateral diabetic foot surgery below the knee. All patients were assessed for autonomic dysfunction using the Survey of Autonomic Symptoms score. Participants were randomly assigned to receive either PNB or SAB for the surgery. Hemodynamic data, including usage of vasopressors, were recorded at 5-min intervals for up to 1 h after the induction of anesthesia. Pain scores were recorded postoperatively, and follow-up was done via telephone 6 months later.
RESULTS: Compared to the PNB group, the SAB group had a larger number of patients with significant hypotension (14 vs. 1; p = 0.001) and more patients who required vasopressor boluses (6 vs. 0 patients). Compared to SAB group, the patients in the PNB group had a longer postoperative pain-free duration (9 vs. 4.54 h; p = 0.002) and lower pain scores 1 day after surgery (3.63 vs. 4.69; p = 0.01).
CONCLUSION: Peripheral nerve block should be considered, whenever possible, as the first option of anesthesia for lower limb surgery in diabetic patients as it provides hemodynamic stability and superior postoperative pain control compared to SAB.
TRIAL REGISTRATION: Clinical trial registry: ClinicalTrials.gov. ID NCT02727348.

Matched MeSH terms: Diabetic Foot/diagnosis; Diabetic Foot/physiopathology; Diabetic Foot/surgery*
Fulltext The Effect of Individualised Glycemic Intervention on Wound Healing Rate in Diabetic Foot Ulcer (The EIGIFU Study)

Lim KP, Nasruddi AB, Rani NM

J ASEAN Fed Endocr Soc, 2018;33(1):22-27.
PMID: 33442107 DOI: 10.15605/jafes.033.01.04

Objective: To evaluate the association of glycated haemoglobin (HbA1c) reduction and wound healing in patients with diabetic foot ulcer (DFU).
Methodology: A 12-week prospective, non-controlled, interventional study in suboptimal-controlled T2DM patients with DFU was conducted. Antidiabetic medications were adjusted with the aim of at least 1% in relation to patient's individualised HbA1c target. The wound area was determined by using specific wound tracing. The daily wound area healing rate in cm2 per day was calculated as the difference between wound area at first visit and the subsequent visit divided by the number of days between the two visits.
Results: 19 patients were included in the study. There was a significant HbA1c reduction from 10.33 %+1.83% to 6.89%+1.4% (p<0.001) with no severe hypoglycaemia. The median daily wound area healing rate was 0.234 (0.025,0.453) cm2/day. There was a strong positive correlation between these two variables (r=0.752, p=0.01). After dividing the patients into four quartiles based on final HbA1c and comparing the first quartile vs fourth quartile, there was a significant difference in daily wound area healing rates (0.597 vs 0.044 cm2/day, p=0.012).
Conclusion: There was a positive correlation between HbA1c reduction and wound healing rate in patients with DFU. Although this is an association study, the study postulated the benefits of achieving lower HbA1c on wound healing rate in DFU which require evidence from future randomised controlled studies.

Matched MeSH terms: Diabetic Foot
Fulltext A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers

Shukrimi A, Sulaiman AR, Halim AY, Azril A

Med J Malaysia, 2008 Mar;63(1):44-6.
PMID: 18935732 MyJurnal

Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidences to justify it benefits in the treatment of diabetic foot ulcers. We conducted a prospective study to compare the effect of honey dressing for Wagner's grade-II diabetic foot ulcers with controlled dressing group (povidone iodine followed by normal saline). Surgical debridement and appropriate antibiotics were prescribed in all patients. There were 30 patients age between 31 to 65-years-old (mean of 52.1 years). The mean healing time in the standard dressing group was 15.4 days (range 9-36 days) compared to 14.4 days (range 7-26 days) in the honey group (p < 0.005). In conclusion, ulcer healing was not significantly different in both study groups. Honey dressing is a safe alternative dressing for Wagner grade-II diabetic foot ulcers.

