Rosinha Patrícia, Saraiva Miguel, Ferreira Lia, Garrido Susana, Carvalho André, Freitas Cláudia, Amaral Cláudia, Costa Luís, Loureiro Luís, Carvalho Rui
Endocrinology, Centro Hospitalar Baixo Vouga, Aveiro, PRT.
Endocrinology, Centro Hospitalar Universitário do Porto, Porto, PRT.
Cureus. 2022 Aug 19;14(8):e28189. doi: 10.7759/cureus.28189. eCollection 2022 Aug.
Background and aims Diabetic foot ulcer location is a known independent predictor for cure with a better healing gradient proximal to distal. Although advanced age is one of the main factors associated with greater diabetic foot ulcer severity, there are no studies evaluating diabetic foot ulcer location specifically in the elderly population in an outpatient setting. This study evaluated diabetic foot ulcer location and age-group interactions in diabetic foot presentation. Methods A retrospective cohort study including adult patients with diabetic foot ulcers observed on their first visit to our center's Diabetic Foot Unit in 2018, divided into younger adults (YA) (18 to 64 years) and older adults (OA) (≥65 years). Results A total of 435 patients were included in the study with 159 (36.6%) in the YA, and 276 (63.4%) in the OA group. Neuro-ischemic diabetic foot ulcers were more frequent in the OA group (71.4% vs 43.4%, p<0.001). The number of patients with a history of diabetic foot ulcers was lower in the OA group (18.1% vs 25.2%, p=0.03). A smaller proportion of forefoot diabetic foot ulcers (74.9% vs 86.2%, p=0.007) and plantar location diabetic foot ulcers (9.4% vs 24.5%, p<0.001) occurred in the OA group. By univariate logistic regression analysis, we found two associations with older age: proximal (odds ratio (OR) 2.09 (1.23-3.53), p=0.006), and non-plantar (OR 3.13 (1.82-5.37), p<0.001) diabetic foot ulcer location. After adjusting for potential confounders in a multivariate analysis, older age lost the association to more proximal (OR 1.72 (0.94-3.15), p=0.081) and non-plantar (OR 1.78 (0.83-3.77), p=0.133) diabetic foot ulcer location. Conclusions There are essential age differences in diabetic foot ulcer presentation. The OA group more frequently presents neuro-ischemic diabetic foot ulcers with more proximal and non-plantar locations.
糖尿病足溃疡的位置是已知的治愈独立预测因素，从近端到远端愈合梯度更佳。尽管高龄是糖尿病足溃疡严重程度增加的主要因素之一，但尚无研究专门评估门诊环境中老年人的糖尿病足溃疡位置。本研究评估了糖尿病足表现中糖尿病足溃疡位置与年龄组的相互作用。方法：一项回顾性队列研究，纳入2018年首次就诊于本中心糖尿病足科的成年糖尿病足溃疡患者，分为年轻成年人（YA）（18至64岁）和老年人（OA）（≥65岁）。结果：本研究共纳入435例患者，其中YA组159例（36.6%），OA组276例（63.4%）。神经缺血性糖尿病足溃疡在OA组更常见（71.4%对43.4%，p<0.001）。OA组有糖尿病足溃疡病史的患者数量较少（18.1%对25.2%，p=0.03）。OA组前足糖尿病足溃疡（74.9%对86.2%，p=0.007）和足底位置糖尿病足溃疡（9.4%对24.5%，p<0.001）的比例较小。通过单因素逻辑回归分析，我们发现与高龄相关的两个因素：近端（优势比（OR）2.09（1.23 - 3.53），p=0.006）和非足底（OR 3.13（1.82 - 5.37），p<0.001）糖尿病足溃疡位置。在多因素分析中对潜在混杂因素进行校正后，高龄与更靠近近端（OR 1.72（0.94 - 3.15），p=0.081）和非足底（OR 1.78（0.83 - 3.77），p=0.133）糖尿病足溃疡位置的关联消失。结论：糖尿病足溃疡表现存在重要的年龄差异。OA组更常出现神经缺血性糖尿病足溃疡，且位置更靠近近端和非足底。
