College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Diabetes Care. 2017 Jul;40(7):936-942. doi: 10.2337/dc16-2189. Epub 2017 May 11.
To evaluate ambulatory clinical cases of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) in the U.S. from 2007 to 2013 and to assess outcomes of emergency department or inpatient (ED/IP) admission, number of clinic visits per year, and physician time spent per visit.
A cross-sectional historical cohort analysis was conducted by using the nationally representative Centers for Disease Control and Prevention National Ambulatory Medical Care Survey data from 2007 to 2013, including patients age ≥18 years with diabetes and either DFIs or DFUs. Study outcomes were analyzed by using generalized linear models controlling for key demographics and chronic conditions.
Across the estimated 5.6 billion ambulatory care visits between 2007 and 2013, 784.8 million involved diabetes and ∼6.7 million (0.8%) were for DFUs (0.3%) or DFIs (0.5%). Relative to other ambulatory clinical cases, multivariable analyses indicated that DFUs were associated with a 3.4 times higher odds of direct ED/IP admission (CI 1.01-11.28; = 0.049), 2.1 times higher odds of referral to another physician (CI 1.14-3.71; = 0.017), 1.9 times more visits in the past 12 months (CI 1.41-2.42; < 0.001), and 1.4 times longer time spent per visit with the physician (CI 1.03-1.87; = 0.033). DFIs were independently associated with a 6.7 times higher odds of direct ED referral or IP admission (CI 2.25-19.51; < 0.001) and 1.5 times more visits in the past 12 months (CI 1.14-1.90; = 0.003).
This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits, with DFUs also associated with a higher odds of referrals to other physicians and longer physician visit times.
评估 2007 年至 2013 年期间美国门诊糖尿病足溃疡（DFUs）和糖尿病足感染（DFIs）的临床病例，并评估急诊或住院（ED/IP）入院、每年就诊次数和每次就诊医生花费的时间等结局。
本研究采用 2007 年至 2013 年全国代表性疾病控制和预防中心国家门诊医疗调查数据，进行了一项横断面历史队列分析，纳入年龄≥18 岁且患有糖尿病并有 DFIs 或 DFUs 的患者。研究结果采用广义线性模型进行分析，模型中控制了关键人口统计学和慢性疾病因素。
在 2007 年至 2013 年估计的 56 亿次门诊就诊中，7.848 亿次涉及糖尿病，其中 670 万次（0.8%）为 DFUs（0.3%）或 DFIs（0.5%）。与其他门诊临床病例相比，多变量分析表明，DFUs 与直接 ED/IP 入院的几率高 3.4 倍（CI 1.01-11.28；P=0.049）、转至其他医生的几率高 2.1 倍（CI 1.14-3.71；P=0.017）、过去 12 个月就诊次数多 1.9 倍（CI 1.41-2.42；P<0.001）、每次就诊医生花费的时间多 1.4 倍（CI 1.03-1.87；P=0.033）。DFIs 与直接 ED 转诊或 IP 入院的几率高 6.7 倍（CI 2.25-19.51；P<0.001）和过去 12 个月就诊次数多 1.5 倍（CI 1.14-1.90；P=0.003）独立相关。
本研究对估计 670 万例糖尿病足病例的调查显示，ED/IP 入院和门诊就诊次数的风险明显增加，DFUs 还与转至其他医生的几率和每次就诊医生花费的时间增加有关。
