Efficacy of shock wave therapy on chronic diabetic foot ulcer: A single-blinded randomized controlled clinical trial

ObjectiveThis study was conducted to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) on the healing rate, wound surface area and wound bed preparation in chronic diabetic foot ulcers (DFU).MethodsThirty eight patients with 45 chronic DFU were randomly assigned into; the ESWT-group (19 patients/24 ulcers) and the control-group (19 patients/21 ulcers). Blinded therapist measured wound surface area (WSA), the percentage of reduction in the WSA, rate of healing and wound bed preparation at baseline, after the end of the interventions (W8), and at 20-week follow-up (W20). The ESWT group received shock wave therapy twice per week for a total of eight treatments. Each ulcer was received ESWT at a frequency of 100 pulse/cm², and energy flux density of 0.11 mJ/cm². All patients received standardized wound care consisting of debridement, blood-glucose control agents, and footwear modification for pressure reduction.ResultsThe overall clinical results showed completely healed ulcers in 33.3% and 54% in ESWT-groups and 14.28% and 28.5% in the control group after intervention (W8), and at follow-up (W20) respectively. The average healing time was significantly lower (64.5 ± 8.06 days vs 81.17 ± 4.35 days, p < 0.05) in the ESWT-group compared with the control group.ConclusionESWT-treated ulcers had a significant reduction in wound size and median time required for ulcer healing, with no adverse reactions. So, the ESWT is advocated as an adjunctive therapy in chronic diabetic wound.     

Effects of virgin coconut oil consumption on metabolic syndrome components and asymmetric dimethylarginine: A randomized controlled clinical trial

Background and aimsThere is some promising evidence regarding the beneficial effect of coconut oil on cardiometabolic risk factors. This study aimed to assess the effects of virgin coconut oil (VCO) consumption on metabolic syndrome (MetS) components, as well as, asymmetric dimethylarginine (ADMA) in adults with MetS.Methods and resultsIn this randomized controlled trial, 48 subjects, aged 20–50 years, with MetS were allocated into two groups; the intervention group was given 30 ml of VCO per day to substitute the same amounts of fat in their usual diet for four weeks. The control group was advised to follow their usual diet. VCO consumption significantly reduced serum levels of triglyceride (TG) (P = 0.001), very low-density lipoprotein (VLDL) (P = 0.001), and fasting blood sugar (FBS) (P = 0.015) compared to the control group. The levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were significantly increased in the VCO group when compared to the control group (P = 0.001). Circulatory ADMA also increased in the VCO group compared to the control group (P = 0.003). No significant differences were observed in the LDL-C/HDL-C ratio, anthropometric parameters, and blood pressure measurements between the two groups at the end of the study (P > 0.05).ConclusionVCO consumption increased the values of HDL-C while reduced TG and FBS levels. Blood pressure and waist circumference did not change. However, levels of TC, LDL-C, and ADMA elevated by VCO consumption. Caution is warranted until the results of further studies become available to explain the long-term effects of VCO consumption.Registration numberIRCT20131125015536N11.     

Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study

AimsPropolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated.MaterialsSerial consenting subjects (n = 24) with DFU ≥ 4 week's duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data were compared with a matched control cohort of n = 84 with comparable DFU treated recently at the same center.ResultsUlcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P < 0.001), and by 63 vs. 44% at week 3, respectively (P < 0.05). In addition, 10 vs. 2% (P < 0.001), then 19 vs. 12% (P < 0.05) of propolis treated vs. control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1 vs. 2.8% week 3 from baseline in propolis treated ulcers vs. controls (P < 0.001), as were bacterial counts (P < 0.001). No adverse effects from propolis were reported.ConclusionsTopical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers.     

