Lavery Lawrence A, Lavery David C, Hunt Nathan A, La Fontaine Javier, Ndip Agbor, Boulton Andrew J
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA.
Statistical Consulting, Aurora, CO, USA.
Int Wound J. 2015 Oct;12(5):523-6. doi: 10.1111/iwj.12146. Epub 2013 Sep 19.
Patients with diabetes have increased risk for foot ulcers, amputations and hospitalisations. We evaluated a closed cohort of patients with diabetes and established risk factors in two high risk groups: (i) dialysis patients and (ii) patients with previous foot ulceration. We used claims data for diabetes (ICD-9 250.X), ulceration (ICD-9 707·10, 707·14 and 707·15) and dialysis (CPT 90935-90937) from the Scott and White Health Plan to identify 150 consecutive patients with diabetes on dialysis (dialysis group) and 150 patients with a history of foot ulceration (ulcer history group). We verified these diagnoses by manually reviewing corresponding electronic medical records. Each patient was provided 30 months follow-up period. The incidence of foot ulcers was the same in dialysis patients and patients with an ulcer history (210 per 1000 person-years). The amputation incidence rate was higher in dialysis patients (58·0 versus 13·3, P < 0·001). Hospital admission was common in both study groups. The incidence of hospitalisation was higher in the ulcer history group (477·3 versus 381·3, P < 0·001); however, there were more foot-related hospital admissions in the dialysis group (32·9% versus 14·0%, P < 0·001) during the 30-month evaluation period. The incidence of ulcers, amputations and all-cause hospitalisations is high in persons with diabetes and a history of foot ulceration or on dialysis treatment; however, those on dialysis treatment have disproportionately higher rates of foot-related hospitalisations. Intervention strategies to reduce the burden of diabetic foot disease must target dialysis patients as a high-risk group.
糖尿病患者发生足部溃疡、截肢和住院的风险增加。我们评估了一组糖尿病患者的封闭队列，并确定了两个高危组中的危险因素：（i）透析患者和（ii）既往有足部溃疡的患者。我们使用了来自斯科特与怀特健康计划的糖尿病（国际疾病分类第九版250.X）、溃疡（国际疾病分类第九版707·10、707·14和707·15）和透析（现行程序编码90935 - 90937）的理赔数据，以识别150例连续接受透析的糖尿病患者（透析组）和150例有足部溃疡病史的患者（溃疡病史组）。我们通过人工查阅相应的电子病历对这些诊断进行了核实。每位患者都有30个月的随访期。透析患者和有溃疡病史的患者足部溃疡的发生率相同（每1000人年210例）。透析患者的截肢发生率更高（58.0对13.3，P＜0.001）。两个研究组的住院情况都很常见。溃疡病史组的住院发生率更高（477.3对381.3，P＜0.001）；然而，在30个月的评估期内，透析组与足部相关的住院更多（32.9%对14.0%，P＜0.001）。糖尿病患者以及有足部溃疡病史或接受透析治疗的患者中，溃疡、截肢和全因住院的发生率都很高；然而，接受透析治疗的患者与足部相关的住院率过高。减轻糖尿病足病负担的干预策略必须将透析患者作为高危人群。
