A Retrospective Qualitative Study on Current Diabetic Foot Ulcer Management and Discussion on Extended Role of Clinical Pharmacist

Year 2017, Volume: 21 Issue: 2, 412 - 418, 01.04.2017

A. Porselvi M. S. Uma Shankar K. S. Lakshmi V. Sankar

https://doi.org/10.12991/marupj.301197

Abstract

Diabetic foot ulcers (DFU) are chronic complications due to

poor diabetic control. Diabetic foot ulcers can lead to lifelong

disability and substantially diminish the quality of life. The aim

of this study was to carry out a thorough evaluation of diabetic

foot ulcer management, compare current scenario of DFUs care

with the International guidelines and to identify the extended

roles of clinical pharmacist to improve the conditions of diabetic

patient with foot ulcers.

It is a retrospective qualitative study carried out in two

tertiary care hospitals of Tamil Nadu state. The patients were

selected based on inclusion and exclusion criteria admitted

in the hospitals with diabetic foot ulcers. The patient’s sociodemographic

and clinical characteristics tools from the patient

medication records (PMR) were collected and taken into

considerations for the study.

The study revealed that diabetic foot ulcer was more prevalent

among male patients with type 2 diabetes since 11 to 25 yrs

belongs to the age group between 51-60 years. It was found that

60.5% of the patients having at least one co-morbid condition

and 90.6% of patients possess one or more risk factors to

develop diabetic foot ulcers. Glycated hemoglobin (HbA1c) test

were done only by 54.7% of the patients, which showed that it

was not insisted as an important identification tool for diabetic

foot ulcer. The PMR revealed numerous antibiotics switch-over

for the wound treatment as well.

From the study it was concluded that an immediate requirement

and thorough evaluation of enhanced foot care management,

patient centered care and diabetic foot surveillance etc is

needed for diabetic foot ulcer management. A comparative

current scenario of DFUs care with the International guidelines

and its adaptation and modifications according to our need is

to be emphasized. Amalgamation of clinical pharmacy services

with the multidisciplinary diabetic foot care team services is

to be made. The clinical pharmacist’s intervention is to be put

forward to improve the conditions of diabetic patient with foot

ulcers to decrease the alarming incidences in Indian hospital

settings.

Keywords

Diabetes, diabetic foot ulcer, wounds, guidelines, clinical pharmacy intervention