Matched MeSH terms: Diabetic Foot/therapy*
Fulltext Bacteriology of diabetic foot lesions

Yoga R, Khairul A, Sunita K, Suresh C

Med J Malaysia, 2006 Feb;61 Suppl A:14-6.
PMID: 17042222

Infection plays a pivotal role in enhancing a diabetic foot at risk toward amputation. Effective antibiotic therapy against the offending pathogens is an important component of treatment of diabetic foot infections. Recognition of the pathogen is always difficult as the representative deep tissue sample for culture is surrounded by ulcer surface harbouring colonies of organisms frequently labelled as skin commensals. The emergent of resistant strains represents a compounding problem standing against efforts to prevent amputation. This study was undertaken to identify the pathogens associated with diabetic foot infection in terms of their frequency and sensitivity against certain commonly used antibiotics. Forty-four consecutive patients with open diabetic foot infections had wound swab taken for culture and sensitivity testing. Cultures positive were observed in 89% of the cases with Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeroginosa encountered in 20%, 14% and 14% of cases respectively. Mixed growths were isolated in 6% of cultures. All Staphylcoccus aureus isolates were resistant to Penicillin but 80% were sensitive to Erythromycin and Co-trimoxazole. Klebsiella pneumoniae isolates were sensitive to Methicillin and Gentamycin in 80% and 60% of cases respectively, and resistant to Ampicillin and Ceftazidime in 83% and 50% respectively. All Pseudomonas aeroginosa isolates were sensitive to Amikacin and Ciprofloxacin but 50% were resistant to Gentamycin. There was no single antibiotic possessing good coverage for all common organisms isolated from diabetic foot lesions. Staphylococcus aureus remains the predominant cause of diabetic foot infections followed by Klebsiela pneumonia and Pseudomonas aeroginosa. Most infections are monomicrobial. The emergence of multiresistant organisms is a worrying feature in diabetic foot infections.

Matched MeSH terms: Diabetic Foot/microbiology*
Effectiveness of hyaluronic acid and its derivatives on chronic wounds: a systematic review

Shaharudin A, Aziz Z

J Wound Care, 2016 Oct 02;25(10):585-592.
PMID: 27681589 DOI: 10.12968/jowc.2016.25.10.585

OBJECTIVE: Hyaluronic acid (HA) and its derivatives are used for chronic wounds, but evidence of their effectiveness remains unclear. The aim of this study was to provide more updated evidence for the effectiveness of HA (or its derivatives) compared with placebo or other agents for promoting healing in chronic wounds.
METHOD: The Cochrane Central Register of Controlled Trials, MEDLINE via Ovid Online, CINAHL and the EMBASE via EBSCO host databases were searched. Drug companies and experts in wounds were also contacted. Randomised controlled trials of HA (or its derivatives) compared with control were eligible for inclusion.
RESULTS: We identified nine randomised controlled trials involving 865 participants with chronic wounds were included in the review. The reporting for mixed arterial and venous ulcers seems to be better quality than that for venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). Studies provided little evidence regarding the claimed effects of HA or its derivaties on healing of chronic wounds. However, there is some evidence on their effectiveness for reducing pain intensity for mixed arterial and venous ulcers, which involved 255 patients (MD=-6.78 [95% CI: -11.10 to -2.46]).
CONCLUSION: Evidence to guide decisions regarding the use of HA or its derivatives to promote wound healing is still limited. More good-quality randomised controlled trials are warranted.
KEYWORDS: assessment bias; chronic ulcers; hyaluronan; meta-analysis

Matched MeSH terms: Diabetic Foot/drug therapy*
Fulltext Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia

Ng BW, Azhar AA, Azman MH, Sukri MS, Arvinder-Singh HS, Abdul Wahid AM

Med J Malaysia, 2020 07;75(4):391-395.
PMID: 32724000

INTRODUCTION: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care.

OBJECTIVES: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia.

METHODS: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care.

RESULTS: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care.

CONCLUSIONS: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.

Matched MeSH terms: Diabetic Foot/nursing*
Fulltext Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care

Kawarada O, Zen K, Hozawa K, Ayabe S, Huang HL, Choi D, et al.

Cardiovasc Interv Ther, 2018 Oct;33(4):297-312.
PMID: 29654408 DOI: 10.1007/s12928-018-0523-z

The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.

Matched MeSH terms: Diabetic Foot/complications; Diabetic Foot/therapy*
Fulltext Alteration of foot temperature in diabetic neuropathy: is it another piece of puzzle?

