Glycemic Control and Diabetic Foot Ulcer Outcomes: A Systematic Review and Meta-Analysis of Observational Studies - PubMed

Last updated: 06-18-2020

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Glycemic Control and Diabetic Foot Ulcer Outcomes: A Systematic Review and Meta-Analysis of Observational Studies - PubMed

doi: 10.1016/j.jdiacomp.2020.107638. Online ahead of print.
Glycemic Control and Diabetic Foot Ulcer Outcomes: A Systematic Review and Meta-Analysis of Observational Studies
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Affiliations
1 Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
3 Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
4 Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
5 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
6 Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America. Electronic address: nmathio1@jhmi.edu.
PMID: 32527671
Glycemic Control and Diabetic Foot Ulcer Outcomes: A Systematic Review and Meta-Analysis of Observational Studies
Kyrstin L Lane et al. J Diabetes Complications.
2020
doi: 10.1016/j.jdiacomp.2020.107638. Online ahead of print.
Authors
Kyrstin L Lane   1 ,  Mohammed S Abusamaan   1 ,  Betiel Fesseha Voss   1 ,  Emilia G Thurber   1 ,  Noora Al-Hajri   1 ,  Shraddha Gopakumar   1 ,  Jimmy T Le   2 ,  Sharoon Gill   1 ,  Jaime Blanck   3 ,  Laura Prichett   4 ,  Caitlin W Hicks   5 ,  Ronald L Sherman   5 ,  Christopher J Abularrage   5 ,  Nestoras N Mathioudakis   6
Affiliations
1 Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
3 Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
4 Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
5 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
6 Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America. Electronic address: nmathio1@jhmi.edu.
PMID: 32527671
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Abstract
Objective: 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).
Research design and methods: 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).
Results: 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.


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