Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

A retrospective study of nutritional status in a cohort of patients with diabetes and foot ulceration (#268)

Johanna Kuehn 1 , Julia E Martin 1 , Kate Carroll 2 , Julie Zwarteveen 2 , Katie Wynne 1 3 4 , Christy P Sankoorikal 1
  1. Department of Diabetes & Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  2. High Risk Foot Clinic, GNS CACS Podiatry & Footcare Service, Newcastle, NSW, Australia
  3. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  4. Hunter Medical Research Institute, Newcastle, NSW, Australia

Diabetic Foot Ulceration (DFU) affects up to 15% of people with diabetes and is the most common cause of non-traumatic lower extremity amputation, antecedent in >80% of amputations.1 Suboptimal nutrition contributes to delayed would healing, and nutritional supplementation with protein and amino acids3 may improve wound healing in a subset of patients with diabetes.2-5 The aim of this study was to review the status of patients with DFU in our tertiary centre.

A retrospective analysis was performed in a cohort of attenders at an ambulatory high risk foot clinic. The data was collected from fifty-seven consecutive patients attending for their first foot ulcer assessment between September 2016 to March 2017. Albumin levels and other biomarkers of nutrition (Table 1) were collated with HbA1c and toe-brachial index (TBI). The University of Texas classification was applied as a validated grading tool of diabetic foot wounds.

Participants were 65±15 years (range 19-93 years) and most were male (38/57; 66.7%). The majority presented with superficial wounds without infection or critical ischemia (40.0% Grade 1, Stage A; Table 2). Overall glycaemic control was suboptimal (HbA1c 8.1±1.7%) and 32/49 (65.3%) patients had an abnormal TBI of <0.7. Vascular compromise was particularly evident in older patients (>65 years 0.56±0.22 vs. <65 years 0.73±0.20). Few patients had hypoalbuminemia (4/40; 10.0%) or anaemia (3/41; 7.3%, defined haemoglobin <100g/L). Hypomagnesaemia (4/27; 14.8%) and iron deficiency (1/9; 11.1%) were the most frequent micronutrient deficiencies.

The majority of patients had suboptimal limb perfusion; one fifth demonstrated evidence of micronutrient inadequacy. The highest risk patients with poor limb perfusion and/or malnutrition may benefit from nutritional supplementation to facilitate wound healing and maintain tissue integrity.5-8 Universal dietary review and biochemical assessment of patients may reveal a higher prevalence of poor quality nutrition; these patients may benefit from supplementation to promote ulcer healing.

 

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  1. Tan T, Shaw EJ, Siddiqui F, Kandaswamy P, Barry PW, Baker M: Inpatient management of diabetic foot problems: summary of NICE guidance. BMJ 2011; 342: d1280.
  2. Tatti P, Barber A: The Use of a Specialized Nutritional Supplement for Diabetic Foot Ulcers Reduces the Use of Antibiotics. JEM 2012; 2(1):26-31.
  3. Sipahi S, Gungor O, Gunduz M, Cilci M, Demirci MC, Tamer A: The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients. BMC Nephrology. 2013, 14:8.
  4. Tatti P, Barber A: Nutritional Supplement is Associated with a Reduction in Healing Time and Improvement of Fat Free Body Mass in Patients with Diabetic Foot Ulcers. EWMA Journal. 2010, 10: 13-18.
  5. Armstrong DG, Hanft JR, Driver VR, Smith AP, Lazaro-Martinez JL, Reyzelman AM, Furst GJ, Vayser DJ, Cervantes HL, Snyder RJ, Moore MF, May PE, Nelson JL, Baggs GE, Voss AC; Diabetic Foot Nutrition Study Group: Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabet Med. 2014 ;31(9):1069-77.
  6. Wu G, Bazer FW, Davis TA, Kim SW, Li P, Marc Rhoads J, Carey Satterfield M, Smith SB, Spencer TE, Yin Y: Arginine metabolism and nutrition in growth, health and disease. Amino Acids. 2009, 37: 153-168.
  7. Arana V, Paz Y, González A, Méndez V, Méndez JD: Healing of diabetic foot ulcers in L-arginine-treated patients. Biomed Pharmacother. 2004, 58: 588-597.
  8. Jones MS, Rivera M, Puccinelli CL, Wang MY, Williams SJ, Barber A: Targeted Amino Acid Supplementation in Diabetic Foot Wounds: Pilot Data and a Review of the Literature. Surg Infect (Larchmt). 2014, 15(6): 708–712.