Diabetes/Metabolism Research and Reviews Journal Impact Factor & Information

Publisher: Wiley

Journal description

Diabetes/Metabolism Research and Reviews is a print and electronic journal that publishes original research articles and reviews in diabetes and related areas of metabolism. The journal is dedicated to publishing papers with the shortest achievable lead times. The Editor-in-Chief and Co-Editors will consider original articles on the aetiology and pathogenesis of diabetes as well as treatment and management issues related to patient care. Areas of controversy are especially welcome. The reviews section serves the community of clinicians and researchers by providing an ongoing update of clinical and basic scientific advances in the most important areas of diabetes and metabolism.

Current impact factor: 3.55

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 3.553
2013 Impact Factor 3.593
2012 Impact Factor 2.968
2011 Impact Factor 3.373
2010 Impact Factor 3.094
2009 Impact Factor 2.762
2008 Impact Factor 3.149

Impact factor over time

Impact factor

Additional details

5-year impact 3.42
Cited half-life 6.50
Immediacy index 0.80
Eigenfactor 0.01
Article influence 1.08
Website Diabetes/Metabolism Research and Reviews website
Other titles Diabetes/metabolism research and reviews (Online), Diabetes/metabolism research and reviews, Diabetes metabolism research and reviews
ISSN 1520-7560
OCLC 39529047
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • Non-Commercial
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: To investigate the association of serum uric acid (UA) level with renal function change in patients with type 2 diabetes mellitus (T2DM). Methods: T2DM patients who had been followed-up for at least 3 years were included. Participants were categorized into stable, progression, or regression groups according to their change in chronic kidney disease (CKD) stage. During the follow-up period, all numeric values of metabolic factors, including the UA level and the medication possession rate were calculated in order to investigate their associations with CKD development. Multivariate Cox regression analyses were used to identify independent factors associated with change in CKD. Results: 2367 T2DM patients were enrolled in this study and followed-up for a mean of 4.6 years. The numbers of patients in the stable, progression and regression groups were 1133 (47.9%), 487 (20.6%), and 747 (31.5%), respectively. The progression group had the highest serum UA level (6.9 ± 1.8 mg/dL) and the regression group had the lowest UA level (5.4 ± 1.5 mg/dL). In addition, we found that the serum UA level was an independent factor associated with CKD progression when the value exceeded 6.3 mg/dL. A lower UA level could be beneficial for CKD improvement in T2DM patients with stage 3 ~ 5 CKD. Conclusions: Our data indicated that the serum UA level is associated with CKD regression and progression and suggested that a high normal serum UA level should be closely monitored in patients with T2DM. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 11/2015; DOI:10.1002/dmrr.2768
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Our study aims to assay the irisin level and investigate the relationships of irisin level with BMI, body composition, and bone metabolism in the PCOS and control women. Methods: 52 PCOS and 39 control women were recruited. Serum sex hormone, fasting insulin and C-peptide were tested. Fasting serum irisin and adiponectin were measured with ELISA. Body composition and bone mineral density were assayed by dual energy X-ray absorptiometry. Results: PCOS women showed different body composition compared with controls. Serum irisin level of PCOS didn't show significant difference compared with controls although it was decreased. The level of adiponectin in PCOS patients was significantly reduced. BMI had no correlation with irisin level. It indicated a positive correlation between serum irisin levels and BMD in the control group and a negative correlation in the PCOS group after BMI and age adjusted. Furthermore, total lean mass has a significant effect on irisin concentration in the PCOS group. There are no correlations between adiponection and body compositions and BMD in both groups. Conclusions: The abnormal body composition in PCOS may contribute to the circulation irisin. The crosstalk of irisin in different organs was found and may be related to disease development in PCOS. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 11/2015; DOI:10.1002/dmrr.2767
