Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A Preliminary Study

Loyola University Medical Center, Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA.
Foot & Ankle International (Impact Factor: 1.51). 03/2005; 26(2):128-34.
Source: PubMed


Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression.
Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group.
The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group (p <0.001) and amputee (p <0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups (p <0.314).
The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.

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Available from: Michael S Pinzur, Aug 28, 2014
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    • "There are only a few published studies that have comprehensively compared the psychological issues of patients with DF with diabetic patients without this late complication [31, 36] or with healthy volunteers [33]. However, these published studies had their own limitations in terms of data collection or sample size. "
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    ABSTRACT: Unlabelled: The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls). Methods: 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics. Results: Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups. Conclusions: Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.
    Journal of Diabetes Research 03/2014; 2014:371938. DOI:10.1155/2014/371938 · 2.16 Impact Factor
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    • "Existing research has not focused on psychological morbidity in patients specifically with diabetic Charcot foot. Ulcerations and Charcot foot have either been grouped together [20] or Charcot foot is not mentioned as a distinct diagnosis [21]. Existing studies are based on small groups of Charcot patients, but findings specific to this group are not presented in publications [22]. "
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    ABSTRACT: Background/aims: Charcot foot is a rare but devastating complication of diabetes. Little research is available on the mental health impact of Charcot foot. Aim of the study is to assess mental health in diabetes patients with Charcot foot and to investigate the moderating effects of socio-demographic factors. The severity of the problem will be statistically evaluated with the help of a reference data set. Cross-sectional questionnaire data using the Hospital Anxiety and Depression Scale (HADS) and demographic background were collected from 50 patients with diabetes and Charcot complications (males 62%; mean age 62.2 +/- 8.5 years). Statistical comparisons with a large data set of general diabetes patients acting as a point of reference was carried out. Anxiety and depression levels were high, (anxiety and depression scores 6.4 +/- 4, and 6.3 +/- 3.6 respectively). Females reported more severe anxiety and depression. Ethnic minorities and patients out of work reported more severe anxiety. Comparisons with published HADS data indicate that diabetes patients with Charcot foot experience more serious levels of anxiety and depression. The high levels of mental health problems which were found in this study in diabetes patients with Charcot foot require recognition by researchers and clinicians. The findings imply the need to screen for mental health problems in diabetes patients with Charcot foot and other serious foot complications.
    Journal of Foot and Ankle Research 03/2014; 7(1):22. DOI:10.1186/1757-1146-7-22 · 1.46 Impact Factor
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    • "About 15% of diabetic patients will develop chronic ulcer, and about 25% of those will have to undergo foot amputation [1] [2]. In the nonhealing diabetes mellitus (DM) ulcers, in addition to vascular and neurological disorders, the healing process is impaired in part due to deficiency of growth factors [3]. "
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    ABSTRACT: Lower extremity ulcers in diabetic patients are difficult to treat. Recently, the use of human blood platelet-derived components in this indication has been raising interest. In this study, we have evaluated the safety and efficacy of the combination of autologous platelet gel (PG) and skin graft for treating large size recalcitrant ulcers. Eight consecutive diabetic patients aged 25 to 82 with nine nonhealing lower extremity ulcers (median size of 50 cm(2); range 15-150 cm(2)) were treated. Skin ulcer was debrided, and the wound was sprayed after 7 to 10 days with autologous platelet-rich plasma and thrombin. Thin split-thickness skin graft with multiple slits was then applied on the wound bed and fixed with staples or cat-gut sutures. There were no adverse reactions observed during the study. Eight out of 9 skin grafts took well. The interval between skin graft and complete wound healing ranged from 2 to 3 weeks in the 8 successful cases. No ulcer recurrence was noted in those patients during the follow-up period of 2 to 19 months. In this study, the combination of autologous platelet gel and skin grafting has proven beneficial to heal large-size recalcitrant ulcers.
    BioMed Research International 03/2013; 2013:837620. DOI:10.1155/2013/837620 · 2.71 Impact Factor
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