Factors influencing diabetes‐related foot ulcer healing in Australian adults: A prospective cohort study

Objective: Diabetes related foot ulceration (DFU) is a common limb threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to healing of diabetes-related foot ulceration in an Australian population. Research design and methods: This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. Index of relative socioeconomic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over six months. Logistic regression was performed to determine the relationship between healing, and diet quality, toe systolic pressure, wound size, IRSD, infection and previous amputation. Results: 117 participants were included. The majority were male n= 96(82%), socioeconomically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36kg/m2, SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n=85, 73%) and classified 1A (n=63, 54%) on the University of Texas wound classification system with few infections (n=23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95%1.28-14.84, p=0.02), greater levels of socioeconomic advantage was also associated with increased odds of healing (OR 1.01, 95%CI 1.01-1.02, p=0.03). Conclusions: In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socioeconomic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.