Authors :
Dr. Junior Sundresh N; Punitha S; Rakshana M
Volume/Issue :
Volume 10 - 2025, Issue 9 - September
Google Scholar :
https://tinyurl.com/y466dfek
Scribd :
https://tinyurl.com/mwtbd6hp
DOI :
https://doi.org/10.38124/ijisrt/25sep188
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Abstract :
Background:
Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus, often leading to delayed
wound healing, infection, and lower limb amputation. Identifying key predictors of poor outcomes is crucial for effective
clinical management.
Objectives:
To identify and evaluate key clinical, chemical, and biochemical predictors—particularly ulcer size, HbA1c, and
infection status—that influence wound healing outcomes and the risk of amputation in patients with diabetic foot ulcers, in
order to guide early intervention and improve patient management.
Methods:
A prospective observational study was conducted on 51 inpatients with DFUs at Government Cuddalore Medical
College and Hospital over a three-month period. Patient demographics, ulcer characteristics, comorbidities, glycemic
control (HbA1c), and infection status were recorded. Statistical analysis included Cox regression and ROC curve analysis
to identify independent predictors of healing and amputation risk.
Results:
The mean age of this study was 58.2 years, with a mean HbA1c of 8.8% and average ulcer size of 4.7 cm2. In
multivariate Cox regression, ulcer size (HR 0.89, p=0.038), HbA1c (HR 0.82, p=0.014), and infection status (HR 0.65,
p=0.017) were identified as independent predictors of delayed healing. ROC analysis showed ulcer size had the highest
predictive value for both wound healing (AUC 0.81) and amputation risk (AUC 0.86), while HbA1c and ABI demonstrated
moderate predictive ability.
Conclusion:
Ulcer size is the strongest independent predictor of poor wound healing and amputation risk in DFU patients. Early
recognition and aggressive management of larger ulcers, along with infection control and glycemic optimization, are
critical to improving patient outcomes and reducing complications.
References :
- Zadeh, M. M., Lingsma, H., van Neck, J. W., Vasilic, D., & van Dishoeck, A.-M. (2016). Outcome predictors for wound healing in patients with a diabetic foot ulcer. International Wound Journal, 13(6), 1339–1345. https://doi.org/10.1111/iwj.12494
- Jeffcoate, W. J., Chipchase, S. Y., Ince, P., & Game, F. L. (2006). Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care, 29(8), 1784–1787. https://doi.org/10.2337/dc06-0206
- Boyko, E. J., Ahroni, J. H., Stensel, V., Forsberg, R. C., Davignon, D. R., & Smith, D. G. (1999). A prospective study of risk factors for diabetic foot ulcer: The Seattle Diabetic Foot Study. Diabetes Care, 22(7), 1036–1042. https://doi.org/10.2337/diacare.22.7.1036
- Treece KA, Macfarlane RM, Pound N, Game FL, Jeffcoate WJ. Validation of a system of foot ulcer classification in diabetes mellitus. Diabet Med. 2004 Sep;21(9):987-91. doi: 10.1111/j.1464-5491.2004.01275.x. PMID: 15317603.
- Edmonds, M. E., & Foster, A. V. M. (2006). Diabetic foot ulcers. BMJ, 332(7538), 407–410. https://doi.org/10.1136/bmj.332.7538.407
- Frykberg, R. G. (2002). Diabetic foot ulcers: Pathogenesis and management. American Family Physician, 66(9), 1655–1662. Retrieved from https://www.aafp.org
- Reardon, R., Simring, D., Kim, B., Mortensen, J., Williams, D., & Leslie, A. (2020). The diabetic foot ulcer. Australian Journal of General Practice, 49(5). https://doi.org/10.31128/AJGP-11-19-5161
- Armstrong, D. G., Boulton, A. J. M., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence. The New England Journal of Medicine, 376(24), 2367–2375. https://doi.org/10.1056/NEJMra1615439
- Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, G. (2005). Treatment for diabetic foot ulcers. The Lancet, 366(9498), 1725–1735. https://doi.org/10.1016/S0140-6736(05)67695-4
- Alexiadou, K., & Doupis, J. (2012). Management of Diabetic Foot Ulcers. Diabetes Therapy, 3(1), 4. https://doi.org/10.1007/s13300-012-0004-9
- Ugwu, E. F., Adeleye, O. O., Gezawa, I., Okpe, I. E., Enamino, M., & Ezeani, I. (2019). Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. Journal of Foot and Ankle Research, 12(1), 1–8. https://doi.org/10.1186/s13047-019-0327-8
- Vella, L., & Formosa, C. (2017). Characteristics predicting the outcome in individuals with diabetic foot ulcerations. Journal of the American Podiatric Medical Association, 107(3), 180–191. https://doi.org/10.7547/15-112
- Fife, C. E., Horn, S. D., Smout, R. J., Barrett, R. S., & Thomson, B. (2016). A predictive model for diabetic foot ulcer outcome: The wound healing index. Advances in Wound Care, 5(7), 279–287. https://doi.org/10.1089/wound.2015.0641
- Monteiro-Soares, M., Boyko, E. J., Ribeiro, J., Ribeiro, I., & Dinis-Ribeiro, M. (2012). Predictive factors for diabetic foot ulceration: A systematic review. Diabetes/Metabolism Research and Reviews, 28(7), 574–600. https://doi.org/10.1002/dmrr.2319
- Noor, S., Zubair, M., & Ahmad, J. (2015). Diabetic foot ulcer—A review on pathophysiology, classification and microbial etiology. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 9(3), 192–199. https://doi.org/10.1016/j.dsx.2015.04.007
- Mansoor Z, Modaweb A. Predicting amputation in patients with diabetic foot ulcers: a systematic review. Cureus. 2022 Jul 25;14(7):e27245. doi:10.7759/cureus.27245. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399679/
- 17.Mohammad Zadeh M, et al. Outcome predictors for wound healing in patients with a diabetic foot ulcer. Int Wound J. 2019;16(6):1339–1346. doi:10.1111/iwj.13194. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948747/
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- doi:10.1186/s13047-019-0345-y. Availablefrom:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570910/
Background:
Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus, often leading to delayed
wound healing, infection, and lower limb amputation. Identifying key predictors of poor outcomes is crucial for effective
clinical management.
Objectives:
To identify and evaluate key clinical, chemical, and biochemical predictors—particularly ulcer size, HbA1c, and
infection status—that influence wound healing outcomes and the risk of amputation in patients with diabetic foot ulcers, in
order to guide early intervention and improve patient management.
Methods:
A prospective observational study was conducted on 51 inpatients with DFUs at Government Cuddalore Medical
College and Hospital over a three-month period. Patient demographics, ulcer characteristics, comorbidities, glycemic
control (HbA1c), and infection status were recorded. Statistical analysis included Cox regression and ROC curve analysis
to identify independent predictors of healing and amputation risk.
Results:
The mean age of this study was 58.2 years, with a mean HbA1c of 8.8% and average ulcer size of 4.7 cm2. In
multivariate Cox regression, ulcer size (HR 0.89, p=0.038), HbA1c (HR 0.82, p=0.014), and infection status (HR 0.65,
p=0.017) were identified as independent predictors of delayed healing. ROC analysis showed ulcer size had the highest
predictive value for both wound healing (AUC 0.81) and amputation risk (AUC 0.86), while HbA1c and ABI demonstrated
moderate predictive ability.
Conclusion:
Ulcer size is the strongest independent predictor of poor wound healing and amputation risk in DFU patients. Early
recognition and aggressive management of larger ulcers, along with infection control and glycemic optimization, are
critical to improving patient outcomes and reducing complications.