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

Abstract

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.

Citation

Bajpai, R., Zhu, X., Olsson, M. M., Goh, L. J., & Lim, V. H. (2022). Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample. Advances in skin & wound care, 35(1), 22 - 29. https://doi.org/10.1097/01.ASW.0000801524.42349.4d

• 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
• DOI: https://doi.org/10.1097/01.ASW.0000801524.42349.4d
• Keywords: diabetes; diabetic foot ulcer; healing outcomes; primary care; Singapore
• Publisher URL: https://journals.lww.com/aswcjournal/Abstract/2022/01000/Factors_Associated_with_Healing_Outcomes_in.6.aspx