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Clinical Research
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Healing times and HgbA1c values for lower extremity ulcers in the diabetic population Melanie Mutnansky, SN, Darlene Hanson, MS, RN, Julie Anderson, PhD, RN, CCRC, Diane Langemo, PhD, RN, FAAN, Susan Hunter, MSN, RN, Patricia Thompson, MS, RN, University of North Dakota, Grand Forks, ND The diabetic population is at a 15% increased risk of developing leg and foot ulcers due to such factors as neuropathy, ischemia, and infection. While the literature is clear that tight glucose control may diminish these complications, the relationship between HgbA1c values and healing times of ulcers is less well defined. This study explored the relationship between HgbA1c values and healing times of lower extremity ulcers As part of a larger study, a retrospective chart review was performed on 63 (Men = 41; Women = 22) clients with diabetes served by a midwestern outpatient wound clinic. A tool was developed by researchers through literature review, including demographics, medical diagnoses, wound measurements, admission HgBA1c and HgBA1c at wound closure, and healing time. Statistics were generated using the SPSS program. Of the 63 ulcers, 36 healed and 26 did not heal, and for one ulcer, healing was not determined. Admission HgbA1c values ranged from 4.5 to 15.4 (M = 8.05, SD = 2.29). HgbA1c values closest to ulcer closure ranged from 5.3 to 12.3 (M = 7.68, SD = 1.81). The majority of the ulcers sized 0Ð2 cm and 2.1Ð10 cm healed in 12 weeks, whereas larger ulcers (> 10.1 cm) took longer to heal. Overall, patients with higher HgbA1c levels experienced healing, but in a significantly longer period of time than those with lower HgbA1c's. The majority of ulcers healed in 12 weeks. Individuals with type 1 diabetes had a higher healing rate (77.8%) than individuals with type 2 diabetes (53.7%), while 40% of all closed ulcers reopened. Decreased healing times should result in lower patient costs, a decreased chance of infection, and increased quality of life. Diabetic patient education may increase self-care practices, resulting in better glucose control. Further studies using larger samples or more closely monitored HgbA1c values are recommended. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2005;28(suppl 1):S4ÐS36 DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med. 1993;329:977Ð983 Guthrie R, Guthrie D. Pathophysiology of diabetes mellitus. Crit Care Nurs Q. 2004;27(2):113Ð125 Jeffcoate W, Harding K. Diabetic foot ulcers. Lancet. 2003;361(9368):1545Ð1551 Mantey I, Foster AVM, Spencer S, Edmonds ME. Why do foot ulcers recur in diabetic patients? Diab Med. 1999;16:245Ð249. Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol. 2000;136(12):1531Ð1535 Reiber GE, Lipsky BA, Gibbons GW. Am J Surg. 1998;176(suppl 2A):5SÐ10S. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998;352:854Ð865 Zimny S, Schatz H, Pfohl M. Determinants and estimation of healing times in diabetic foot ulcers. J Diabetes Complications. 2002;16:327Ð332.. .. |
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