Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

Figures & data

Table 1. Clinical characteristic and DFU outcome.

Total sample 230	Frequency (n)	Percentage	p-Value ulcer outcome	Odds ratio (95% confidence interval)
Total males	156	68	0.1	–
50 years and older	203	88	0.3	–
Type 2 diabetes mellitus	217	95	0.8	–
Diabetes mellitus duration ≥ 20 years.	129	59	0.8	–
Smoker	44	19	0.02^a	0.23 (0.12–0.45)
History of acute vascular event	26	11	0.6	–
Chronic heart disease	79	34	0.6	–
Chronic kidney disease	58	25	0.001^b	3.64 (1.38–9.63)
End stage renal disease	20	9	0.01^c	0.29 (0.11–0.77)
Retinopathy	130	57	0.03^d	1.77 (0.96–3.28)
Coronary artery revascularisation	44	18	0.4	–
Peripheral artery revascularisation	26	11	0.4	–
History of diabetic foot ulcer	140	61	0.9	–
History of osteomyelitis	62	30	0.9	–
History of amputation	86	37	0.8	–
	Mean	Standard deviation (±)	95% Confidence interval
Age	62.6	9.5	59.2–65.3	–
Glycosylated haemoglobin (HbA1c)	8.8 (73 mmol/mol)	2.02	8.2–9.3 (66-78 mmol/mol)	–
Body mass index (BMI)	33.2	6.7	31.3–35.0	–
Haemoglobin	122.8	14.6	118.7–126.9	–
Creatinine	129.0	102.7	114.3–158.3	–
Ankle brachial pressure index (ABPI)	1.1	0.4	0.91–1.2	–

p-values related to factors which have a significant impact on DFU healing (p = 0.05 or less is significant).

^aCompared to non-smokers and ex-smokers.

^bCompared to normal kidney function.

^cCompared to normal kidney function and CKD.

^dCompared to no proliferation/macular oedema.

Table 2. DFU clinical characteristics related to outcome.

	Total	Healed
DFU clinical characteristics	n	n	%	p-Value	Odds ratio (95% confidence interval)
Dorsal diabetic foot ulcer (dorsum, toes and digital amputation sites)	153	118	77	0.03^a	–
≥2 diabetic foot ulcers	66	46	70	0.6	–
Diabetic foot ulcer duration ≥ 1 month	118	86	73	0.8	–
Loss of pain sensation	218	161	74	0.6	–
Monophasic Doppler signal	74	45	63	0.004^b	0.43 (0.2–0.8)
Neuroischaemic/ischaemic DFU classification	120	77	64	0.02^c	0.49 (0.29–0.81)
Positive probe-to-bone	66	41	62	0.02^d	0.52 (0.29–0.92)
Positive X-ray	60	37	62	0.03^e	0.67 (0.3–1.5)
Osteomyelitis	90	58	64	0.05^f	0.60 (0.36–1.01)
Positive bacterial growth	129	90	70	0.4	–
Methicillin-resistant Staphylococcus aureus	11	8	73	0.4	–

p-value related to clinical factors which may or may not affect DFU healing (p = 0.05 or less shows significance).

^aCompared to plantar and calcaneal ulcers.

^bCompared to biphasic and triphasic Doppler pulses.

^cCompared to neuropathic DFU.

^dCompared to negative probe-to-bone.

^eCompared to negative radiological findings.

^fCompared to DFU not complicated by osteomyelitis.

Figure 1. Risk factors and outcome.

Table 3. Days to heal.

Risk factors	Median days to heal	p-Value
Male gender	55	0.5
≥50 years age	59.5	0.05^a
≥20 years diabetes mellitus	53	0.4
Chronic kidney disease	42	0.9
End stage renal disease	72.5	0.3
Proliferative retinopathy	51	0.3
Smoker	62	0.5
History of acute vascular event	75.5	0.1
Chronic cardiac disease	60.5	0.1
Coronary artery revascularisation	64	0.1
Peripheral artery revascularisation	62	0.2
Diabetic foot ulcer
Duration <1 month	43	0.06^b
Calcaneal location	78	0.1
Neuroischaemic classification	61	0.005^c
Clinical investigations
Monophasic Doppler signal	62	<0.001^d
Positive X-ray	83	0.05^e
Positive probe-to-bone	77	0.05^f
Total osteomyelitis	77	<0.001^g
Positive bacterial growth	66	0.002^h
Methicillin-resistant Staphylococcus aureus	100.5	<0.001^i

Factors that may or may not influence total number of days to heal (p ≤ 0.05 shows significance).

^aCompared to patients < 50 years of age.

^bCompared to DFU present for longer than 1 month.

^cCompared to neuropathic classification.

^dCompared to biphasic and triphasic Doppler pulses.

^eCompared to negative radiological findings.

^fCompared to negative probe-to-bone.

^gCompared to DFU not complicated by osteomyelitis.

^hCompared to no bacterial growth.

ⁱCompared to gram-positive, gram-negative growth and no growth.