Association according to the San Elian classification in diabetic foot in adults with type 2 diabetes mellitus: quality of life and depression
DOI:
https://doi.org/10.47196/diab.v59i1.1160Keywords:
diabetic foot, San Elian classification, depression, quality of life, diabetes mellitusAbstract
Introduction: diabetic foot (DF) is one of the main causes of non-traumatic amputation of lower limbs; its lesions directly impact the quality of life and the emotional state of the patient, which requires a long follow-up period to achieve healing of ulcers, an extensive period of rest by the patient, and the assistance of family members and/or third parties to carry out the instructions corresponding to healing and collaborate with the tasks of daily life of the person suffering from it.
Objectives: to analyze in adult patients with DF according to the San Elian classification the presence of depression and the characteristics of the quality of life; to study the extension and severity of DF according to personal history, clinical characteristics and laboratory markers; to evaluate the incidence of complications for each DF group according to the degree of severity using the San Elian scale and cases of recurrence.
Materials and methods: cohort study that included 106 adult patients with type 2 diabetes mellitus (DM2) and PD from a public hospital in the Province of Buenos Aires. They were categorized according to severity by San Elian classification (CSE) into three groups according to the San Elian scale (topographic and anatomical characteristics, presence of ischemia and vascular components) and were followed for a period of up to 9 months of treatment (from September 2022 to May 2023). At the beginning and at the end of the follow-up period or in case of discharge, the Hamilton Depression Rating Scale (HDRS) and the modified Diabetes Quality of Life Questionnaire (EsDQoL) were applied. Laboratory and clinical markers and personal history were analyzed.
Results: the total number of individuals (78 men and 28 women) was grouped according to the CSE, with 7.5% having grade I, 84.9% grade II and 7.5% grade III. The mean age in men was 64 and in women 70 years (p=0.007 Chi2); the mean duration of DM2 was 16 years. Of the total population studied, the difference was recorded with respect to sex in relation to the risk factors for the development of PD for the male sex: a greater number of minor amputations of 42.3% (p=0.008), history of osteomyelitis of 60.3% (p=0.004), peripheral artery disease of 65.4% and hospitalization of 33.3%. The female sex registered more major amputations with 17.9% and 25% for revascularization (p=0.032). No significant differences were recorded between the level of depression and the degree of PD, but when comparing each group according to the severity at the beginning and at the end of depression, the tendency decreased.
Conclusions: during the follow-up, the association between the degree of severity of PD, depression and quality of life was not confirmed, but it cannot be underestimated that the mentioned aspects were improved by obtaining a favorable evolution and healing of the lesions. A high percentage of relapses and complications were recorded, where the emotional and social factors were involved. The application of the San Elian scale proved to be pertinent.
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