Prospectively Clinical Study in 81 Patients with D
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RESEARCH ARTICELS
Prospectively Clinical Study in 81 Patients with Diabetic Foot
from 1990 to 2003: a Follow-up of 13 Years
Xueyi Ma*, Danqing Jing, Jingsheng Hu, Hua Bai, Yan Sun
Abstract: To investigate the clinical characteristics and mortality of clinical endpoint events of the patients with diabetic foot(DF), we prospectively studied 81 cases with DF. According to the foot ulcer classifications system of university of Texas, the 81 cases were divided into four groups, A, B, C and D, their clinical data from inpatient records and outpatient follow-up records were analyzed from 1 Nov. 1990 to 31 Dec. 2003. The levels of blood glucose and lipids, the accumulated amputations rates, mortalities and death reasons were compared. All the patients in 4 groups had a bad glucose control (HbA1c>8.6%), although there were no significant differences in BP, TC, TG and LDL levels and smokers (p>0.05), the cases with hyperlipemia, hypertension and hyperglycemia in all the 4 groups were above 50%. The creatinine clean rate decreased gradually from group D to group A (A: 98.8±33.4 ml/min, B: 68.7±48.4 ml/min, C: 67.2±25.4 ml/min, D: 55.5 ± 24.3 ml/min, p<0.05). In group C with severe infections, the levels of CRP and ESR, the count of WBC and PLT significantly increased comparing with the other 3 groups (p<0.01), while the HGB count and HCT decreased significantly in group C and D. The accumulated amputation rate in group C and D were 22.2% and 47.1% respectively and the accumulated mortality in D group after 13 years was 58.8%, significantly higher than the 7.1% in group A. Among the deaths in group D, 95% of cases died of cerebro-cardiovascular endpoint events. In conclusion, good control of hyperglycemia, hyperlipidemia and hypertension in diabetics was the basal way to prevent DF. Diabetes education and protecting foot from trauma and infection can effectively avoid DF, as well as decrease the mortality of clinical endpoint events.
Key words: diabetic foot; risk factors; mortality
Diabetic foot (DF) is a serious end-stage complication in diabetic patients, both neuropathy and ischemic or obstructive arteriosclerosis disease act as permissive factors .The trauma and infection are the main startup or inducement factors. DF include intermittent claudication, chronic ulcer and infections in foot and/or in low limbs, charcot's joints, dry and/or moisture gangrenes, which are the most difficult clinical syndromes to deal with, and they even results in amputations and deformities in diabetic patients. DF also severely depresses the life quality of diabetic patients, consuming high costs of medical and health care. It not only threatens the patients' lives, but also brings them a heavy psychological pressure and distresses. Prevention of DF now is much more important and imperative than treatment of this disease. In order to investigate the clinical progression and prognosis characteristics in Chinese patients with DF, and to help both doctors and patients find and treat in advance the risk factors which may cause amputations or deaths for those with foot problems, we have done a prospective clinical study to follow up 81 patients with DF for 13 years (from 1990 to 2003), analyzing the possible risk factors which might deteriorate the foot progress and all the clinical endpoint events ......
RESEARCH ARTICELS
Prospectively Clinical Study in 81 Patients with Diabetic Foot
from 1990 to 2003: a Follow-up of 13 Years
Xueyi Ma*, Danqing Jing, Jingsheng Hu, Hua Bai, Yan Sun
Abstract: To investigate the clinical characteristics and mortality of clinical endpoint events of the patients with diabetic foot(DF), we prospectively studied 81 cases with DF. According to the foot ulcer classifications system of university of Texas, the 81 cases were divided into four groups, A, B, C and D, their clinical data from inpatient records and outpatient follow-up records were analyzed from 1 Nov. 1990 to 31 Dec. 2003. The levels of blood glucose and lipids, the accumulated amputations rates, mortalities and death reasons were compared. All the patients in 4 groups had a bad glucose control (HbA1c>8.6%), although there were no significant differences in BP, TC, TG and LDL levels and smokers (p>0.05), the cases with hyperlipemia, hypertension and hyperglycemia in all the 4 groups were above 50%. The creatinine clean rate decreased gradually from group D to group A (A: 98.8±33.4 ml/min, B: 68.7±48.4 ml/min, C: 67.2±25.4 ml/min, D: 55.5 ± 24.3 ml/min, p<0.05). In group C with severe infections, the levels of CRP and ESR, the count of WBC and PLT significantly increased comparing with the other 3 groups (p<0.01), while the HGB count and HCT decreased significantly in group C and D. The accumulated amputation rate in group C and D were 22.2% and 47.1% respectively and the accumulated mortality in D group after 13 years was 58.8%, significantly higher than the 7.1% in group A. Among the deaths in group D, 95% of cases died of cerebro-cardiovascular endpoint events. In conclusion, good control of hyperglycemia, hyperlipidemia and hypertension in diabetics was the basal way to prevent DF. Diabetes education and protecting foot from trauma and infection can effectively avoid DF, as well as decrease the mortality of clinical endpoint events.
Key words: diabetic foot; risk factors; mortality
Diabetic foot (DF) is a serious end-stage complication in diabetic patients, both neuropathy and ischemic or obstructive arteriosclerosis disease act as permissive factors .The trauma and infection are the main startup or inducement factors. DF include intermittent claudication, chronic ulcer and infections in foot and/or in low limbs, charcot's joints, dry and/or moisture gangrenes, which are the most difficult clinical syndromes to deal with, and they even results in amputations and deformities in diabetic patients. DF also severely depresses the life quality of diabetic patients, consuming high costs of medical and health care. It not only threatens the patients' lives, but also brings them a heavy psychological pressure and distresses. Prevention of DF now is much more important and imperative than treatment of this disease. In order to investigate the clinical progression and prognosis characteristics in Chinese patients with DF, and to help both doctors and patients find and treat in advance the risk factors which may cause amputations or deaths for those with foot problems, we have done a prospective clinical study to follow up 81 patients with DF for 13 years (from 1990 to 2003), analyzing the possible risk factors which might deteriorate the foot progress and all the clinical endpoint events ......
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