Naicker AS, Roohi SA, Lee CS, Chan WH, Tay LS, Din XJ, et al.

Med J Malaysia, 2006 Feb;61 Suppl A:10-3.
PMID: 17042221

Poor glycaemic control and the duration of diabetes mellitus are known to accelerate development and progression of neuropathy. Diabetic co-morbidities: hypertension and hyperlipidaemia, have been postulated to associate with development of neuropathy. A diabetic foot with low temperature and frequent exposure to low temperature environment has recently been hypothesized to be at higher risk to develop early neuropathy. This cross-sectional study is undertaken to identify risk factors for diabetic neuropathy and the association between foot temperature and development of diabetic neuropathy by using simple clinical examination in the outpatient setting. From April 18, to April 30, 2005, universal sampling method was used to select 134 diabetic patients (type 1 or type 2 for >1 year) with peripheral neuropathy. Excluded are those with chronic alcoholism, drug-induced neuropathy, dietary history of vitamin B deficiency and family history of porphyria and hereditary sensorimotor neuropathy. The patient's duration of diabetes, glycaemic control status and the presence of co-morbids: hypertension and hyperlipidemia, were recorded. The temperature of the foot was measured by using thermo buddy. Of 134 patients representing Malaysian ethnic distribution with an equal number of males and females, 20.1% were in the age group of 61 to 65 years and, 85.1% and 67.9% belonged to lower socioeconomic and educational groups respectively. Associations between diabetic neuropathy and glycaemic control (p = 0.018) and duration of diabetes (p < 0.05) were significant. However, hypertension, hyperlipidaemia and low foot temperature were not significantly associated with development of diabetic neuropathy. Poor glycaemic control is significantly associated with diabetic neuropathy. Foot temperature alteration is merely an effect of autonomic neuropathy with a cold foot is attributed to co-existing peripheral arterial disease.

Study site: Pusat Perubatan Primer Bandar Tasik Selatan, Kuala Lumpur, Malaysia

Matched MeSH terms: Diabetic Foot/physiopathology; Diabetic Foot/prevention & control*
Fulltext Antibacterial-Integrated Collagen Wound Dressing for Diabetes-Related Foot Ulcers: An Evidence-Based Review of Clinical Studies

N Amirrah I, Mohd Razip Wee MF, Tabata Y, Bt Hj Idrus R, Nordin A, Fauzi MB

Polymers (Basel), 2020 Sep 22;12(9).
PMID: 32972012 DOI: 10.3390/polym12092168

Diabetic foot ulcer (DFU) is a chronic wound frequently delayed from severe infection. Wound dressing provides an essential barrier between the ulcer and the external environment. This review aimed to analyse the effectiveness of antibacterial collagen-based dressing for DFU treatment in a clinical setting. An electronic search in four databases, namely, Scopus, PubMed, Ovid MEDLINE(R), and ISI Web of Science, was performed to obtain relevant articles published within the last ten years. The published studies were included if they reported evidence of (1) collagen-based antibacterial dressing or (2) wound healing for diabetic ulcers, and (3) were written in English. Both randomised and non-randomised clinical trials were included. The search for relevant clinical studies (n) identified eight related references discussing the effectiveness of collagen-based antibacterial wound dressings for DFU comprising collagen impregnated with polyhexamethylene biguanide (n = 2), gentamicin (n = 3), combined-cellulose and silver (n = 1), gentian violet/methylene blue mixed (n = 1), and silver (n = 1). The clinical data were limited by small sample sizes and multiple aetiologies of chronic wounds. The evidence was not robust enough for a conclusive statement, although most of the studies reported positive outcomes for the use of collagen dressings loaded with antibacterial properties for DFU wound healing. This study emphasises the importance of having standardised clinical trials, larger sample sizes, and accurate reporting for reliable statistical evidence confirming DFU treatment efficiency.

