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Moore Z, Dowsett C, Smith G TIME CDST: an updated tool to address the current challenges in wound care. J Wound Care. 2019; 28:154-161

Kaile K, Mahadevan J, Leiva K Tissue oxygenation measurements to aid scalpel debridement removal in patients with diabetes. Journal of Diabetes Science and Technology. 2021;

Abbas ZG. The diabetic foot worldwide: Sub-Saharan Africa. The foot in diabetes, 5th edn. : John Wiley & Sons Ltd; 2020

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Landén NX, Li D, Ståhle M. Transition from inflammation to proliferation: a critical step during wound healing. CMLS. 2016; 73:3861-3885

Karri VV, Kuppusamy G, Talluri SV Current and emerging therapies in the management of diabetic foot ulcers. Current Medical Research and Opinion. 2016; 32:519-542

Game FL. Local management of diabetic foot ulcers, dressings and other local treatments. In: Piaggesi A, Apelqvist J (eds). : Karger Publishers; 2018

Caruso P, Longo M, Gicchino M Long-term diabetic complications as predictors of foot ulcers healing failure: a retrospective study in a tertiary-care center. Diabetes Research and Clinical Practice. 2020; 163

Hurst JE, Barn R, Gibson L Geospatial mapping and data linkage uncovers variability in outcomes of foot disease according to multiple deprivation: a population cohort study of people with diabetes. Diabetologia. 2020; 63:659-667

Vileikyte L. Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Rev. 2001; 17:246-249

Sekhar MS, Thomas RR, Unnikrishnan MK Impact of diabetic foot ulcer on health-related quality of life: a cross-sectional study. Seminars in Vascular Surgery. 2015; 28:165-171

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Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab. 2018; 22:696-704

Ribu L, Wahl A. Living with diabetic foot ulcers: a life of fear, restrictions, and pain. Ostomy Wound Management. 2004; 50:57-67

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Frescos N, Copnell B. Podiatrists’ views of assessment and management of pain in diabetes-related foot ulcers: a focus group study. J Foot Ankle Res. 2020; 13

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Jupiter DC, Thorud JC, Buckley CJ The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. International Wound Journal. 2016; 13:892-903

Carter MJ. Economic evaluations of guideline-based or strategic interventions for the prevention or treatment of chronic wounds. Applied Health Economics and Health Policy. 2014; 12:373-389

Raghav A, Khan ZA, Labala RK Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab. 2018; 9:29-31

Armstrong DG, Swerdlow MA, Armstrong AA Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020; 13

Syed M, Salata K, Hussain M The economic burden of inpatient diabetic foot ulcers in Toronto, Canada. Vascular. 2020;

Cavanagh P, Attinger C, Abbas Z Cost of treating diabetic foot ulcers in five different countries. Diabetes/metabolism research and reviews. 2012; 28:107-111

Kerr M, Barron E, Chadwick P The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabetic Medicine. 2019; 36:995-1002

Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Therapy. 2012; 3

Driver VR, Fabbi M, Lavery LA The costs of diabetic foot: the economic case for the limb salvage team. Journal of Vascular Surgery. 2010; 52:17s-22s

Alshammary S, Othman SA, Alshammari E Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study. Annals of Saudi Medicine. 2020; 40:425-435

Joret MO, Dean A, Cao C The financial burden of surgical and endovascular treatment of diabetic foot wounds. Journal of Vascular Surgery. 2016; 64:648-655

Kieu TTM, Trinh HN, Pham HTK Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey. BMJ Open. 2020; 10

Al-Maskari F, El-Sadig M, Nagelkerke N. Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates. BMC Public Health. 2010; 10

Woods TJ, Tesfay F, Speck P Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: a systematic review. PloS One. 2020; 15

Chan B, Campbell K. An economic evaluation examining the cost-effectiveness of continuous diffusion of oxygen therapy for individuals with diabetic foot ulcers. International Wound Journal. 2020;

