The association between baseline characteristics and the outcome of foot ulceration in a Maltese population with diabetes

Abstract

AIM: To determine patient and ulcer characteristics which predict wound healing in patients living with diabetes. METHODS: A prospective observational study was conducted on 100 subjects presenting with a diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up to a maximum of 1 year. RESULTS: After 1 year of follow-up, ulcer characteristics were more predictive of ulcer healing than patient characteristics. Seventy-seven per cent of ulcers healed and 23% had not healed. Independent predictors of non-healing were ulcer stage (p=0.003), presence of biofilm (p=0.020), presence of infection (p=0.022) and ulcer depth (p=0.028) in the study group. Although this study demonstrated that the baseline HBA1c reading at the start of the study was not a significant predictor of foot ulcer outcome [p=0.603, resolved vs. amputated], however upon further statistical analyses, when HbA1c was compared to the time taken for complete ulcer healing [n=77], it proved to be significant [p=0.009]. CONCLUSION: The factors influencing healing are ulcer stage, presence of biofilm and ulcer depth. These findings have important implications for clinical practice especially in an out-patient setting. Prediction of outcome may be helpful for healthcare professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life and lesser diabetes related foot complications.