Tina Lefrancois1, Kinjal Mehta2, Victoria Sullivan3, Sheldon Lin4, Mark Glazebrook5. 1. Thunder Bay Regional Health Sciences Centre, 980 Oliver Road, Thunder Bay, Ontario P7B 6V4, Canada. Electronic address: tinalefrancoise@gmail.com. 2. Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore. Electronic address: kinjalmehta@hotmail.com. 3. Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, Nova Scotia B3H3A7, Canada. Electronic address: tor_sullivan@msn.com. 4. Overlook Medical Center, Hackensack University Medical Center, 90 Bergen St, Newark, NJ 07103, USA. Electronic address: linsheldon2@gmail.com. 5. Dalhousie University, Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, Nova Scotia B3H3A7, Canada. Electronic address: markglazebr@hotmail.com.
Abstract
BACKGROUND: Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. METHOD: A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. RESULTS: Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. CONCLUSION: Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.
BACKGROUND:Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. METHOD: A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. RESULTS: Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. CONCLUSION: Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.
Authors: Kyrstin L Lane; Mohammed S Abusamaan; Betiel Fesseha Voss; Emilia G Thurber; Noora Al-Hajri; Shraddha Gopakumar; Jimmy T Le; Sharoon Gill; Jaime Blanck; Laura Prichett; Caitlin W Hicks; Ronald L Sherman; Christopher J Abularrage; Nestoras N Mathioudakis Journal: J Diabetes Complications Date: 2020-05-22 Impact factor: 2.852