Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies
To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs). Medline, EMBASE, Cochrane Library, and Scopus were searched for observati...
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| Veröffentlicht in: | Journal of diabetes and its complications 2020-10, Vol.34 (10), p.107638-107638, Article 107638 |
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| creator | Lane, Kyrstin L. Abusamaan, Mohammed S. Voss, Betiel Fesseha Thurber, Emilia G. Al-Hajri, Noora Gopakumar, Shraddha Le, Jimmy T. Gill, Sharoon Blanck, Jaime Prichett, Laura Hicks, Caitlin W. Sherman, Ronald L. Abularrage, Christopher J. Mathioudakis, Nestoras N. |
| description | To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs).
Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842).
Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. |
| doi_str_mv | 10.1016/j.jdiacomp.2020.107638 |
| format | Article |
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Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842).
Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. <8%, the pooled OR for LEA was 4.80 (95% CI 2.83, 8.13). For cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl, the pooled OR for LEA was 1.46 (95% CI, 1.02, 2.09). There was no association with A1C category and wound healing (OR or HR). There was high risk of bias with respect to comparability of cohorts as many studies did not adjust for potential confounders in the association between glycemic control and DFU outcomes.
Our findings suggest that A1C levels ≥8% and fasting glucose levels ≥126 mg/dl are associated with increased likelihood of LEA in patients with DFUs. A purposively designed prospective study is needed to better understand the mechanisms underlying the association between hyperglycemia and LEA.
•Role of glycemic control in diabetic foot ulcers (DFUs) is unclear.•Previous meta-analyses have included small numbers of studies.•Higher A1C and fasting glucose are associated with increased amputation risk in patients with DFUs.•A1C and glucose were not associated with wound healing.</description><identifier>ISSN: 1056-8727</identifier><identifier>EISSN: 1873-460X</identifier><identifier>DOI: 10.1016/j.jdiacomp.2020.107638</identifier><identifier>PMID: 32527671</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>A1C ; Amputation ; Bias ; Diabetes ; Diabetic foot ulcer ; Fasting ; Foot diseases ; Glucose ; Healing ; Hemoglobin ; Hyperglycemia ; Leg ulcers ; Lower extremity amputation ; Meta-analysis ; Observational studies ; Peripheral arterial disease ; Peripheral neuropathy ; Systematic review ; Wound ; Wound healing</subject><ispartof>Journal of diabetes and its complications, 2020-10, Vol.34 (10), p.107638-107638, Article 107638</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c565t-342a5d8914491c37993516a7a8c05b8c17b22be91ce1452b281e4b12389bf9033</citedby><cites>FETCH-LOGICAL-c565t-342a5d8914491c37993516a7a8c05b8c17b22be91ce1452b281e4b12389bf9033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1056872720303974$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32527671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lane, Kyrstin L.</creatorcontrib><creatorcontrib>Abusamaan, Mohammed S.</creatorcontrib><creatorcontrib>Voss, Betiel Fesseha</creatorcontrib><creatorcontrib>Thurber, Emilia G.</creatorcontrib><creatorcontrib>Al-Hajri, Noora</creatorcontrib><creatorcontrib>Gopakumar, Shraddha</creatorcontrib><creatorcontrib>Le, Jimmy T.</creatorcontrib><creatorcontrib>Gill, Sharoon</creatorcontrib><creatorcontrib>Blanck, Jaime</creatorcontrib><creatorcontrib>Prichett, Laura</creatorcontrib><creatorcontrib>Hicks, Caitlin W.</creatorcontrib><creatorcontrib>Sherman, Ronald L.</creatorcontrib><creatorcontrib>Abularrage, Christopher J.</creatorcontrib><creatorcontrib>Mathioudakis, Nestoras N.</creatorcontrib><title>Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies</title><title>Journal of diabetes and its complications</title><addtitle>J Diabetes Complications</addtitle><description>To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs).
Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842).
Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. <8%, the pooled OR for LEA was 4.80 (95% CI 2.83, 8.13). For cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl, the pooled OR for LEA was 1.46 (95% CI, 1.02, 2.09). There was no association with A1C category and wound healing (OR or HR). There was high risk of bias with respect to comparability of cohorts as many studies did not adjust for potential confounders in the association between glycemic control and DFU outcomes.