Negative pressure wound therapy in grade 1 and 2 diabetic foot ulcers: A randomized controlled study

Background and aimsFoot ulcers are one of the major causes of morbidity and mortality among diabetics in India. Early diagnosis and timely management is vital in preventing the progression of the disease which may require amputation. Conventional methods take a long time for healing. This study aims to compare negative pressure wound therapy (NPWT) and conventional saline dressings in diabetic foot ulcer (DFU) healing.MethodsThis prospective randomized study was conducted in 45 patients with grade 1 and 2 DFUs. 22 patients in group A received NPWT and 23 patients in group B received saline dressings. The formation of granulation tissue, reduction in ulcer size, duration of hospital stay and time for complete healing of wounds were assessed.ResultsThe formation of granulation tissue (91.14 vs 52.61%, p < 0.001) and reduction in ulcer size (40.78 vs 21.18%, p = 0.008) at 14 days was significantly more in group A. The duration of hospital stay (15.68 vs 29.00 days, p < 0.001) and time for 100% coverage of the wound with granulation tissue (14.82 ± 7.30 vs 44.57 ± 7.11 days, p < 0.001) was significantly less in group A. Complete healing of wounds at 3 months was observed in 20 patients (90.9%) in group A and 6 patients (26.1%) in group B (p = 0.006).ConclusionIn our study NPWT led to early reduction in ulcer size, more granulation tissue formation, shorter hospital stay and complete wound healing. In lower and middle income countries like India with high prevalence of DFUs, early recovery is a boon to the patients to resume their daily activities.     

Effects of low glycemic index/high-fat,high-calorie diet on glycemic control and lipid profiles of children and adolescence with cystic fibrosis: A randomized double-blind controlled clinical trial

PurposeLow glycemic index diets seem to be potentially effective to improve glycemic control and reduce lipid profiles. Hence, this study aimed to evaluate the effect of a low glycemic index/high fat, high-calorie diet on glycemic status and lipid profiles of patients with cystic fibrosis.MethodsIn this randomized clinical trial, 44 children and adolescents with cystic fibrosis were randomized to receive for three months either a high fat, high-calorie diet (n = 22) or a low glycemic index/high fat, high-calorie diet (n = 22) with similar calorie and macronutrients composition. Patients in high fat, high-calorie diet arm were allowed to use all sources of carbohydrates with different glycaemic indices; whereas those in another arm consumed carbohydrates from low glycemic index sources. Serum levels of lipid profiles (triglyceride, total cholesterol, HDL cholesterol, LDL cholesterol), insulin, fasting blood glucose, and glycated hemoglobin were measured at baseline and after the intervention.ResultsBetween-group differences were significant only for fasting blood glucose (P < 0.001). However, fasting blood glucose (P = 0.003) and glycated hemoglobin (P = 0.002) significantly decreased after the intervention in the low glycemic index group, while in another group a significant increase in fasting blood glucose (P = 0.038) and triglyceride (P = 0.004) was found. No significant within-group differences were observed in other variables in both groups.ConclusionsIt seems that adherence to a low glycemic index/high fat, high-calorie diet can improve glycemic indices in children and adolescents with cystic fibrosis compared to the high fat, high-calorie diet.Trial registrationIRCT2017102325267N5.     

Improving the efficacy of nutritional supplementation in the hospitalised elderly

Background: Protein‐energy malnutrition delays wound healing, extends length of stay, and increases complication rates. Identification of patients at risk of malnutrition, together with early intervention, may prevent further deterioration of nutritional status. Objectives: Through the use of nutrition screening and assessment, prioritise nutrition intervention to those at greatest nutritional risk. To improve the consumption rate of nutritional supplements, using a ‘nutrition as medication’ program. Methods: We assessed 200 acute aged care patients for malnutrition risk using the Mini Nutritional Assessment (MNA) tool (Nestle SA, Vevey, Switzerland) within 72 h of hospital admission. Patients ‘at risk’ or malnourished, received either mid meal supplements (control group) or 60 mL of a 2 kcal per ml supplement, given four times daily (trial group). Outcome measures included comparison of supplement consumption changes in MNA scores on fortnightly reassessment or discharge. Results: Thirty per cent of patients were malnourished on admission, with a further 42%‘at risk’. Patient compliance with the ‘nutrition as medication’ program was excellent (95%) compared with current practice (48%). On reassessment patients in the trial group showed a trend towards a greater improvement in score for appetite (P = 0.065), number of meals consumed (P = 0.01) and protein intake (P = 0.007). Improvement in score for weight was significant in the trial group (P = 0.027). Length of stay was shorter in the trial group (P = 0.044). Conclusion: Routine use of a validated assessment tool is essential for early identification of malnutrition risk. A ‘nutrition as medication’ program is effective in attenuating deterioration in nutritional status.     

