Researchers Offer Closer Look At Complications In Patients With Diabetes
Two abstracts, which will be presented at the upcoming Symposium on Advanced Wound Care (SAWC), seek to address the impact of dialysis upon diabetic wound healing and the long-term mortality rates of those who undergo non-traumatic amputation.
For the one abstract’s retrospective review, researchers evaluated 150 patients with diabetes on hemodialysis. These patients had 30 months of follow-up for foot ulcers, infections, amputations and death. The abstract authors sought to determine if the patients received “standard preventative care” consistent with patient education, therapeutic shoes and foot care, and whether the preventative care had an impact.
The researchers note that the annual incidence of ulceration was 19.5 percent, the incidence of amputation was 11.6 percent and the incidence of death was 21 percent. Furthermore, only 1 percent of the population received diabetic education, 7 percent received therapeutic shoes or insoles, and 50 percent received foot care, according to the abstract. Researchers note no difference in foot complications among the patients who received preventive care.
However, the study notes that the incidence of foot complications was much higher among diabetic patients on hemodialysis in comparison to patients with diabetes who did not have renal disease. Only a small proportion of the population received preventive services during the 30-month evaluation period.
Abstract lead author Lawrence Lavery, DPM, calls the study results preliminary and says more research is needed. For example, he notes that in many populations, podiatry visits are predictive of amputations since DPMs see high-risk patients with wounds very frequently and 20 percent of people with ulcers have amputations.
“It is like identifying that if a cardiologist sees you, there is an increased risk of dying from a myocardial infarction,” says Dr. Lavery, a Professor in the Department of Surgery at Texas A&M Health Science Center College of Medicine.
Dr. Lavery also notes that approximately 50 percent or more of patients with diabetes on hemodialysis have peripheral vascular disease (PVD) in comparison to 12 percent of a general population of diabetes patients with PVD. Dr. Lavery says many patients with diabetes and PVD on hemodialysis may not be able to achieve wound healing or the prevention of such wounds unless they receive a bypass.
Exploring The Link Between Long-Term Mortality Rates And Amputation
In a second SAWC abstract, researchers reviewed 1,043 charts of diabetic patients who had undergone non-traumatic amputations in six metropolitan areas in Texas in 1993. They then used the Social Security Death Index to identify the mortality data for those patients in 2007.
The abstract found overall mortality at three, five and 10 years was 38.5 percent, 52.3 percent and 75.9 percent respectively. Dialysis patients had a consistently higher mortality rate in comparison to those with chronic renal insufficiency (CRI) or without renal disease despite associated comorbidities, according to the abstract.
Furthermore, the abstract notes that dialysis patients had a significantly higher risk of undergoing a higher level amputation. The abstract researchers say the significant risk factors for mortality are amputation level, dialysis and age. Dr. Lavery adds that patients on dialysis have more severe lower extremity disease, have a longer incidence of diabetes, have more comorbidities and have a poor survival rate. Accordingly, the study authors say there is a significant need for wound care and amputation prevention in diabetic patients on hemodialysis.
The Symposium on Advanced Wound Care will be held from April 24 to 27 at the San Diego Convention Center in San Diego. For more info, go to www.sawc.net.