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Retinol binding protein (RBP) and its membrane receptor, STRA6, are vital for the management of vitamin A in the body. Recently, elevated serum RBP levels have been implicated as a contributing factor to the development of insulin resistance and type 2 diabetes. However, conflicting opinions exist as to how these increased levels can cause insulin resistance. Methods: In order to better understand the influences of RBP, a proteomic study was devised to determine the direct effect of RBP on a mouse muscle cell line, since the muscle is the principal site of insulin induced glucose uptake. C2C12 cells were treated with RBP for 16 hours and the proteome analysed for alterations in protein abundance and phosphorylation by 2-DE. Results: A number of changes were observed in response to RBP treatment, of which the most interesting were decreased levels of the phosphatase, protein phosphatase 1 β. This phosphatase is responsible for regulating glycogen synthase (GS) and glycogen phosphorylase (GP), the rate-limiting enzymes involved in glycogen storage and utilisation. RBP treatment resulted in increased phosphorylation and inhibition of GS, with detrimental effects on insulin stimulated glycogen production in these cells. Conclusion: The results indicate that RBP may have a negative effect on energy storage in the cell and could contribute to the development of insulin resistance in muscle tissue. Understanding how RBP influences insulin resistance may reveal novel strategies to target this disease. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 11/2015; DOI:10.1002/dmrr.2764
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Physical functioning may be an important pre-clinical marker of chronic disease, used as a tool to identify patients at risk for future cardiometabolic abnormalities. This study evaluated if self-reported physical functioning was associated with the development of cardiometabolic abnormalities or their clustering (metabolic syndrome) over time. Methods: Participants (n=2,254) from the Study of Women's Health Across the Nation who reported physical functioning on the Short Form health survey and had a metabolic syndrome assessment (elevated fasting glucose, blood pressure, triglycerides, and waist circumference; reduced HDL cholesterol) in 2000 were included. Discrete survival analysis was used to assess the 10 year risk of developing metabolic syndrome or a syndrome component through 2010. Results: At baseline, the prevalence of metabolic syndrome was 22.0%. Women with substantial limitations (OR=1.60; 95% CI: 1.12, 2.29) in physical functioning were significantly more likely to develop the metabolic syndrome compared to women reporting no limitations. Self-reported physical functioning was significantly associated with incident hypertension and increased waist circumference. Conclusions: Simple screening tools for cardiometabolic risk in clinical settings are needed. Self-reported physical functioning assessments are simple tools that may allow health care providers to more accurately predict the course of chronic conditions.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2765
  • [Show abstract] [Hide abstract]
    ABSTRACT: Insulin production by the pancreas follows a basic pattern where basal levels of insulin are secreted during fasting periods, with prandial increases in insulin associated with food ingestion. The aim of insulin therapy in patients with diabetes is to match the endogenous pattern of insulin secretion as closely as possible without causing hypoglycemia. There are several optimal pharmacokinetic and pharmacodynamic properties of long-acting basal insulins that can help to achieve this aim, namely: activity that is flat and as free of peaks as possible, a duration of action of ≥24-h, and as little day-to-day variation as possible. The long-acting basal insulins are a fundamental therapy for patients with type 1 and type 2 diabetes, and those that are currently available have many benefits; however, the development of even longer-acting insulins and improved insulin delivery techniques may lead to better glycemic control for patients in the future. Established long-acting basal insulins available in the US and Europe include insulin glargine 100 units/mL and insulin detemir, both of which exhibit similar glycemic control to that of the intermediate-acting NPH insulin, but with a reduction in hypoglycemia. Newer insulin products available include new insulin glargine 300 units/mL (US and Europe) and the ultra-long-acting insulin degludec (Europe) with basal insulin peglispro currently in development. These new insulins demonstrate different pharmacokinetic/pharmacodynamic profiles and longer durations of action (>24-h) compared with insulin glargine 100 units/mL, which may lead to potential benefits. The introduction of biosimilar insulins may also broaden access to insulins by reducing treatment costs. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2763
  • [Show abstract] [Hide abstract]
    ABSTRACT: Frailty: The progressive aging of population is causing a simultaneous increase of frailty worldwide. The identification of the optimal therapeutic approach is often difficult in frail subjects due to the complexity of "frailty syndrome". Nevertheless, given the relevance of diabetes in the development and progression of frailty, a safe and effective cure of diabetes is extremely important to guarantee a good medical outcome. There are few data about diabetes treatment in this delicate category of patients and the choice of the appropriate therapy mostly remains a challenge. Geography: Type 2 diabetes affects more than 382 million people of different countries, races and ethnicities. To face the lack of solid Evidence Based Medicine for the treatment of diabetes in different ethnic groups, it is extremely important to increase knowledge about the different pathophysiology of diabetes according to ethnicity. In this way a tailored approach to treatment of various ethnic groups living in the same or different regions can eventually be developed.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2762