Healing of diabetic foot ulcers is independently associated with the use of angiotensin receptor blockers but not with those of diuretics and angiotensin conversion enzyme inhibitors

Aim. Dysregulation of the renin angiotensin system (RAS) has been proven in diabetic animal models, and studies in humans show that diuretic use is associated with lower limb amputation in diabetes. While patients with diabetes are often treated with diuretics and RAS blockers, the association between wound healing and these treatments is still unknown. We aimed to determine whether the use of diuretics and RAS blockers could influence healing of diabetic foot ulcers (DFU).Methods. Two hundred seventy-six patients referred to a specialized diabetes foot care unit for a new foot ulcer were included in this retrospective observational study.Results. Healing rate was significantly higher in patients not treated with diuretics than in those receiving diuretics (75.9 vs. 62.9%, P = 0.026) and in patients treated with angiotensin receptor blockers (ARB) than in those not treated with ARB (79.5 vs 64.4%, P = 0.012). The difference was not significant for angiotensin conversion enzyme inhibitor use. ARB use was independently and positively associated with wound healing in a multivariate adjusted model including several factors affecting wound healing (odds ratio (OR) 2.79 [1.13, 6.86] P = 0.025). Diuretic use was negatively associated with wound healing in univariate analysis (OR 0.54 [0.32, 0.91] P = 0.02) but not in multivariate adjusted analysis (OR 0.53 [0.26, 1.10] P = 0.088).Conclusions. This novel study found that ARB use is independently and positively associated with wound healing in 276 patients with DFU. On the contrary, diuretics were associated with healing rate only at univariate analysis. Further prospective studies are needed to confirm our findings.     

Effect of Benson relaxation technique on the preoperative anxiety and hemodynamic status: A single blind randomized clinical trial

BackgroundPreoperative anxiety is a challenge in most surgical interventions that needs to be taken into consideration. This trial assessed the effect of relation technique on the anxiety and hemodynamic response in patients undergoing surgical procedures.MethodsThis single blind, randomized clinical trial was conducted on patients who were candidates for coronary artery bypass graft, coronary angiography, percutaneous intervention, or general surgery at Ekbatan and Besat Hospitals, Hamadan University of Medical Sciences, from March to August 2014. Patients were randomly assigned to intervention and control groups. The intervention group received Benson's relaxation technique, a half an hour before surgical procedures. The preoperative anxiety and hemodynamic status (systolic and diastolic blood pressure, pulse pressure, heart rate, and respiratory rate) were evaluated before and after intervention.ResultsOf 166 patients identified, 144 patients enrolled into the study. No patient declined follow-up. The baseline clinical characteristics of the patients in the intervention and control groups were nearly the same. The mean systolic and diastolic blood pressure, pulse pressure, the average number of heart rates and respiratory rates declined significantly in the intervention group compared to the control group (P < 0.001). The mean score of hospital anxiety was significantly lower in the intervention group than in the control group (P < 0.001). The intervention was effective in both males and female patients.ConclusionThis trial indicated that Benson's relaxation technique is a safe method with no adverse effects with significant beneficial effect on preoperative anxiety and hemodynamic responses in patients who were candidates for surgical procedures.Trial registrationIranian Registry of Clinical Trials registration number: IRCT201312249014N19. http://www.irct.ir/searchresult.php?id=9014&number=19.     

