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Dear Readers:
The global epidemic of type 2 diabetes can be managed if we recognize and alleviate its causes as early as possible.¹ A diabetic foot ulcer (DFU) need not be a sentence to amputation and early death with pre-emptive evaluation and effective care. Early detection of sensory loss, bone and soft tissue injury, impending infection,² and consistent 24/7 off-loading³ are important steps toward healing and maintaining a healthy diabetic foot. The 80%–90% healing in 12 weeks reported for non-infected, non-ischemic Wagner Grade 1 and 2 foot ulcers that are consistently off-loaded with either a total contact cast (TCC) or an “instant” TCC and moist wound environments, exceeds outcomes I’ve found for any other topical modality applied to similar DFU. What else can improve DFU healing? The Kurd et al study underscores the importance of informing wound care providers about healing progress, and builds on the discovery by Sheehan et al⁴ that one can recognize a DFU not on the path to healing after only 4 weeks of standardized care. The second study summarized in this Evidence Corner goes beyond healing to examine risk factors and likelihood of long-term DFU patient and wound outcomes. These studies suggest that to be forewarned is to be forearmed, enabling care providers to be proactive in achieving goals of DFU care.

Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor

     Reference: Kurd SK, Hoffstad OJ, Bilker WB, Margolis DJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17(3):318–325.

     Rationale: Earlier research showed that baseline venous leg ulcer (VU) and neuropathic DFU characteristics and 4-week reduction in wound area predicts wound-healing status at 24 weeks for VU or 20 weeks for DFU.

     Objective: Determine if providing feedback about the healing or non-healing status of a VU or neuropathic DFU to its professional caregivers improves healing outcomes.

     Methods: Existing electronic databases within 74 centers were used to provide 1 of 4 kinds of feedback to wound care providers for patients with either a VU (n =1506) or a DFU (n = 1810). Each center was considered a “cluster” that was randomly assigned to receive either no prognostic information (20 centers), baseline prognostic information only (19 centers), prognostic information based on 4-week wound area change (17 centers), or prognostic information at both baseline and after 4 weeks of treatment. The educational intervention gave wound care providers a facility-specific printout with the likelihood of healing within 24 weeks for VU or 20 weeks for DFU, but no added guidance on clinical treatment of the patient or wound. The baseline prognostic printout included likelihood of ulcer healing based on VU area and duration, or DFU area, duration, and depth. The 4-week prognostic printout informed providers that the patient had or had not passed a 4-week healing landmark of being at least 70% likely to heal in 20 weeks, as defined by complete epithelization or not requiring a wound dressing for at least 2 weeks. Healing outcomes were analyzed using chi-square analysis with logistic regression correcting for effects of patient age, gender, initial wound area, duration, and for DFU, depth.

     Results: The likelihood of healing for both VU and DFU by study end improved significantly, even when corrected for age, gender, baseline ulcer area, and duration differences on enrollment, DFU patients with wound care providers informed only of healing predictions based on 4-week healing progress were 1.5 times more likely to heal in 20 weeks than those whose providers lacked this information (P < 0.05).