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Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample

Bajpai, Ram; Zhu, Xiaoli; Olsson, Maja M.; Goh, Ling Jia; Lim, Voon Hooi


Xiaoli Zhu

Maja M. Olsson

Ling Jia Goh

Voon Hooi Lim


OBJECTIVE To identify and determine patient- and ulcer-related factors associated with healing outcomes within 3 months for patients with diabetic foot ulcer (DFU) in a multiethnic primary care sample. METHODS Retrospective data were collected over 3 months from 520 primary care patients with a DFU between April 1, 2016 and March 31, 2017. Multivariable prevalence ratios (PRs) were calculated using Poisson regression to find associations between patient- and ulcer-related factors and healing outcomes. RESULTS Most patients were male (66%) and Chinese (49.8%) and had a diabetes mellitus duration longer than 5 years (81.8%). Toe ulcers (64%) were most common. Healing occurred for 33.9% of participants; 19.1% and 1.5% underwent minor and major amputation, respectively. Wound sizes between 1 and 10 cm2 (PR, 0.61; 95% confidence interval [CI], 0.46–0.76; P < .001) and over 10 cm2 (PR, 0.55; 95% CI, 0.33–0.76; P = .003), ulcer duration 6 months or longer (PR, 0.36; 95% CI, 0.19–0.53; P < .001), ischemic ulcers (PR, 0.54; 95% CI, 0.22–0.86; P = .044), and neuroischemic ulcers (PR, 0.73; 95% CI, 0.53–0.93; P = .027) were negatively associated with healing outcomes. Women were more likely to experience healing (PR, 1.18; 95% CI, 0.91–1.45; P = .157). CONCLUSIONS Ulcer healing varied by sex and was affected by wound size, wound duration, and ischemic etiology, regardless of ethnicity. Prompt attention to these risk factors may reduce healing time. Further studies are warranted to elucidate the mechanism underlying sex differences in association with DFU healing.

Journal Article Type Article
Acceptance Date Feb 18, 2021
Publication Date 2022-01
Publicly Available Date May 30, 2023
Journal Advances in Skin & Wound Care
Print ISSN 1527-7941
Electronic ISSN 1538-8654
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 35
Issue 1
Pages 22 - 29
Keywords diabetes; diabetic foot ulcer; healing outcomes; primary care; Singapore
Publisher URL