Marshall SM, Barth JH. Standardization of HbA1c measurements: a consensus statement. Ann Clin Biochem. 2000; 37:45-46

Hirst JA, McLellan JH, Price CP Performance of point-of-care HbA1c test devices: implications for use in clinical practice - a systematic review and meta-analysis. Clinical Chemistry and Laboratory Medicine. 2017; 55:167-180

Azzopardi K, Gatt A, Chockalingam N Hidden dangers revealed by misdiagnosed diabetic neuropathy: A comparison of simple clinical tests for the screening of vibration perception threshold at primary care level. Primary Care Diabetes. 2018; 12:111-115

Armstrong DG, Lavery LA, Vela SA Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Archives of Internal Medicine. 1998; 158:289-292

Hu A, Koh B, Teo M-R. A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus. Diabetology International. 2021; 12:145-150

Dutta A, Rastogi A, Jude EB. Screening developments for the foot in diabetes. The Diabetic Foot Journal. 2020; 23:(2)62-69

Arnold JF. Vascular assessment of the lower extremity with a chronic wound. The Surgical Clinics of North America. 2020; 100:807-822

Formosa C, Gatt A, Chockalingam N. A critical evaluation of existing diabetic foot screening guidelines. The Review of Diabetic Studies. 2016; 13:158-186

Álvaro-Afonso FJ, García-Morales E, Molines-Barroso RJ Interobserver reliability of the ankle-brachial index, toe-brachial index and distal pulse palpation in patients with diabetes. Diabetes & Vascular Disease Research. 2018; 15:344-347

Ming A, Walter I, Alhajjar A Study protocol for a randomized controlled trial to test for preventive effects of diabetic foot ulceration by telemedicine that includes sensor-equipped insoles combined with photo documentation. Trials. 2019; 20

Crawford F, Cezard G, Chappell FM. The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta-analyses. Diabetic Medicine. 2018; 35:1480-1493

Soukup T, Lamb BW, Arora S Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. Journal of Multidisciplinary Healthcare. 2018; 11:49-61

Taberna M, Gil Moncayo F, Jané-Salas E The multidisciplinary team (MDT) approach and quality of care. Front Oncol. 2020; 10:85-85

Brousseau-Foley M, Blanchette V. Multidisciplinary management of diabetic foot ulcers in primary cares in Quebec: can we do better?. Journal of Multidisciplinary Healthcare. 2020; 13:381-385

Musuuza J, Sutherland BL, Kurter S A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. Journal of Vascular Surgery. 2020; 71:1433-1446

Buggy A, Moore Z. The impact of the multi-disciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care. 2017; 26:324-339

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Fiordaliso F, Clerici G, Maggioni S Prospective study on microangiopathy in type 2 diabetic foot ulcer. Diabetologia. 2016; 59:1542-1548

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Dumville JC, Lipsky BA, Hoey C Topical anti-microbial agents for treating foot ulcers in people with diabetes. The Cochrane Database of Systematic Reviews. 2017; 6

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Diabetic foot ulcers: treatment overview and cost considerations

02 December 2022
Volume 6 · Issue 4

Diabetic foot ulcers (DFUs) are deep tissue lesions associated with ischaemic, neuropathic, or combined neuroischaemic abnormalities and are a leading cause of morbidity and mortality.1,2 Of concern is that DFUs affect multiple areas of a person’s functioning, including both physical and psychological distress.3,4 For example, inactivity due to a DFU can cause feelings of frustration, anger and guilt in patients.5,6 This distress has the potential to impair the immune response as well as impacting the quality of life (QoL).7,8,9

DFUs are often complicated by the presence of infection and this combined with abnormalities are a key cause of amputation in patients with DM, indeed up to 85% of lower extremity amputations are preceded by the presence of a DFU.10 Furthermore, even when treatment plans are followed, not all DFUs heal, and those that do have a high rate of recurrence.11,12

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