Our findings suggest that A1C levels ≥8% and fasting glucose levels ≥126 mg/dl are associated with increased likelihood of LEA in patients with DFUs. A purposively designed prospective study is needed to better understand the mechanisms underlying the association between hyperglycemia and LEA.
•Role of glycemic control in diabetic foot ulcers (DFUs) is unclear.•Previous meta-analyses have included small numbers of studies.•Higher A1C and fasting glucose are associated with increased amputation risk in patients with DFUs.•A1C and glucose were not associated with wound healing.</description><subject>A1C</subject><subject>Amputation</subject><subject>Bias</subject><subject>Diabetes</subject><subject>Diabetic foot ulcer</subject><subject>Fasting</subject><subject>Foot diseases</subject><subject>Glucose</subject><subject>Healing</subject><subject>Hemoglobin</subject><subject>Hyperglycemia</subject><subject>Leg ulcers</subject><subject>Lower extremity amputation</subject><subject>Meta-analysis</subject><subject>Observational studies</subject><subject>Peripheral arterial disease</subject><subject>Peripheral neuropathy</subject><subject>Systematic review</subject><subject>Wound</subject><subject>Wound 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studies</title><author>Lane, Kyrstin L. ; Abusamaan, Mohammed S. ; Voss, Betiel Fesseha ; Thurber, Emilia G. ; Al-Hajri, Noora ; Gopakumar, Shraddha ; Le, Jimmy T. ; Gill, Sharoon ; Blanck, Jaime ; Prichett, Laura ; Hicks, Caitlin W. ; Sherman, Ronald L. ; Abularrage, Christopher J. ; Mathioudakis, Nestoras N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c565t-342a5d8914491c37993516a7a8c05b8c17b22be91ce1452b281e4b12389bf9033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>A1C</topic><topic>Amputation</topic><topic>Bias</topic><topic>Diabetes</topic><topic>Diabetic foot ulcer</topic><topic>Fasting</topic><topic>Foot diseases</topic><topic>Glucose</topic><topic>Healing</topic><topic>Hemoglobin</topic><topic>Hyperglycemia</topic><topic>Leg ulcers</topic><topic>Lower extremity amputation</topic><topic>Meta-analysis</topic><topic>Observational 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observational studies</atitle><jtitle>Journal of diabetes and its complications</jtitle><addtitle>J Diabetes Complications</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>34</volume><issue>10</issue><spage>107638</spage><epage>107638</epage><pages>107638-107638</pages><artnum>107638</artnum><issn>1056-8727</issn><eissn>1873-460X</eissn><abstract>To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs).
Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842).
Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. <8%, the pooled OR for LEA was 4.80 (95% CI 2.83, 8.13). For cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl, the pooled OR for LEA was 1.46 (95% CI, 1.02, 2.09). There was no association with A1C category and wound healing (OR or HR). There was high risk of bias with respect to comparability of cohorts as many studies did not adjust for potential confounders in the association between glycemic control and DFU outcomes.
Our findings suggest that A1C levels ≥8% and fasting glucose levels ≥126 mg/dl are associated with increased likelihood of LEA in patients with DFUs. A purposively designed prospective study is needed to better understand the mechanisms underlying the association between hyperglycemia and LEA.
•Role of glycemic control in diabetic foot ulcers (DFUs) is unclear.•Previous meta-analyses have included small numbers of studies.•Higher A1C and fasting glucose are associated with increased amputation risk in patients with DFUs.•A1C and glucose were not associated with wound healing.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32527671</pmid><doi>10.1016/j.jdiacomp.2020.107638</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of diabetes and its complications, 2020-10, Vol.34 (10), p.107638-107638, Article 107638 |
| issn | 1056-8727 1873-460X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7721205 |
| source | Elsevier ScienceDirect Journals |
| subjects | A1C Amputation Bias Diabetes Diabetic foot ulcer Fasting Foot diseases Glucose Healing Hemoglobin Hyperglycemia Leg ulcers Lower extremity amputation Meta-analysis Observational studies Peripheral arterial disease Peripheral neuropathy Systematic review Wound Wound healing |
| title | Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies |
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