The impact of intensified clinical care on glycaemic control in patients with type 2 diabetes at Khayelitsha Community Health Centre,South Africa: Quasi-experimental study

AimThe aim was to evaluate the effect on glycaemic control of more intensive care for patients with very uncontrolled type-2 diabetes (HbA1c > 10%) at Khayelitsha Community Health Centre, South Africa.MethodsA pragmatic, quasi-experimental study. Patients with HBA1c > 10% were consecutively selected into a 6-month programme of intensified care involving monthly visits to a doctor, diabetes group education, escalation of treatment, and more frequent HbA1c testing by either point-of-care (POC) or laboratory. Participants were their own controls in a retrospective analysis of usual care during the previous year.ResultsAt baseline 236 patients had a mean HbA1c of 12.1%. The mean difference in HbA1c in the intervention group was −1.1% (p < 0.001). The intervention group were exposed to group diabetes education (100% vs 0%), more visits (3.8 vs 3.2, p < 0.001), more HbA1c tests (2.2 vs 0.9, p < 0.001). There was no difference in increased dose of insulin between the groups or between POC and standard laboratory intervention sub-groups.ConclusionThe introduction of group diabetes education was the most likely explanation for improved glycaemic control in this poor, under-resourced, public sector, peri-urban setting. The study demonstrates a feasible approach to improving diabetes care in the South African context.     

Efficacy and safety of saroglitazar in managing hypertriglyceridemia in type-2 diabetes: A meta-analysis

Background and aimsSaroglitazar is commonly used in India for managing hypertriglyceridemia in diabetes. This meta-analysis evaluated the efficacy and safety of saroglitazar in hypertriglyceridemia.MethodsElectronic databases were searched for RCTs involving diabetes patients receiving saroglitazar in intervention arm, and placebo/lipid/diabetes medication in the control arm. Primary outcome was to evaluate change in serum triglyceride and HbA1c. Secondary outcomes were to evaluate changes in other lipid parameters, glycaemia and adverse effects. Analysis for lipid and glycaemic parameters were done separately for controls receiving anti-lipid medications (statins/fibrates) [active control group (ACG)] and those receiving placebo/diabetes medications [passive control group (PCG)].ResultsFollowing 12 weeks therapy, individuals receiving saroglitazar had significantly lower triglycerides when compared to PCG [MD -71.67 mg/dl (95% CI: −123.67 to −19.66 mg/dl); P < 0.01; I² = 91% (considerable heterogeneity); low certainty of evidence (LCE)], but not ACG [MD -37.38 mg/dl (95% CI: −84.55–9.79 mg/dl; P = 0.12; I² = 98% (considerable heterogeneity); LCE]. Individuals receiving saroglitazar had significantly lower fasting glucose when compared to PCG [MD -24.61 mg/dl (95% CI: −44.13 to −5.09 mg/dl); P = 0.01; I² = 65% (moderate heterogeneity); LCE], but not ACG [MD -13.5 mg/dl (95% CI: −33.1–6.10 mg/dl; P = 0.18; I² = 98% (considerable heterogeneity); LCE]. HbA1c, total cholesterol, LDL-C, apolipoprotein-B and HDL-C were not significantly different among study groups. Creatinine was significantly higher in patients receiving saroglitazar as compared to controls [MD 0.12 mg/dl (95% CI: 0.04–0.21 mg/dl); P < 0.01; I² = 29% (low heterogeneity); high certainty of evidence].ConclusionThis meta-analysis reinforces the excellent triglyceride lowering of saroglitazar, but highlights significant increase in creatinine.     

Comparative efficacy of growth factor therapy in healing diabetes-related foot ulcers: A network meta-analysis of randomized controlled trials

Introduction

This study examined the relative efficacy of growth factor therapies in healing diabetes-related foot ulcers (DFU).

Methods

PubMed and Cochrane databases were searched for randomized controlled trials testing growth factor therapies for treating DFU. The primary outcome was complete wound closure. Results were reported as relative risk (RR) ± 95% credible intervals (CrI). The risk of bias was assessed using Cochrane's RoB-2 tool.

