Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Department of Medicine, University of Washington, Seattle, USA.
BMC Res Notes. 2022 Jul 27;15(1):264. doi: 10.1186/s13104-022-06150-9.
Constantly high glycemia levels might influence outcomes in the management of patients undergoing surgery for diabetic foot infections (DFI). In our center for DFI, we performed a case-control study using a multivariate Cox regression model. Patients developing a new DFI could participate in the study several times.
Among 1013 different DFI episodes in 586 individual adult patients (type I diabetes 148 episodes [15%], 882 [87%] with osteomyelitis; median antibiotic therapy of 21 days), professional diabetes counselling was provided by a specialized diabetes nurse in 195 episodes (19%). At admission, blood glucose levels were elevated in 110 episodes (11%). Treatments normalized glycemia on postoperative day 3 in 353 episodes (35%) and on day 7 for 321 (32%) episodes. Glycemia levels entirely normalized for 367 episodes (36%) until the end of hospitalization. Overall, treatment of DFI episodes failed in 255 of 1013 cases (25%), requiring surgical revision. By multivariate analysis, neither the provision of diabetes counseling, nor attaining normalizations of daily glycemic levels at day 3, day 7, or overall, influenced the ultimate incidence of clinical failures. Thus, the rapidity or success of achieving normoglycemia do not appear to influence the risk of treatment failure for operated DFI episodes.
持续的高血糖水平可能会影响糖尿病足感染（DFI）患者手术管理的结果。在我们的 DFI 中心，我们使用多变量 Cox 回归模型进行了病例对照研究。患有新发 DFI 的患者可以多次参与研究。
在 586 名成年患者的 1013 例不同 DFI 发作中（1 型糖尿病发作 148 例[15%]，882 例[87%]伴骨髓炎；中位抗生素治疗 21 天），195 例（19%）由专门的糖尿病护士提供专业的糖尿病咨询。在入院时，110 例（11%）的血糖水平升高。在 353 例（35%）患者中，术后第 3 天血糖水平得到控制，321 例（32%）患者在第 7 天血糖水平得到控制。在 367 例（36%）患者中，血糖水平在整个住院期间完全恢复正常。总的来说，1013 例 DFI 发作中有 255 例（25%）治疗失败，需要手术修正。通过多变量分析，糖尿病咨询的提供或在第 3、7 天或总体上达到日常血糖水平的正常化，均不影响临床失败的最终发生率。因此，实现正常血糖的速度或成功似乎不会影响手术治疗 DFI 发作的失败风险。
