The landscape of diabetic foot in Peru.
El panorama del pie diabético en el Perú.
Keywords:
diabetic foot, diabetes mellitus, Peru, Public Health
Abstract
Diabetic foot (DF) is one of the main complications responsible for the significant deterioration of the quality of life in diabetic patients, particularly, in developing countries. In Peru, 18.9% of diabetic inpatients present DF and 61% develop a foot sepsis. Therefore, the burden of DF is considerable in the country. In this work, we summarize the current scientific evidence of DF in the Peruvian population describing its epidemiology, risk factors, increase of time of hospitalization, bacterial resistance, rate of amputations, and the theoretical medical costs for disease management. According to the reviewed literature, we suggest that more local research should be conducted to better understand the impact of the DF on the Peruvian population.
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References
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Lim JZM, Ng NSL, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med 2017;110(3):104–109.
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Villena J, Burga, J, Corigliano S, Valdivia J. Morbimortalidad por diabetes mellitus no insulino dependiente (DMNID) en el Hospital Nacional Cayetano Heredia, 1985- 1995. Rev Médica del Perú 1996;64–68.
Gonzales-Grández NN, Rodríguez-Lay EG, Manrique-Hurtado H. Características clínicas y factores asociados a morbilidad intra-hospitalaria en los pacientes con diabetes mellitus tipo 2. Rev Soc Peru Med Interna 2013;26(4):159–165.
Hicks CW, Selvarajah S, Mathioudakis N, Sherman RL, Hines KF, Black III JH, Abularrage CJ. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg 2016;33:149–158.
Kasiya MM, Mang’anda GD, Heyes S, Kachapila R, Kaduya L, Chilamba J, Goodson P, Chalulu K, Allain TJ. The challenge of diabetic foot care: Review of the literature and experience at Queen Elizabeth Central Hospital in Blantyre, Malawi. Malawi Med J 2017;29(2):218–223.
Barbosa Marques AD, Sales da Silva LM, Magalhães Moreira TM, Martins Torres RA. Asociação entre internação hospitalar por diabetes mellitus e amputação de pé diabético. Enfermería Glob 2018;17(3):238.
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Torres-Aparcana HL, Gutiérrez C, Pajuelo- Ramírez J, Pando-Álvarez R, Arbañil-Huamán H. Características clínicas y epidemiológicas de los pacientes hospitalizados por pie diabético en el Hospital Nacional Dos de Mayo entre 2006 y 2008, Lima-Perú. Rev Peru Epidemiol 2012;16(3):1–6.
Ibarra CT, Rocha J de J, Hernández R, Nieves RE, Leyva R. Prevalencia de neuropatía periférica en diabéticos tipo 2 en el primer nivel de atención. Rev Med Chile 2012;140(9):1126–1131.
Damas-Casani VA, Yovera-Aldana M, Seclén Santisteban S. Clasificación de pie en riesgo de ulceración según el Sistema IWGDF y factores asociados en pacientes con diabetes mellitus tipo 2 de un hospital peruano. Rev Medica Hered 2017;28(1):5.
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Ghanassia E, Villon L, Dieudonné JFTD, Boegner C, Avignon A, Sultan A. Long term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers. Diabetes Care 2008;31(7):1288–1292.
Capellari C, Pinheiro da Costa-Bartira E, Larre A, Pasin D, Cardoso A, Vasconcelos L de, Figueiredo AE. Educational interventions and glycemic control: Integrative Review. J Diabetes Metab 2016;7(6).
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Tan JH, Hong CC, Shen L, Tay EYL, Lee JKX, Nather A. Costs of patients admitted for diabetic foot problems. Ann Acad Med Singapore 2015;44(12):567–570.
Game F, RJ H, Apelqvist J, Bakker K, Hatermann A, Löndahl M, Price P, Jeffcoate W. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012;28(suppl 1): 119-141. doi: 10.1002/ dmrr.2246.
