影响澳大利亚成年人糖尿病相关足部溃疡愈合的因素：一项前瞻性队列研究。

Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study.

机构信息

Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Allied Health, Monash University, Clayton, Victoria, Australia.

School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.

出版信息

Diabet Med. 2023 Jan;40(1):e14951. doi: 10.1111/dme.14951. Epub 2022 Sep 8.

DOI:10.1111/dme.14951

PMID:36054775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10087534/

Abstract

OBJECTIVE

Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population.

RESEARCH DESIGN AND METHODS

This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation.

RESULTS

A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03).

CONCLUSIONS

In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.

摘要

目的

糖尿病相关足部溃疡（DFU）是一种常见的威胁肢体的疾病，其病情复杂，因此治疗具有挑战性。本研究旨在确定一系列临床和社会因素对澳大利亚人群中糖尿病相关足部溃疡愈合的影响。

研究设计和方法

这是一项对糖尿病相关足部溃疡（DFU）患者的前瞻性队列研究。在基线时，收集了年龄、性别、病史、药物、饮食补充剂（如维生素 C 摄入）和吸烟史。计算了相对社会经济劣势指数（IRSD）。进行了澳大利亚饮食调查和国际体力活动问卷-短版。在 6 个月的时间内，记录和监测了伤口病史、大小、等级、愈合时间和感染情况。采用逻辑回归分析了饮食质量、趾动脉收缩压、愈合时的伤口大小、IRSD、感染和既往截肢与愈合之间的关系。

结果

共纳入 117 名参与者。大多数是男性 n=96（82%），社会经济地位较低（平均 IRSD 965，SD 60），肥胖（BMI 36kg/m2，SD 11），糖尿病病史较长（20 年，SD 11）。伤口主要为神经病变（n=85，73%），按德克萨斯大学伤口分类系统分类为 1A（n=63，54%），感染较少（n=23，16%）。饮食补充与愈合的几率增加 4.36 倍（95%CI 1.28-14.84，p=0.02）有关，较高的社会经济优势水平也与愈合几率增加有关（OR 1.01，95%CI 1.01-1.02，p=0.03）。