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Accumulating evidence suggests an association between diabetes and cancer. Inflammation is a key event that underlies the pathological processes of the two diseases. Metformin displays anti-cancer effects, but the mechanism is not completely clear. This study investigated whether metformin regulated the microenvironment of macrophage polarization to affect the characteristics of HepG2 cells and the possible role of the Notch signaling pathway. Methods: RAW264.7 macrophages were cultured alone or co-cultured with HepG2 cells and treated with metformin. We analyzed classical (M1) and alternative (M2) gene expression in RAW264.7 cells using qRT-PCR. Changes in mRNA and protein expressions of Notch signaling in both cell types were also detected using qRT-PCR and Western blotting analyses. The proliferation, apoptosis and migration of HepG2 cells were detected using Cell Titer 96 AQueous One Solution Cell Proliferation Assay (MTS), Annexin V-FITC/PI and the cell scratch assay, respectively. Results: Metformin induced single cultured RAW264.7 macrophages with an M2 phenotype but attenuated the M2 macrophage differentiation and inhibited MCP-1 secretion in a co-culture system. The co-cultured group of metformin pretreatment activated Notch signaling in macrophages, but repressed it inHepG2 cells. Co-culture also promoted the proliferation and migration of HepG2 cells. However, along with the enhanced apoptosis, the proliferation and migration of HepG2 cells were remarkably inhibited in another co-culture system with metformin pretreatment. Conclusions: Metformin can skew RAW264.7 macrophages toward different phenotypes according to changes in the microenvironment, which may affect the inflammatory conditions mediated by macrophages, induce apoptosis, and inhibit the proliferation and migration of HepG2 cells. Notch signaling pathway is a potentially important mechanism in the regulation of metformin on macrophage polarization and the subsequent change of hepatoma cells. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2761
  • S A Bus ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements have long been present, only recently evidence shows their importance in ulcer prevention, as a data-driven approach to therapeutic footwear provision. The long-term monitoring of plantar pressures with the option to provide feedback when alarming pressure levels occur, is a promising development in this area, although more technical and clinical validation is required. Shear is considered important in ulcer aetiology, but is technically difficult to measure. Innovative research is underway to assess if foot temperature can act as a useful surrogate for shear. Because the skin heats up before it breaks down, frequent monitoring of foot temperature can identify these warning signals. This approach has shown to be effective in preventing foot ulcers. Innovation in diagnostic methods for foot temperature monitoring and evidence on cost-effectiveness will likely facilitate implementation. Finally, monitoring of adherence to offloading treatment using temperature-based sensors has proven to be a feasible and relevant method with a wide range of possible research and patient care applications. These innovations in plantar pressure and temperature measurements illustrate an important transfer in diabetic foot care from subjective to objective evaluation of the high-risk patient. They demonstrate clinical value and a large potential in helping to reduce the patient and economic burden of diabetic foot disease. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2760
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is known that the relative importance of factors involved in the development of diabetic foot problems can vary in both their presence and severity between patients and lesions. This may be one of the reasons why outcomes seem to vary centre to centre and why some treatments may seem more effective in some people than others. There is a need therefore to classify and describe lesions of the foot in patients with diabetes in a manner that is agreed across all communities but is simple to use in clinical practice. No single system is currently in widespread use, although a number have been published. Not all are well validated outside the system from which they were derived, and it has not always been made clear the clinical purposes to which such classifications should be put to use, whether that be for research, clinical description in routine clinical care or audit. Here the currently published classification systems, their validation in clinical practice, whether they were designed for research, audit or clinical care, and the strengths and weaknesses of each are explored.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2746