Results

A total of 31 RCTs involving 2174 participants were included. Only 13 of the trials (n = 924) reported on the aetiology of the ulcers (85.4% neuropathic and 14.6% ischaemic). Epidermal growth factor (RR 3.83; 95% CrI 1.81, 9.10), plasma-rich protein (PRP) (RR 3.36; 95% CrI 1.66, 8.03) and platelet-derived growth factor (PDGF) (RR 2.47; 95% CrI 1.23, 5.17) significantly improved the likelihood of complete ulcer healing compared to control. Sub-analyses suggested that PRP (3 trials - RR 9.69; 95% CrI 1.37, 103.37) and PDGF (6 trials - RR 2.22; 95% CrI 1.12, 5.19) significantly improved the likelihood of wound closure amongst trial mainly recruiting participants with neuropathic ulcers. Eleven trials had a low risk of bias, 9 had some concerns and 11 had a high risk of bias. Sub-analysis of trials with a low risk of bias suggested that none of the growth factors significantly improved ulcer healing compared with control.

Discussion

This network meta-analysis found low-quality evidence that Epidermal growth factor, PRP and PDGF therapy improved DFU healing likelihood compared with control. Larger well-designed trials are needed.     

Liraglutide decreases energy expenditure and does not affect the fat fraction of supraclavicular brown adipose tissue in patients with type 2 diabetes

Background and aimsSeveral studies have shown that glucagon-like peptide-1 (GLP-1) analogues can affect resting energy expenditure, and preclinical studies suggest that they may activate brown adipose tissue (BAT). The aim of the present study was to investigate the effect of treatment with liraglutide on energy metabolism and BAT fat fraction in patients with type 2 diabetes.Methods and resultsIn a 26-week double-blind, placebo-controlled trial, 50 patients with type 2 diabetes were randomized to treatment with liraglutide (1.8 mg/day) or placebo added to standard care. At baseline and after treatment for 4, 12 and 26 weeks, we assessed resting energy expenditure (REE) by indirect calorimetry. Furthermore, at baseline and after 26 weeks, we determined the fat fraction in the supraclavicular BAT depot using chemical-shift water-fat MRI at 3T. Liraglutide reduced REE after 4 weeks, which persisted after 12 weeks and tended to be present after 26 weeks (week 26 vs baseline: liraglutide −52 ± 128 kcal/day; P = 0.071, placebo +44 ± 144 kcal/day; P = 0.153, between group P = 0.057). Treatment with liraglutide for 26 weeks did not decrease the fat fraction in supraclavicular BAT (−0.4 ± 1.7%; P = 0.447) compared to placebo (−0.4 ± 1.4%; P = 0.420; between group P = 0.911).ConclusionTreatment with liraglutide decreases REE in the first 12 weeks and tends to decrease this after 26 weeks without affecting the fat fraction in the supraclavicular BAT depot. These findings suggest reduction in energy intake rather than an increase in REE to contribute to the liraglutide-induced weight loss.Trial registry numberNCT01761318.     

Interventions in the diagnosis and adoption of pacemaker therapy in sinus node dysfunction patients: Results from the IMPROVE Brady study

AimsIMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients.Methods/Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant.A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001).ConclusionsA process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.     

Addition of fish oil to atherogenic high fat diet inhibited atherogenesis while olive oil did not,in LDL receptor KO mice

Background and aimsMediterranean diet has been associated with decreased cardiovascular morbidity and mortality. Both fish and olive oil are key components of this diet. Therefore, we compared their effects on nonalcoholic fatty liver disease (NAFLD) and atherogenesis in a mouse model, fed a high fat diet.Methods and resultsForty nine, female LDL receptor knockout (LDLR KO) mice were allocated into 3 groups and fed an atherogenic high fat (HF) diet for 9 weeks. The HF group was fed a high fat diet alone. A HF + OO group was fed a HF diet with added olive oil (60 ml/kg feed), and the third group (HF + FO) was fed a HF diet with added fish oil (60 ml/kg feed).Both additions of fish and olive oil, significantly decreased plasma cholesterol elevation compared to HF diet. Nevertheless, only fish oil addition reduced significantly atherosclerotic lesion area by 51% compared to HF group. Liver levels of eicosapentenoic (EPA) and docosahexaenoic (DHA) acids were several folds higher in HF + FO group than in HF and HF + OO groups. Liver levels of oleic acid were higher in HF + OO compared to the other groups. Moreover, Fish oil addition significantly decreased NAFLD scores related to steatosis and inflammation and lowered the expression of the inflammatory genes interleukin 6 (IL6) and monocyte chemoattractant protein 1 (MCP1).ConclusionThese results suggest that fish oil addition on top of an atherogenic, HF diet, is beneficial, while olive oil is not, in its effect on plaque formation and NAFLD in LDLR KO mice.     

