Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of and risk factors for DFU recurrence after healing during a 3-year follow-up period. At our site, 93 Eurodiale-enrolled patients had a healed DFU. Among these, 14 were not alive; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study, we assessed demographic factors (age, sex and distance from hospital); diabetes-related factors [duration, and glycated haemoglobin (HbA1c) levels]; comorbidities (obesity, renal failure, smoking and alcohol abuse) and DFU-related factors [peripheral arterial disease, ulcer infection, C-reactive protein (CRP) and; foot deformities]. During the 3-year follow-up period, a DFU had recurred in 42 patients (57.5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location [odds ratio (OR) 8.62, 95% confidence interval (CI) 2.2-33.2]; presence of osteomyelitis (OR 5.17, 95% CI 1.4-18.7); HbA1c > 7.5% ([DCCT], OR 4.07, 95% CI 1.1-15.6) and CRP > 5 mg/l (OR 4.27, 95% CI 1.2-15.7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3-year follow-up period, despite intensive foot care. The findings at diagnosis of the initial DFU were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) and define those at high risk for recurrence, but may be amenable to targeted interventions.

Diabetes Centre Institute for Clinical and Experimental Medicine Prague Czech Republic Department of Internal Medicine University Hospital Maastricht Maastricht The Netherlands General Medical Service VA Puget Sound Health Care System Department of Medicine University of Washington Seattle WA USA

Zobrazit více v PubMed

International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot & Practical Guidelines on the Management and Prevention of the Diabetic Foot. 2011.

Boulton AJ. The diabetic foot: from art to science. The 18th Camillo Golgi lecture. Diabetologia 2004;47:1343–53. PubMed

Edmonds M. Multidisciplinary care of the diabetic foot patient with infection. Int J Low Extrem Wounds 2010;9:6–8. PubMed

Fosse S, Hartemann‐Heurtier A, Jacqueminet S, Ha Van G, Grimaldi A, Fagot‐Campagna A. Incidence and characteristics of lower limb amputations in people with diabetes. Diabet Med 2009;26:391–6. PubMed

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003;361: 1545–51. PubMed

Armstrong DG, Boulton AJ, Andros G, Attinger C, Eisenbud D, Lavery LA, Lipsky BA, Mills JL, Sibbald G, Smith AP, Wukich D, Margolis DJ. Defining success in clinical trials of diabetic foot wounds: the Los Angeles DFCon consensus. Int Wound J 2009;6:211–3. PubMed PMC

Crawford F, McCowan C, Dimitrov BD, Woodburn J, Wylie GH, Booth E, Leese GP, Bekker HL, Kleijnen J, Fahey T. The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study. QJM. 2011;104:403–10. PubMed

Apelqvist J, Larsson J, Agardh CD. Long‐term prognosis for diabetic patients with foot ulcers. J Intern Med 1993;233:485–91. PubMed

Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA 2009;301:603–18. PubMed

Apelqvist J, Ragnarson‐Tennvall G, Larsson J, Persson U. Long‐term costs for foot ulcers in diabetic patients in a multidisciplinary setting. Foot Ankle Int 1995;16:388–94. PubMed

Connor H, Mahdi OZ. Repetitive ulceration in neuropathic patients. Diabetes/Metab Res Rev. 2004;20 Suppl 1:S23–8. PubMed

Ince P, Kendrick D, Game F, Jeffcoate W. The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes. Diabet Med 2007;24:977–81. PubMed

Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, Van Acker K, van Baal J, van Merode F, Schaper N. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 2007;50:18–25. PubMed

Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson‐Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008;51:747–55. PubMed PMC

van Battum P, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Ferreira I, Huijberts M. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabetic Med J Brit Diabetic Assoc 2011;28:199–205. PubMed

Jirkovska A, Boucek P, Woskova V, Bartos V, Skibova J. Identification of patients at risk for diabetic foot: a comparison of standardized noninvasive testing with routine practice at community diabetes clinics. J Diabetes Complications 2001;15:63–8. PubMed

Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes/Metab Res Rev 2004;20 Suppl 1:S68–77. PubMed

Peters EJ, Armstrong DG, Lavery LA. Risk factors for recurrent diabetic foot ulcers: site matters. Diabetes Care 2007;30:2077–9. PubMed

Ghanassia E, Villon L, Thuan Dit Dieudonne JF, Boegner C, Avignon A, Sultan A. Long‐term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5‐year follow‐up study. Diabetes Care 2008;31:1288–92. PubMed PMC

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217–28. PubMed

Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward JD, Duckworth T. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 1983;6:26–33. PubMed

Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Risk factors associated with adverse outcomes in a population‐based prospective cohort study of people with their first diabetic foot ulcer. J Diabetes Complications 2007;21:341–9. PubMed

Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yapar N, Atabey A, Kucukyavas Y, Comlekci A, Eraslan S. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens) 2009;8:286–95. PubMed

Kowalski TJ, Matsuda M, Sorenson MD, Gundrum JD, Agger WA. The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection. J Foot Ankle Surg 2011;50:171–5. PubMed

Aragon‐Sanchez J, Lazaro‐Martinez JL, Hernandez‐Herrero C, Campillo‐Vilorio N, Quintana‐Marrero Y, Garcia‐Morales E, Hernandez‐Herrero MJ. Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series. Diabetic Med J Brit Diabetic Assoc 2011; 29:813–8. PubMed

Cuttica DJ, Philbin TM. Surgery for diabetic foot infections. Foot Ankle Clin 2010;15:465–76. PubMed

Jeandrot A, Richard JL, Combescure C, Jourdan N, Finge S, Rodier M, Corbeau P, Sotto A, Lavigne JP. Serum procalcitonin and C‐reactive protein concentrations to distinguish mildly infected from non‐infected diabetic foot ulcers: a pilot study. Diabetologia 2008;51:347–52. PubMed PMC

Lipsky BA, Sheehan P, Armstrong DG, Tice AD, Polis AB, Abramson MA. Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. Int Wound J 2007;4:30–8. PubMed PMC

Volaco A, Chantelau E, Richter B, Luther B. Outcome of critical foot ischaemia in longstanding diabetic patients: a retrospective cohort study in a specialised tertiary care centre. Vasa 2004;33:36–41. PubMed

Mantey I, Foster AV, Spencer S, Edmonds ME. Why do foot ulcers recur in diabetic patients? Diabetic Med J Brit Diabetic Assoc 1999;16:245–9. PubMed

Poolsup N, Suksomboon N, Rattanasookchit S. Meta‐analysis of the benefits of self‐monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther 2009;11:775–84. PubMed

Valk G, Kriegsman, DM , Assendfelft, WJ. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2005;25:CD001488. PubMed

Jude EB, Eleftheriadou I, Tentolouris N. Peripheral arterial disease in diabetes – a review. Diabetic Med J Brit Diabetic Assoc 2010;27:4–14. PubMed

An Alteration of Lymphocytes Subpopulations and Immunoglobulins Levels in Patients with Diabetic Foot Ulcers Infected Particularly by Resistant Pathogens