Matched MeSH terms: Diabetic Foot
Pericardial abscess: The corollary of disseminated Methicillin-resistant Staphylococcus aureus following diabetic foot ulcer infection

Tan TL, Lim SH, Ruslan Mustapa M, Ganeswary R

Med J Malaysia, 2020 11;75(6):742-744.
PMID: 33219189

Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, characterised by frank pus collection or microscopic pyogenic effusion in the pericardium represents the most serious form of pericardial infection. The route of MRSA acquisition in pericardial abscess commonly occurs via the blood stream infection and it is more commonly observed among immunocompromised individuals. To date, diabetic foot ulcer infection rarely disseminates and becomes a nidus for pericardial infection. Herein, we report an unusual case of MRSA pericardial abscess in a 44-year-old man who presented at Hospital Seri Manjung, Malaysia with cardiac tamponade. Past medical history indicated that he was recently treated for infected diabetic foot ulcer with MRSA bacteraemia one week earlier. Despite adequate pericardial drainage and extended parenteral vancomycin therapy, this case ended in fatality on day 42 of admission due to nosocomial infection. It is hoped that this report serves to increase the vigilance among clinicians that diabetic foot ulcer infections have the potential to progress to pericardial abscess in the presence of MRSA bacteraemia, although they may appear seemingly innocuous at presentation. Systemic vancomycin must be instituted promptly when MRSA bacteraemia is confirmed in order to circumvent the propagation of MRSA.

Matched MeSH terms: Diabetic Foot
Fulltext Foot problem and Foot care practices among diabetic patients in a primary care clinic, Kuala Lumpur

Nurjasmine Aida Jamani, Noor Azimah Muhammad, Aida Jaffar, Saharuddin Ahmad, Noorlaili Tohit

International Journal of Allied Health Sciences, 2018;2(3):435-444.
MyJurnal

Foot problems are very common in diabetic patients but may go unnoticed by the patients and
undiagnosed by the healthcare providers leading to substantial morbidity and amputations. The aims of this study were to assess patient’s foot care practices, awareness on their foot condition as well as to determine the prevalence of diabetic foot problem and its associated factors. Methods: This was a cross sectional study conducted among diabetic patients in a primary care clinic in Kuala Lumpur. Patients with diabetes, aged more than 18 years were selected using systematic random sampling technique. Patients were requested to answer a set of self-administered pre-tested questionnaire that obtain information on their socio-demographic profiles, diabetic clinical data, awareness on their feet condition and foot care practice. A trained clinician examined patients’ feet using a standard foot examination protocol. Results: A total of 166 patients with diabetes participated in this study. Nearly half of the patients (70, 42.2%) had diabetic foot problem but only 31 (18.7%) of them were aware of their foot condition. The three common problem were trophic changes of the skin (92.8%), followed with hair loss (71.1%) and callosity (65.7%). The independent associated factors for foot problem were increasing age (AOR=1.05, 95% CI 1.015-1.095; p

Matched MeSH terms: Diabetic Foot
Fulltext Knowledge, attitude and practice of diabetic foot care in patients in HUMS Polyclinic, Sabah. [Abstract]

Kabir S, Hossain AT, Majin R, Paul S, Hassan H

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):43-0.
MyJurnal

1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM. A view into the future of nursing: Nursing Transformation towards IR-4.0; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 6-8th March 2020
Introduction: Diabetic foot is an alarming complication of Diabetes Mellitus, results from neurological and vascular insufficiencies. If untreated, it may lead to amputation, resulting in a significant reduction in the quality of life and increase the risk of early death. Proper foot care with daily foot inspection and hygiene can prevent amputations. The objective of this study is to evaluate the knowledge, attitude, and practise of Diabetic foot care thus to establish the baseline reference for the effective foot care education and to propose an intervention method that is suitable for various cultural, religious and local circumstances. Methods: It was a cross-sectional survey conducted on diabetic patients who are seeking health care at HUMS Polyclinic, Kota Kinabalu, Sabah. A semi-structured Knowledge, Attitude and Practice validated questionnaire were used to get the information. Results: Around 93% of 30 diabetic patients knew that the self-examination was required but only 14 patients (46%)had the proper knowledge of foot care. Only 50% of respondent knew the correct way of cutting nails. 53% of the respondents were aware of prop- er foot-ware. The attitudes towards diabetic foot care, 96% were motivated to perform self-care. Although a high percentage of patients knew about diabetic foot care, but in practice the activities such as washing (100%), proper drying (83%), moisturizing (90%) and massaging (46%) were not executed together. Regarding nail cutting, only 33% practices proper technique and only 40% uses proper foot ware. Conclusions: Early detection and recognition of high-risk feet by patients and health care providers at regular intervals should be encouraged. It is essential to improve the awareness and practice of diabetic foot care daily by patients. Effective educational strategies should be established for both the health care providers and diabetic patients to create awareness for effective foot care.