紫草油联合艾灸对糖尿病足伤口溃疡的护理效果观察

目的研究紫-草油联合艾灸对糖尿病足伤口溃疡的护理效果。方法选择2017年6月-2018年12月期间该院接收的60例糖尿病足伤口溃疡患者为研究对象,将其分为观察组30例和对照组30例。对照组采用常规碘伏进行消毒和换药,观察组采用艾灸局部熏烤后外敷紫草油。观察组和对照组皆为2次/d。6个星期后观察对比疗效。结果观察组伤口愈合程度(93.3%)高于对照组(60.0%),差异有统计学意义(P<0.05)。结论对于糖尿病足伤口溃疡的愈合效果来看,紫草油联合艾灸比用常规碘伏进行消毒和换药更有效。     

Diabetes-related foot ulcers and associated factors: Results from the Nord-Trøndelag Health Survey (HUNT3) (2006–2008)

AimTo determine the proportion of people with diabetes reporting a history of foot ulcer and investigate associated factors and healing time in the Nord-Trøndelag Health Survey (HUNT3), Norway.MethodsIn 2006–2008, all inhabitants in Nord-Trøndelag County aged ≥ 20 years were invited to take part in this population-based study; 54% (n = 50,807) attended. In participants reporting to have diabetes we examined the relationships between foot ulcers requiring more than 3 weeks to heal (DFU) and sociodemographic, lifestyle and clinical variables using logistic regression analysis.ResultsAmong participants with diabetes, 7.4% (95% confidence interval (CI) 6.2%–8.6%) reported a DFU. The median healing time was 6.0 weeks. In the final model, factors associated with a DFU were age ≥ 75 years (odds ratio (OR) 2.3, 95% CI 1.4–3.7), male sex (OR 2.0, 95% CI 1.3–3.1), waist circumference ≥ 102 cm (men) or 88 cm (women) (OR 1.95, 95% CI 1.2–3.2), insulin use (OR 2.1, 95% CI 1.3–3.4) and any macrovascular complication (OR 1.8, 95% CI 1.1–2.8).ConclusionsThe proportion of people with diabetes reporting a DFU was 7.4%, associated factors were age ≥ 75 years, male sex, waist circumference ≥ 102 cm (men) or 88 cm (women), insulin use and any macrovascular complication. The median healing time was 6 weeks.     

Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

AimsThe objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors.MethodsWe assessed the period prevalence of foot complications on 6992 patients using ICD-9 diagnosis codes from health plan administrative data. Demographic and biological variables were ascertained from surveys and medical record reviews. We defined four mutually exclusive groups: any Charcot foot, DFU with debridement, amputation ± DFU and debridement, and no foot conditions.ResultsOverall, 55 (0.8%) patients had Charcot foot, 205 (2.9%) had DFU with debridement, and 101 (1.4%) had a lower-extremity amputation. There were 6631 patients with no prevalent foot conditions. Racial/ethnic minorities were less likely to have Charcot foot (OR = 0.21; 95% CI: 0.10, 0.46) or DFU (OR = 0.61; 95% CI: 0.44, 0.84) compared to non-Hispanic Whites, but there were no racial/ethnic differences in amputation. Histories of micro- or macrovascular disease were associated with a two- to four-fold increase in the odds of foot complications.ConclusionIn managed care patients with uniform access to health care, we found a relatively high prevalence of foot complications, but attenuation of the racial/ethnic differences of rates reported in the literature.     

