The Effect of Individualised Glycemic Intervention on Wound Healing Rate in Diabetic Foot Ulcer (The EIGIFU Study)
Keywords:diabetic foot ulcer, individualised glycemic intervention, wound healing
Abstract*Visual Abstracts prepared by Dr. Francis Xavier Mislang
Objective: To evaluate the association of glycated haemoglobin (HbA1c) reduction and wound healing in patients with diabetic foot ulcer (DFU).
Methodology: A 12-week prospective, non-controlled, interventional study in suboptimal-controlled T2DM patients with DFU was conducted. Antidiabetic medications were adjusted with the aim of at least 1% in relation to patient’s individualised HbA1c target. The wound area was determined by using specific wound tracing. The daily wound area healing rate in cm2 per day was calculated as the difference between wound area at first visit and the subsequent visit divided by the number of days between the two visits.
Results: 19 patients were included in the study. There was a significant HbA1c reduction from 10.33 %+1.83% to 6.89%+1.4% (p<0.001) with no severe hypoglycaemia. The median daily wound area healing rate was 0.234 (0.025,0.453) cm2/day. There was a strong positive correlation between these two variables (r=0.752, p=0.01). After dividing the patients into four quartiles based on final HbA1c and comparing the first quartile vs fourth quartile, there was a significant difference in daily wound area healing rates (0.597 vs 0.044 cm2/day, p=0.012).
Conclusion: There was a positive correlation between HbA1c reduction and wound healing rate in patients with DFU. Although this is an association study, the study postulated the benefits of achieving lower HbA1c on wound healing rate in DFU which require evidence from future randomised controlled study.
Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: Part II. management. J Am Acad Dermatol. 2014;70(1):21.e1–2124. PMID: 24355276. https://doi.org/10.1016/j.jaad.2013.07.048.
Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of International Working Group on Diabetic Foot (IWGDF) Pak J Med Sci. 2013;29(3):730–4. PMID: 24353617. PMCID: PMC3809295.
Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group pf the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679-85. PMID: 18663232. PMCID: PMC2494620. https://doi.org/10.2337/dc08-9021.
Clinical practice guidelines on management of diabetic foot, Academy of Medicine Malaysia and Ministry of Health, Malaysia. 2004. http://www.acadmed.org.my/index.cfm?menuid=67.
Khalid BAK. Status of diabetics in Malaysia: In World book of Diabetes in Practice, 7th ed. Elsevier Science Publishers, 1998, pages 341-2.
Snyder RJ, Hanft JR. Diabetic foot ulcers--effects on QOL, costs, and mortality and the role of standard wound care and advanced-care therapies. Ostomy Wound Manage. 2009;55(11):28–38. PMID: 19934461.
Ragnarson Tennvall G, Apelqvist J. Health-economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39 Suppl 2:S132–9. PMID: 15306992. https://doi.org/10.1086/383275.
Patout CA, Birke JA, Horswell R, Williams D, Cerise FP. Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population. Diabetes Care. 2000;23(9):1339–42. PMID: 10977029.
Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005;366(9498):1725–35. PMID: 16291067. https://doi.org/10.1016/S0140-6736(05)67699-4.
Driver VR, Madsen J, Goodman RA. Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. Diabetes Care. 2005;28(2):248–53. PMID: 15677774.
Bowering CK. Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001;47:1007-16. PMID: 11398715. PMCID: PMC2018500.
McMurry JF Jr. Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes. Surg Clin North Am. 1984;64(4):769–78. PMID: 6433493.
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):854–65. PMID: 9742977.
Hasan R, Firwana B, Elraiyah T, et al. A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome. J Vasc Surg. 2016;63(2 Suppl):22S-8S. PMID: 26804364. https://doi.org/ 10.1016/j.jvs.2015.10.005.
Pomposelli JJ, Baxter JK 3rd, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22(2):77–81. PMID: 9527963. https://doi.org/10.1177/014860719802200277.
Dhatariya KK, Li Ping Wah-Pun Sin E, Cheng JOS, et al. The impact of glycaemic variability on wound healing in the diabetic foot - a retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic. Diab Res Clin Pract. 2018;134:23-9. PMID: 29097286. https://doi.org/10.1016/j.diabres.2017.10.022.
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37-53. PMID: 25685277. PMCID: PMC4317316. https://doi.org/ 10.4239/wjd.v6.i1.37.
Clinical practice guideline management of type 2 diabetes mellitus, 5th edition, Ministry of Health, Malaysia. 2015. http://www.moh.gov.my/penerbitan/CPG/CPG%20T2DM%202015.pdf.
Khoo R, Jansen S. The evolving field of wound measurement techniques: A Literature Review. Wounds. 2016;28(6):175-81. PMID: 27377609.
Practical Guide to Insulin Therapy in Type 2 Diabetes Mellitus. Ministry of Health and Malaysian Endocrine & Metabolic Society, Malaysia. 2011. http://www.mems.my/file_dir/3308086634dc0e0f9e1c72.pdf.
Schreiber SA, Ferlinz K, Haak T. The long-term efficacy of insulin Glargine plus oral antidiabetic agents in a 32-month observational study of every day clinic practice. Diabetic Technol Ther. 2008;10(2):121-7. PMID: 18260775. https://doi.org/10.1089/dia.2007.0265.
Sumpio BE, Aruny J, Blume PA. The multidisciplinary approach to limb salvage. Acta Chir Belg. 2004;104(6):647–53. PMID: 15663269.
Wraight PR, Lawrence SM, Campbell DA, Colman PG. Creation of a multidisciplinary, evidence based, clinical guideline for the assessment, investigation and management of acute diabetes related foot complications. Diabet Med. 2005;22(2):127–36. PMID: 15660728. https://doi.org/10.1111/j.1464-5491.2004.01363.x.
Aydin K, Isildak M, Karakaya J, Gürlek A. Change in amputation predictors in diabetic foot disease: Effect of multidisciplinary approach. Endocrine. 2010;38(1):87–92. PMID: 20960107. https://doi.org/ 10.1007/s12020-010-9355-z.
Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: Cluster randomised controlled trial. BMJ. 2008:336(7642);491-5. PMID: 18276664. PMCID: PMC2258400. https://doi.org/10.1136/bmj.39474.922025.BE.
How to Cite
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to firstname.lastname@example.org or email@example.com.
A written agreement shall be emailed to the requester should permission be granted.