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Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelquist J. The global burden of diabetic foot disease. Lancet 2005;366:1719– 1724.
Edmonds M, Manu C, Vas P. The current burden of diabetic foot disease. J Clin Orthop Trauma 2021;17:88–93. Available from: https://www.sciencedirect.com/ science/article/pii/ S0976566221000837
Kerr M. Foot care for people with diabetes: the economic case for change supporting, improving, caring [Internet]. 2012. Available from: https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/ diabetes-storage/migration/pdf/footcare- for-people- with-diabetes.pdf
Van Netten JJ, Bus SA, Apelqvist J, Lipsky BA, Hinchliffe RJ, Game F, Rayman G, Lazzarini PA, Forsythe RO, Peters EJG, Senneville É, Vas P, Monteiro-Soares M, Schaper NC. Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev 2020;36(S1):1–6.
Pitocco D, Spanu T, Di Leo M, Vitiello R, Rizzi A, Tartaglione L, Fiori B, Caputo S, Tinelli G, Zaccardi F, Flex A, Galli M, Pontecorvi A, Sanguinetti M. Diabetic foot infections: a comprehensive overview. Eur Rev Med Pharmacol Sci 2019;23(2):26–37.
Khanolkar M, Bain S, Stephens J. The diabetic foot. QJM 2008;101(9):685–695.
American Diabetes Assocation. 11. Micro-vascular complications and foot care: Standards of medical care in diabetes—2021. Diabetes Care 2021;44:S151–167.
Lim JZM, Ng NSL, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med 2017;110(3):104–109.
Singh N, Amstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes JAMA 2005;293(2):217–228.
Asociación Latinoamericana de Diabetes. Guías ALAD sobre el Diagnóstico, Control y Tratamiento de la Diabetes Mellitus Tipo 2 con Medicina Basada en Evidencia Edición 2019 [Internet]. Revista de la Asociación Latinoamericana de Diabetes 2019. Available from: http://www.revistaalad.com/ guias/5600AX191_guias_alad_ 2019.pdf
Yovera-Aldana M, Sáenz-Bustamante S, Quispe-Landeo Y, Agüero-Zamora R, Salcedo J, Sarria C, Gonzales-Grandez N, Briceño-Alvarado M, Antezana-Román A, Manrique H, Armstrong DG. Nationwide prevalence and clinical characteristics of inpatient diabetic foot complications: A Peruvian multicenter study. Prim Care Diabetes [Internet]. 2021 Mar 11; Available from: https://doi.org/10.1016/ j.pcd.2021.02.009
Grupo de Estudio de la OMS sobre Prevención y Protección de la Diabetes Mellitus (1992: Ginebra S& WHO. Prevención de la Diabetes Mellitus: informe de un Grupo de Estudio de la OMS. Ginebra: Organización Mundial de la Salud; 1994.
Carro G V, Saurral R, Sagüez FS, Witman EL. Pie diabético en pacientes internados en hospitales de Latinoamérica. Medicina (B Aires) 2018;78(4):243–351.
Ramos W, López T, Revilla L, More L, Huamaní M, Pozo M. Resultados de la vigilancia epidemiológica de diabetes mellitus en hospitales notificantes del Perú, 2012. Rev Peru Med Exp Salud Pública 2014;3(1):9–15.
Lazo-Porras M, Bernabe-Ortiz A, Taype-Rondan A, Gilman RH, Malaga G, Manrique H, Neyra L, Calderon J, Pinto M, Armstrong DG, Montori VM, Miranda JJ. Foot thermometry with mHeath-based supplementation to prevent diabetic foot ulcers: A randomized controlled trial. Wellcome Open Res 2020;5:23.
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med 2017;49(2):106–116.
Coffey L, Mahon C, Gallagher P. Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta-synthesis. Int Wound J 2019;16(1):183–210.