References

• 1. World Health Organization. Definition, Diagnosis andClassification of Diabetes Mellitus and its complications. Part1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2 ed. Geneva, World Health Organisation1999.
• 2. Palumbo PJ, Melton Lj. III. Peripheral vascular disease anddiabetes. In: Diabetes in America. Harris MI, Hamman RF.US Government Printing Office, Washington DC. 1985; 1-21.
• 3. Reiber GE. The epidemiology of diabetic foot problems.Diabet Med 1996; 13:S6-S11.
• 4. Bartus CL, Margolis DJ. Reducing the incidence of footulceration and amputation in diabetes. Curr Diab Rep. 2004;4: 413–8.
• 5. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P,Showstack JA. Lower- extremity amputation in people withDiabetes epidemiology and prevention. Diabetes Care 1989:12: 24-31.
• 6. Edmonds ME. Progress in care of the diabetic foot. Lancet1999: 354: 270-2.
• 7. Wild S, Roglic G, Green A, Sieree R King H. Global prevalenceof diabetes: estimates for the year 2000 and projections for2030. Diabetes Care 2004; 27:1047-53.
• 8. International Diabetes Federation. IDF Atlas, 4th ed. Brusels,Belgium. 2009.
• 9. Vijay Snehalatha C, Terin M, Ramachandran A. Socio-culturalpractices that may affect the development of the diabetic foot.IDF Bull 1997: 42; 10-2.
• 10. Alonso-Fernandez M, Mancera-Romero J, Mediavilla-BravoJJ, Comas-Samper JM, Lopez-Simarro F, Perez-UnanuaMP, Iturralde-Iriso J; Work Group of Diabetes SEMERGEN(Sociedad Espanola de Medicos de Atencion Primaria).Glycemic Control and Use of A1c In Primary Care PatientsWith Type 2 Diabetes Mellitus. Primary care Diabetes 2015;9: 385-91.
• 11. Brod M. Quality of life issues in patients with diabetes andlower extremity ulcers: Patients and care givers. Qual Life Res1998; 7: 365-72.
• 12. Popkin BM, Gordon- Larsen P. The nutrition transition:Worldwide obesity dynamics and their determinants. Int JObes Relat Metab Disord. 2004; Suppl.3: S2-S9.
• 13. Unwin N. The diabetic foot in the developing world. DiabetesMetab Res Rev 2008; 24- Suppl I: S31-S33.
• 14. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003;361: 1545-51.
• 15. Boulton AJ, Vleikyte L, Ragnarson- Tennvall G, Apelqvist J.The global burden of diabetic foot disease. Lancet 2005; 366:1719-24.
• 16. Abol Hassani F, Mohajeri Tehrani MR, Tabatabaei O, LarijaniB. Burden of diabetes and its complications in Iran in the year 2000. Iran J Diabetes and Lipid Disord 2005; 5:35-48.
• 17. Reiber GE. The Epidemiology of diabetic foot problems.Diabet Med 1996; 13: S6-S11.
• 18. Al-wahbi AM. Impact of diabetic education program on lowerlimb amputation rate. Vasc Health Risk Manag 2010; 6: 923-34.
• 19. Bus SA, van Deursen RW, Armstrong DG, Lewis JE,Caravaggi CF, Cavanagh PR; International Working Groupon the Diabetic Foot. ootwear and offloading interventionsto prevent and heal foot ulcers and reduce plantar pressurein patients with diabetes: a systematic review. Diabetes MetabRes Rev 2016;32-Suppl 1:99-118.
• 20. Razgallah Khrouf M, Turki M, Louhaichi A, Guerfali M.Evaluation of the management of diabetic foot in RabtaNational Teaching Hospital. Eur J Hosp Pharm 2013; 20.
• 21. Andersen AH, Fredriksen G, Major ALS, Sund JK. Evaluationof implementation of clinical pharmacy services in centralNorway. Eur J Hosp Pharm 2013; 20: A183-A184.
• 22. Larsson J, Apelqvist J, Agardh CD, Stenstorm A. Decreasingincidence of major amputation in diabetic patients: aconsequence of a multidisciplinary foot care team approach.Diabet Med 1995: 12; 770-6.
• 23. Edmonds ME, Blundell MP, Morris ME, Cotton LT, WatkinsPJ. Improved survival of the diabetic foot: The role of aspecialized foot clinic. Q J Med 1986; 60: 763-71.
• 24. Vedhara K, Miles JN, Wetherell MA, Dawe K, Searle A, TallonD, Cullum N, DayA, Dayan C, Drake N, Price P, TarltonJ, Weinman J, Campbell R. Coping style and depressioninfluence the healing of diabetic foot ulcers: observational andmechanistic evidence. Diabetologia 2010; 53: 1590–8.
• 25. Winkley K, Sallis H, Kariyawasam D, Leelarathna LH, ChalderT, Edmonds ME, Stahl D, Ismail K. Five-year follow-up ofa cohort of people with their first diabetic foot ulcer: thepersistent effect of depression on mortality. Diabetologia2012; 55: 303–10.
• 26. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J.The global burden of diabetic foot disease. Lancet. 2005; 366:1719–24.
• 27. Toklu HZ, Akici A, Oktay Ş, Cali Ş, Sezen SF, Keyer-Uysal M.The pharmacy practice of community pharmacists in Turkey.Marmara Pharm J 2010; 14: 53-60.
• 28. Kalsi A, Singh S, Taneja N, Kukal S, Mani S. Current treatment for type2 diabetes , their side effects and possible complementary treatments. Int J Pharm Pharm Sci 2015; 3:13- 8.