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The prevalence of type 2 diabetes in China is increasing rapidly. Appropriate management of glycemia, blood pressure, and dyslipidemia in his population is a major public health concern.Objective We assessed glycated hemoglobin A1c (HbA1c), blood pressure (BP), and LDL cholesterol (LDL-c), the ABCs of good management in a large sample of patients with type 2 diabetes in China and attempted to identify factors that correlated with achievement of ABCs goals.MethodA nationwide survey was conducted in 50 medical centers across China from April to July of 2010. Baseline information on demographics, medical history HbA1c, BP and LDL cholesterol levels were measured in 5961 patients with type 2 diabetes.ResultsMean age, body mass index (BMI), and HbA1c were 59.50 ±1.25 years, 24.49± 4.10 kg/m2, and 8.27±2.23 % respectively. With respect to generally accepted ABC treatment goals, 35.2% of the participants had HbA1c <7%, 35.5% had BP<140/80 mmHg, and 45.1% had LDL-c<100 mg/dl. The proportion of patients met all three targets was only 5.4%. Smoking, higher BMI and insulin use were the strongest determinants of failing to meet ABC targets.Conclusion The percentage of Chinese patients with type 2 diabetes in our sample who met recommended targets met achieving for HbA1c, BP and LDL-c was low. The percentage of patients at target was lower among those who smokes, had higher BMI, and use insulin.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2757
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the growing demand for the specialized care of wounds, there is an ever expanding abundance of wound care modalities available. It is difficult to identify which products or devices enhance wound healing and thus a critical and continual look at new advances is necessary. The goal of any wound regimen should be to optimize wound healing by combining basic wound care modalities including debridement, off-loading, and infection control with the addition of advanced therapies when necessary. This review takes a closer look at current uses of negative pressure wound therapy, bioengineered alternative tissues, and amniotic membrane products. While robust literature may be lacking, current wound care advances are showing great promise in wound healing. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2747
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diabetic foot ulceration (DFU) is a chronic complication of diabetes that is characterized by impaired wound healing in the lower extremities. DFU remains a major clinical challenge due to poor understanding of its pathogenic mechanisms. Impaired wound healing in diabetes is characterized by decreased angiogenesis, reduced bone marrow-derived endothelial progenitor cell (EPC) recruitment, and decreased fibroblast and keratinocyte proliferation and migration. Recently, increasing evidence has suggested that increased hypoxic conditions and impaired cellular responses to hypoxia are essential pathogenic factors of delayed wound healing in DFU. Hypoxia-inducible factor-1 (HIF-1, a heterodimer of HIF-1α and HIF-1β) is a master regulator of oxygen homeostasis that mediates the adaptive cellular responses to hypoxia by regulating the expression of genes involved in angiogenesis, metabolic changes, proliferation, migration and cell survival. However, HIF-1 signaling is inhibited in diabetes due to hyperglycemia-induced HIF-1α destabilization and functional repression. Increasing HIF-1α expression and activity using various approaches promotes angiogenesis, EPC recruitment and granulation, thereby improving wound healing in experimental diabetes. The mechanisms underlying HIF-1α regulation in diabetes and the therapeutic strategies targeting HIF-1 signaling for the treatment of diabetic wounds are discussed in this review. Further investigations of the pathways involved in HIF-1α regulation in diabetes are required to advance our understanding of the mechanisms underlying impaired wound healing in diabetes and to provide a foundation for developing novel therapeutic approaches to treat DFU. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2742
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb length inequality. Surgical management: The primary indication for surgical reconstruction is a nonbraceable deformity associated with instability. Other indications include impending ulceration, inability to heal an ulcer, recurrent ulcers, presence of osteomyelitis and/or significant pain. Arthrodesis of the ankle and /or hindfoot is the method of choice when surgically correcting CN deformities in this region. The choice of fixation (i.e. internal or external fixation) depends on largely on the presence or absence of active infection and bone quality. Conclusion: Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Despite this high complication rate, surgeons embarking on surgical reconstruction of ankle and hindfoot CN should strive for limb salvage rates approximating 90 %. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2748