Joint British Diabetes Societies Inpatient Care. Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams [Internet]. 2013. Available from: http://www.diabetologists- abcd.org.uk/JBDS/JBDS_IP_Admissions_ Avoidance_Diabetes.pdf
Agwu E, Dafiewhare EO, Ekanem PE. Possible Diabetic-Foot Complications in Sub-Saharan Africa. In: Din T, editor. Global Perspective on Diabetic Foot Ulcerations, [Internet]. 2011. Available from: http:// www.intechopen.com/books/global-pers- pective-on-diabetic-foot-ulcerations/possi- ble-diabetic-foot-complications-in-sub-sa- haran-africa.
Villena J, Burga, J, Corigliano S, Valdivia J. Morbimortalidad por diabetes mellitus no insulino dependiente (DMNID) en el Hospital Nacional Cayetano Heredia, 1985- 1995. Rev Médica del Perú 1996;64–68.
Gonzales-Grández NN, Rodríguez-Lay EG, Manrique-Hurtado H. Características clínicas y factores asociados a morbilidad intra-hospitalaria en los pacientes con diabetes mellitus tipo 2. Rev Soc Peru Med Interna 2013;26(4):159–165.
Hicks CW, Selvarajah S, Mathioudakis N, Sherman RL, Hines KF, Black III JH, Abularrage CJ. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg 2016;33:149–158.
Kasiya MM, Mang’anda GD, Heyes S, Kachapila R, Kaduya L, Chilamba J, Goodson P, Chalulu K, Allain TJ. The challenge of diabetic foot care: Review of the literature and experience at Queen Elizabeth Central Hospital in Blantyre, Malawi. Malawi Med J 2017;29(2):218–223.
Barbosa Marques AD, Sales da Silva LM, Magalhães Moreira TM, Martins Torres RA. Asociação entre internação hospitalar por diabetes mellitus e amputação de pé diabético. Enfermería Glob 2018;17(3):238.
Arribasplata-Espinoza Y, Luna-Muñoz C. Factores de riesgo asociados a pie diabético en el Hospital Pnp Luis N. Saenz, Año 2017. Rev la Fac Med Humana 2019;19(2):75–81.
Torres-Aparcana HL, Gutiérrez C, Pajuelo- Ramírez J, Pando-Álvarez R, Arbañil-Huamán H. Características clínicas y epidemiológicas de los pacientes hospitalizados por pie diabético en el Hospital Nacional Dos de Mayo entre 2006 y 2008, Lima-Perú. Rev Peru Epidemiol 2012;16(3):1–6.
Ibarra CT, Rocha J de J, Hernández R, Nieves RE, Leyva R. Prevalencia de neuropatía periférica en diabéticos tipo 2 en el primer nivel de atención. Rev Med Chile 2012;140(9):1126–1131.
Damas-Casani VA, Yovera-Aldana M, Seclén Santisteban S. Clasificación de pie en riesgo de ulceración según el Sistema IWGDF y factores asociados en pacientes con diabetes mellitus tipo 2 de un hospital peruano. Rev Medica Hered 2017;28(1):5.
Boulton AJ. The pathogenesis of diabetic foot problems: an overview. Diabet Med 1996;13 Suppl 1:S12-16.
Mañas LR, Bouzon CA, Rodríguez MC. Peripheral Arterial Disease in Old People with Diabetes. In: Diabetes in Old Age. John Wiley & Sons, Ltd; 2009; 39–49.
Gómez-Hoyos E, Levy E, Díaz-Perez A, Cuesta-Hernández M, Montañez-Zorrilla C, Calle-Pascual AL. Pie Diabético. Semin la Fund Española Reum 2012;13(4):119–129.
Rodríguez-Alonso D, Mercedes-Chávez F, Rodríguez-Díaz D, Polo-López T, Rivera- Begazo Á, Guzmán Yparraguirre EM. Prevalencia moderada de pie en riesgo de ulceración en diabéticos tipo 2 según IGWDF en el contexto de la atención primaria. Horiz Med (Barcelona) 2018;18(4):9–18.
