Risk Factors for Delayed Healing of Neuropathic Diabetic Foot Ulcers

Abstract

Objective To estimate the effect of various risk factors on the probability thatneuropathic diabetic foot ulcers will heal within 20 weeks of care. Design and Setting A pooled or meta-analysis of individual patient data from the standardcare arms of 5 randomized clinical trials was conducted. We analyzed 586 subjectswith diabetes mellitus who had a neuropathic diabetic foot ulcer. All patientsreceived good wound care, debridement, and "off-loading" of the wound. Main Outcome Measure Multivariable logistic regression was used to calculate the magnitudeof the association of each risk factor with patients having healed wounds. Results Logistic regression odds ratios (ORs; 95% confidence intervals [95%CIs]) revealed that those patients with a diabetic neuropathic foot ulcerthat healed within 20 weeks using standard care were more likely to have asmaller wound (OR = 0.67; 95% CI, 0.55-0.81), a wound that existed for a shorterperiod (OR = 0.73; 95% CI, 0.61-0.87), and be nonwhite (OR = 0.64; 95% CI,0.43-0.96) compared with patients whose wounds did not heal within 20 weeks.The patient's age (OR = 0.99; 95% CI, 0.89-1.01), serum level of glycosylatedhemoglobin at the start of the study (OR = 1.03; 95% CI, 0.97-1.10), and sex(OR = 1.02; 95% CI, 0.69-1.50) were unassociated with the probability of woundhealing. Substantial heterogeneity was not found among the studies. Conclusions A standard care regimen for diabetic neuropathic foot ulcers is mostlikely to be effective for patients who have wounds that are small and ofbrief duration. This information should help dermatologists decide initiallywhether to use standard care, to try a new treatment, or to refer the patientto a specialty center.