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is well established that hyperglycaemia is associated with many negative cardiovascular and immunological effects. Due to the high prevalence of underlying vascular disease along with associated infection, patients with diabetic foot ulcers are especially vulnerable to these adverse consequences. While studies consistently demonstrate worse outcomes in the setting of hyperglycaemia during hospitalisation, multiple trials examining the effects of intensive glycaemic control reveal mixed results. In particular, effects on mortality are varied and although there may be some benefit in the setting of infection, hypoglycaemia is a concern when glucose levels are treated down to the normoglycaemic range. Therefore, although metabolic regulation is worthwhile theoretically, the optimal intensity of control is unclear. There is a need for future research to clarify the benefits and risks associated with strict metabolic control in patients with diabetic foot ulceration. In the interim recommendations from international guidelines should be followed; these advise pre-meal glucose targets of <7.8 mmol/L and random targets of <10.0 mmol/L in general medical and surgical settings. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2741
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diabetes is a chronic illness which has an effect on multiple organ systems. Frailty is a state of increased vulnerability to stressors and a limited capacity to maintain homeostasis. It is a multidimensional concept and a dynamic condition that can improve or worsen over time. Frailty is either physical or psychological or a combination of these 2 components. Sarcopenia, which is the age-related loss of skeletal muscle mass and strength, is the main attributor to the physical form of frailty. Although the pathophysiology of diabetes is commonly focused on impaired insulin secretion, overload of gluconeogenesis and insulin resistance, newer insights broaden this etiologic horizon. Immunologic factors which create a chronic state of low-grade inflammation - 'inflammaging' - have an influence on both the ageing process and diabetes. Persons with diabetes mellitus already tend to have an accelerated aging process that places them at greater risk for developing frailty at an earlier age. The development of frailty - and sarcopenia - is multifactorial and includes nutritional, physical and hormonal elements; these elements are interlinked with those of diabetes. A lower muscle mass will lead to poorer glycemic control through lower muscle glucose uptake. This leads to higher insulin secretion and insulin resistance, which is the stepping stone for diabetes itself. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2743
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diabetes patients with ankle equinus are at particularly high risk for forefoot ulceration due to the development of high forefoot pressures. High stiffness in the triceps surae muscles and tendons are thought to be largely responsible for equinus in diabetes patients and underpins the surgical rationale for Achilles tendon lengthening (ATL) procedures to alleviate this deformity and reduce ulcer risk. The established/ traditional surgical approach is the triple hemi-section along the length of the Achilles tendon. Although the percutaneous approach has been successful in achieving increases in ankle dorsiflexion >30 degrees, the tendon rupture risk has led to some surgeons looking at alternative approaches. The gastrocnemius aponeurosis may be considered as an alternative due to the Achilles tendon's poor blood supply. ATL procedures are a balance between achieving adequate tendon lengthening and minimizing tendon rupture risk during or after surgery. After ATL surgery the first seven days should involve reduced loading and protected range of motion to avoid rupture, after which gradual re-introduction to loading should be encouraged to increase tendon strength. In summary, there is a moderate level of evidence to support surgical intervention for ankle joint equinus in diabetes patients with forefoot ulceration that is non-responsive to other conservative treatments. Areas of caution for ATL procedures include the risk for overcorrection, tendon rupture and the tendon's poor blood supply. Further prospective randomized-control trials are required to confirm the benefits of ATL procedures over conservative care and the most optimal anatomical sites for surgical intervention. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2745
  • [Show abstract] [Hide abstract]
    ABSTRACT: Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards. A diabetes foot service should have risk stratification system in place that should compare to the population based figures of 76% having low risk feet, 17% moderate risk and 7% being at high risk of ulceration. Resources can then be directed towards those with high risk feet. Prevalence of foot ulceration needs audited. Community based studies give an audit standard of around 2%, with 2 to 9% having had an ulcer at some stage in the past. Amputation rates should be easier to measure and the best results are reported to be around 1.5-3 per 1,000 people with diabetes. This is a useful benchmark figure and the rate has been shown to decrease by approximately a third over the last fifteen years in some centres. Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals an amputation can be a good outcome. In addition to clinical outcomes, processes of care can be audited such as provision of clinical services, time from new ulcer to be seen by health-care professional, in-patient foot care or use of antibiotics. Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2015; DOI:10.1002/dmrr.2749