Cardoso HC, Zara ALDSA, Rosa SDSRF, Rocha GA, Rocha JVC, Araújo MCE De, Quin-zani PDF, Barbosa YP, Mrué F. Risk factors and diagnosis of diabetic foot ulceration in users of the Brazilian Public Health System. J Diabetes Res 2019;2019:5319892. doi: 10.1155/2019/5319892
Bekele F, Chelkeba L, Fekadu G, Bekele K. Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: Prospective observational study. Ann Med Surg 2020;51(January):17–23. Available from: https://doi.org/10.1016/ j.amsu.2020.01.005
Merza Z, Tesfaye S. The risk factors for diabetic foot ulceration. Foot 2003;13(3):125– 129.
Ghanassia E, Villon L, Dieudonné JFTD, Boegner C, Avignon A, Sultan A. Long term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers. Diabetes Care 2008;31(7):1288–1292.
Capellari C, Pinheiro da Costa-Bartira E, Larre A, Pasin D, Cardoso A, Vasconcelos L de, Figueiredo AE. Educational interventions and glycemic control: Integrative Review. J Diabetes Metab 2016;7(6).
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006;29(6):1288– 1293.
McInnes AD. Diabetic foot disease in the United Kingdom: About time to put feet first. J Foot Ankle Res 2012;5(1):1–7.
National Health Service. National Diabetes Foot Care Audit (NDFA) Hospital Admissions Report 2014-2017 [Internet]. 2017. Available from: https://files.digital.nhs.uk/ publication/ 0/d/ndfa_ 2014-2016_-_hos- pital_admissions_executive_report.pdf
Mejia CR, Paucar-Tito LO, Morales-Concha L, Rondón-Abuhadba EA, Atamari- Anahui N, Ordoñez-Linares ME. Association between hospitalization stay and diabetic foot: an analytical cross-sectional study in three Peruvian hospitals. Medwave 2018;18(07):e7336–e7336.
Tan JH, Hong CC, Shen L, Tay EYL, Lee JKX, Nather A. Costs of patients admitted for diabetic foot problems. Ann Acad Med Singapore 2015;44(12):567–570.
Game F, RJ H, Apelqvist J, Bakker K, Hatermann A, Löndahl M, Price P, Jeffcoate W. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012;28(suppl 1): 119-141. doi: 10.1002/ dmrr.2246.
Zelada H, Bernabe-Ortiz A, Manrique H. Inhospital mortality in patients with type 2 diabetes mellitus: A prospective cohort study in Lima, Peru. J Diabetes Res 2016;2016.
Yovera-Aldana M, Rodrígue A, Vargas M, Heredia P, Huamán M, Vargas-Vilca J, Yalán C, García-Orbegoso E. Resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor en un hospital nacional peruano. Acta Médica Perú 2017;34(3):173–181.
Alcántara W, Flores R, Garmendia F. Prevalencia y riesgo de amputación en pacientes con pie diabético. An Fac Med (Perú) 1999;60(3):159–164.
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E. 2012 infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54(12):132–173.
Falcón FE, Villanueva JS, Arizmendiz LN. Estudio bacteriológico de pacientes con pie diabético infectado en el Hospital Arzobispo Loayza. Rev Soc Peru Med Interna 2006;19(1):5–9.
Neyra L, Lezama V, Lezama W, Medina M, Murillo F, Purizaga H, Válcarcel B. Bacteriología y resistencia bacteriana en el pie diabético infectado en el Hospital Nacional Arzobispo Loayza, Lima. Rev Soc Peru Med Interna 2017;30(1):24–27.
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Published
2021-09-07
How to Cite
Saravia-Hernández, E., Salvador-Carrillo, J., Vizcarra Zevallos, K. A., & Calderón-Ticona, J. (2021). The landscape of diabetic foot in Peru.: El panorama del pie diabético en el Perú. Investigación Clínica, 62(3), 276-289. https://doi.org/10.22209/IC.v62n3a07
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