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Diabetes doubles risk for hospital-acquired foot ulcers
Patients with diabetes have at least double the risk for developing hospital-acquired foot ulcers vs. those without diabetes, according to a study published in BMJ Open Diabetes Research & Care.
In a prospective, multilevel regression analysis, Frances Wensley, PhD, MBBS, formerly of the Royal Free Hospitals NHS Foundation Trust in London, and colleagues analyzed data from 18,946 patients with 28,642 admissions of at least 2 days to the Ipswich Hospital NHS Trust between October 2008 and September 2010, including 3,076 individuals with diabetes with 5,043 admissions. Patients included in the analysis were aged at least 50 years and developed a hospital-acquired foot ulcer at least 48 hours after hospital admission. For all admissions, the analyses included data on diabetes, heel ulcer, length of stay and other covariates. The researchers compared patients with vs. without diabetes using progressive adjustment for important risk factors and subgroup analyses.
Compared with patients without diabetes, those with diabetes were more likely to be men (52.2% vs. 45.4%), have a longer duration of stay (7 days vs. 6 days) and have higher Charlson Comorbidity Index scores (3 vs. 2.3; P < .001 for all).
During admission, 171 (0.6%) patients developed a heel ulcer, including 52 (1%) patients with diabetes and 119 (0.5%) who did not have diabetes, according to the researchers. Patients with diabetes had a higher likelihood of emergency admissions, and these admissions were more likely to be under medical specialties vs. surgical (P < .001 for both). There were no between-group difference for weekday admissions (P = .34).
In the age- and sex-adjusted baseline model, the OR for risk for hospital-acquired foot ulcers in patients with diabetes vs. those without diabetes was 2.24 (95% CI, 1.87-2.62). This estimate was sustained after adjustment for major risk factors or confounders, such as length of stay and comorbidities (OR = 2.23; 95% CI, 1.79-2.67). Results persisted after further adjustment for day of admission, medical and surgical specialty, or elective and emergency admission type.
[hospital-acquired foot ulcers], we hope to improve awareness of this risk among all health care professionals,” the researchers wrote. “Changes to clinical practice may include improved assessment of the diabetic foot on admission to the hospital, inclusion of diabetes as a risk factor in scores for hospital-acquired pressure ulcers, and improved management of patients to prevent heel ulceration.” – by Jennifer Byrne
Disclosures : The authors report no relevant financial disclosures.