Pediatric deep burn management after split-thickness autologous skin transplantation: A comparative study

Treatment of pediatric deep burns remains a challenge for healthcare personnel. After skin grafting, several treatment options are available, but comparative studies of the different options are scarce. Here, we compared the effectiveness of 2 postoperative dressings used to treat deep pediatric burns after split-thickness skin grafting.At the Department of Paediatrics, University of Pécs, 16 children received skin transplantation after the deep second and third-degree injuries between January 1, 2012 and December 31, 2020 whose results have been analyzed, in this cohort study. We compared the traditionally used Grassolind or Mepitel net and Betadine solution (comparison group) with Aquacel Ag foam and Curiosa gel (intervention group).Seven children were included in the comparison and 9 children in the intervention group. In the control group, the average number of anesthesia was 6.29, while the number of dressing changes was 4.29. After complete wound closure, the dressing''s final removal was on the 13th day, while the mean length of hospitalization was 21.89 days. On average, in the intervention group, 3.56 anesthesia was induced, and 0.66 dressing changes were needed after transplantation. Complete healing (dressing removal) was on the 10th day, and the mean length of hospitalization was 12.38 days.In the intervention group, the need for anesthesia significantly decreased by 43% (P = .004), and they required 84% fewer dressing changes after transplantation (P = .001). Moreover, the dressing could be removed 3 days earlier, and the length of hospitalization was reduced by 45% on average.     

Safety and efficacy of once weekly dipeptidyl-peptidase-4 inhibitor trelagliptin in type-2 diabetes: A meta-analysis

Background & aimsPooled systematic analysis of safety and efficacy data of trelagliptin in type-2 diabetes (T2DM) is lacking. We undertook this meta-analysis to address this issue.MethodsElectronic databases were searched for RCTs involving people with T2DM receiving trelagliptin in study arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in pre and post-meal glucose levels, glycaemic targets, lipid parameters and adverse events.ResultsFrom initially screened 63 articles, data from 6 RCTs involving 981 patients was analysed [3 in active control group (ACG) defined as having alogliptin, sitagliptin, linagliptin, teneligliptin, anagliptin or vildagliptin as active comparator; 2 in passive control group (PCG) defined as having placebo as controls; 1 study had both ACG and PCG]. HbA1c reduction by trelagliptin was comparable to ACG [MD 0.06% (95% CI: ?0.03 – 0.16); P = 0.20; I² = 0%], but superior to PCG [MD -0.54% (95% CI: ?0.64 to ?0.44); P < 0.01; I² = 22%]. Fasting blood glucose lowering with trelagliptin was inferior to ACG [MD +6.98 mg/dl (95%CI: 2.55–11.42); P = 0.002; I² = 0%], but superior to PCG [MD -6.11 mg/dl (95%CI: ?12.00 to ?0.23); P = 0.04; I² = 54%]. Glycated albumin lowering was similar to ACG [MD 0.03% (95%CI: ?0.47 – 0.53); P = 0.92; I² = 0%], but superior to PCG [MD -2.31% (95% CI: ?2.86 to ?1.76); P < 0.01; I² = 0%]. Treatment-emergent adverse events [Risk ratio (RR) 1.18 (95%CI:0.63–2.21); P = 0.59; I² = 19%] and severe adverse events [RR 1.75 (95%CI: 0.90–3.40); P = 0.10; I² = 0%] were comparable among groups.ConclusionOnce weekly trelagliptin has good glycaemic efficacy and well tolerated in people with T2DM.     

Continuity of care in patients with type 2 diabetes in Croatian primary care setting during COVID-19 pandemic: A retrospective observational study

AimTo examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not.MethodsThis retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws).ResultsNo differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64–47%, P < 0.001), eye fundus check-ups (39–37%, P = NS), neurologist check-ups (28–25%, P = NS) and FMP check-ups (382–321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7–2.4 mmol/L, P < 0.001) and eGFR (83–80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period.ConclusionAccording to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.