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Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission

INTRODUCTION: Foot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation. RESEARCH DESIGN AND METHODS: We aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) rec...

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Autores principales: Petersen, Brian J, Bus, Sicco A, Rothenberg, Gary M, Linders, David R, Lavery, Lawrence A, Armstrong, David G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528350/
https://www.ncbi.nlm.nih.gov/pubmed/32998870
http://dx.doi.org/10.1136/bmjdrc-2020-001697
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author Petersen, Brian J
Bus, Sicco A
Rothenberg, Gary M
Linders, David R
Lavery, Lawrence A
Armstrong, David G
author_facet Petersen, Brian J
Bus, Sicco A
Rothenberg, Gary M
Linders, David R
Lavery, Lawrence A
Armstrong, David G
author_sort Petersen, Brian J
collection PubMed
description INTRODUCTION: Foot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation. RESEARCH DESIGN AND METHODS: We aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) recurrence coincided with typical intervals between routine preventive care appointments, which would suggest that delays exist between ulcer development and identification. We completed an analysis of existing data from two multicenter studies in 300 total participants. We analyzed unadjusted counts of DFU binned in weekly intervals and defined ‘exam periods’ as intervals from 2 to 4 weeks, from 6 to 8 weeks, within 1 week of 3 months and within 1 week of 6 months. We tested whether recurrence rates during exam periods were equivalent to rates outside exam periods. We estimated the delay between DFU development and DFU identification such that the rate of development would have been constant. RESULTS: During exam periods, a total of 43 DFUs were identified (43/86=50%) despite the fact that these periods represent only 23.5% of follow-up in aggregate. Accounting for censoring, the annualized incidence during exam periods was 0.68 DFU/year (CI 0.48 to 0.89) in contrast to 0.25 DFU/year (CI 0.18 to 0.32) outside exam periods (incidence ratio=2.8, CI 1.8 to 4.3). We estimated delays between DFU occurrence and identification to average 15.3 days (IQR 7.4–23.7 days). CONCLUSIONS: These findings have potential implications for practice, particularly related to the value of telehealth and in-home monitoring of patients in diabetic foot remission. Additionally, there are implications for study design, which should consider the impact of interval censoring and attempt to control for confounders related to frequency and timing of exams.
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spelling pubmed-75283502020-10-19 Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission Petersen, Brian J Bus, Sicco A Rothenberg, Gary M Linders, David R Lavery, Lawrence A Armstrong, David G BMJ Open Diabetes Res Care Pathophysiology/Complications INTRODUCTION: Foot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation. RESEARCH DESIGN AND METHODS: We aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) recurrence coincided with typical intervals between routine preventive care appointments, which would suggest that delays exist between ulcer development and identification. We completed an analysis of existing data from two multicenter studies in 300 total participants. We analyzed unadjusted counts of DFU binned in weekly intervals and defined ‘exam periods’ as intervals from 2 to 4 weeks, from 6 to 8 weeks, within 1 week of 3 months and within 1 week of 6 months. We tested whether recurrence rates during exam periods were equivalent to rates outside exam periods. We estimated the delay between DFU development and DFU identification such that the rate of development would have been constant. RESULTS: During exam periods, a total of 43 DFUs were identified (43/86=50%) despite the fact that these periods represent only 23.5% of follow-up in aggregate. Accounting for censoring, the annualized incidence during exam periods was 0.68 DFU/year (CI 0.48 to 0.89) in contrast to 0.25 DFU/year (CI 0.18 to 0.32) outside exam periods (incidence ratio=2.8, CI 1.8 to 4.3). We estimated delays between DFU occurrence and identification to average 15.3 days (IQR 7.4–23.7 days). CONCLUSIONS: These findings have potential implications for practice, particularly related to the value of telehealth and in-home monitoring of patients in diabetic foot remission. Additionally, there are implications for study design, which should consider the impact of interval censoring and attempt to control for confounders related to frequency and timing of exams. BMJ Publishing Group 2020-09-30 /pmc/articles/PMC7528350/ /pubmed/32998870 http://dx.doi.org/10.1136/bmjdrc-2020-001697 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Pathophysiology/Complications
Petersen, Brian J
Bus, Sicco A
Rothenberg, Gary M
Linders, David R
Lavery, Lawrence A
Armstrong, David G
Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title_full Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title_fullStr Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title_full_unstemmed Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title_short Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
title_sort recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission
topic Pathophysiology/Complications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528350/
https://www.ncbi.nlm.nih.gov/pubmed/32998870
http://dx.doi.org/10.1136/bmjdrc-2020-001697
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