Matched MeSH terms: Diabetic Foot
Fulltext Negative pressure wound therapy: Has it made a revolution in wound management?

Al-Shaham, Ali Abbas Hadi, Al-Shaham, Serene Ali, Jerjess, Mustafa

Medical Health Reviews, 2009;2009(1):3-13.
MyJurnal

Negative pressure if applied in topical manner to a wound surface has been reported to enhance wound healing due to increase in local blood flow, reduction of tissue oedema, and by stimulating angiogenesis. An air-tight film covering the wound is connected by suction tube to a control unit by which negative pressure is applied to the surface of the wound in the range of 80-125 mm Hg. This method has been called negative pressure wound therapy (NPWT) or vacuum assisted closure (VAC). It has been recommended for virtually all kinds of complex wounds. The duration of the therapy varies from several days to several months. This technology promotes formation of granulation tissue, enhances healing of diabetic foot, and significantly reduces the size of the acute and chronic wounds and ulcers. It lowers the morbidity of Fournier’s gangrene, ensures better healing of lower limb wounds and ulcer of ischemic origin, and can serve as temporary wound cover when no closure technique is available. The limitations to using NPWT are presence of dead tissue, exposed vital structures, untreated osteomyelitis, unexplored fistulae and malignant wounds. The cost of the equipment may constitute another factor in limiting the use of this new technology. In conclusion the NPWT under certain circumstances is more effective than other available local wound treatments.

Matched MeSH terms: Diabetic Foot
Fulltext Economic impact of managing acute diabetic foot infection in a tertiary hospital in Malaysia

Lam AWC, Zaim MR, Helmy HH, Ramdhan IMA

Malays Orthop J, 2014;8(1):46-49.
MyJurnal

Diabetic foot disease is the leading cause of non-traumatic amputations of the lower limb, hence a major health care and socioeconomic burden. It has been found that most of the costs occur in the inpatient setting; therefore this study is to quantify the costs of managing inpatient diabetic foot infections (DFI). We treated 182 inpatients from May 2012 till April 2013 and analysed the cost of antibiotic usage, wound dressing, surgical procedure, admission and basic investigation costs. The total cost was ~ USD 11,000 (2013). This number, however, only reflects the cost for managing an acute infection. The price for follow-up care as an outpatient, rehabilitation and indirect costs (emotional suffering, reduced productivity) is estimated to be much more.
Study site: Diabetic Inpatient Registry, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia

Matched MeSH terms: Diabetic Foot
Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound - A randomised trial

Nik Hisamuddin NAR, Wan Mohd Zahiruddin WN, Mohd Yazid B, Rahmah S

Med J Malaysia, 2019 Oct;74(5):418-424.
PMID: 31649219

INTRODUCTION: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management.
METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.
RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).
CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.

Matched MeSH terms: Diabetic Foot
Fulltext Predictive Factors of Major Lower Extremity Amputations in Diabetic Foot Infections: A Cross-sectional Study at District Hospital in Malaysia

Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Lim BC

Malays Orthop J, 2019 Nov;13(3):45-52.
PMID: 31890110 DOI: 10.5704/MOJ.1911.008

Introduction: Diabetic foot infection, a complication which can lead to lower limb amputation, is a major source of morbidity and mortality in Malaysia. The objective of this study was to determine the predictive factors of major lower limb amputation among patients with diabetes mellitus in a cluster of three district hospitals in Pahang, Malaysia. Materials and Methods: This cross-sectional study involved 170 patients who had undergone surgical interventions for diabetic foot infections at three district hospitals from 1st of September 2014 to 31st December 2015. The predictors for major amputation of lower limb were determined using simple logistic regression (LR) and forward LR multiple logistic regression. Results: A total of 21 patients had undergone major amputations of lower limb (15 transtibial and 6 transfemoral). The following factors were associated with major amputation of lower limb; longer duration of disease, age ≥ 60 years, patients from Bentong Hospital, presence of hypertension, presence of fever, history of multiple limb-salvaging surgeries, monomicrobial culture, necrotising fasciitis, anemia and leukocytosis. Upon forward LR multiple logistic regression, only duration of disease, history of more than three previous limb-salvaging surgeries and total white blood cell count ≥15X109/L were found to be significant as predictive factors of major amputation of lower limb. Conclusion: Among the factors analysed in this study, a longer duration of disease, raised total white blood cell count and history of more than three limb-salvaging surgeries were identified as predictors for major amputation of lower limb in diabetic foot infections using stepwise logistic regression analysis.

Matched MeSH terms: Diabetic Foot
Fulltext Diabetic retinopathy among type 2 diabetes mellitus patients in Sabah primary health clinics - Addressing the underlying factors

Naserrudin NA, Jeffree MS, Kaur N, Syed Abdul Rahim SS, Ibrahim MY

PLoS One, 2022 01 28;17(1):e0261249.
PMID: 35089931 DOI: 10.1371/journal.pone.0264247

Every person diagnosed with diabetes mellitus (T2DM) is at risk of developing Diabetic retinopathy (DR). Thus, DR is one of the major chronic microvascular complications of T2DM. However, in Malaysia, research about DR is still scarce. This study aimed to determine the prevalence of DR among diabetic patients across 46 primary healthcare clinics in Sabah, Malaysia. Secondly, it purported to identify the factors influencing the development of DR. This cross-sectional study involved a total of 22,345 Type 2 diabetes mellitus (T2DM) patients in the Sabah Diabetic Registry from 2008 to 2015. Of the 22,345 T2DM patients, 13.5% (n = 3,029) of them were diagnosed with DR. Multiple logistic regression revealed seven major risk factors of DR, i.e. patients with diabetic foot ulcer [aOR: 95% CI 3.08 (1.96-4.85)], patients with diabetic nephropathy [aOR: 95% CI 2.47 (2.13-2.86)], hypertension [aOR: 95% CI 1.63 (1.43-1.87)], dyslipidaemia [aOR: 95% CI 1.30 (1.17-1.44)], glycated haemoglobin [(HbA1c) > 6.5 (aOR: 95% CI 1.25 (1.14-1.38)], duration of diabetes mellitus (T2DM) [aOR: 95% CI 1.06 (1.05-1.07)] and age of patient [aOR: 95% CI 1.01 (1.00-1.02)] respectively. DR is a preventable complication. The effective glycaemic control is crucial in preventing DR. In minimizing the prevalence of DR, the healthcare authorities should institute programmes to induce awareness on the management of DR's risk factors among patient and practitioner.

Matched MeSH terms: Diabetic Foot/diagnosis; Diabetic Foot/etiology; Diabetic Foot/epidemiology
Fulltext Sociodemographic and lifestyle factors as the risk of diabetic foot ulcer in the University of Malaya Medical Centre

Misliza A, Mas Ayu S

JUMMEC, 2009;12(1):15-21.
MyJurnal

A case-control study was conducted between November 2005 and May 2007 in the University of Malaya Medical Centre (UMMC), University of Malaya, Kuala Lumpur, Malaysia. The objective of this study was to identify specific socio-demographic and lifestyle factors which were associated with foot ulcer in Type 1 and Type 2 diabetes patients. There were 125 cases and 250 controls by using universal sampling. Diabetic foot ulcer was defined as "the full thickness skin break at least to Grade 1 Wagner Stage, occurring distal to malleoli". The case was defined as the diabetic patient who was newly diagnosed or who has a known case of diabetic foot ulcer and the control was defined as the diabetic patient without active foot ulcer. Data was collected via face-to-face interview using a structured questionnaire. Results showed that diabetic patients at younger age group, 44 years old and less (OR 5.90 95% CI 2.31, 15.10), Indian (OR 3.24 95% CI 1.66, 6.30), and smoker (OR 3.85 95% CI 1.77, 8.35) were the independent risk factor for diabetic foot ulcer.

Matched MeSH terms: Diabetic Foot

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