Diabetic foot ulcers associated with worsening cognitive decline

1. In a case-control study of approximately 200 patients with type 2 diabetes mellitus (T2DM), patients with diabetic foot ulcers were significantly associated with lower cognitive scores compared to T2DM controls

Evidence Rating Level: 3 (Average)       

Study Rundown: Diabetic foot ulcers are associated with significant morbidity and mortality in patients with T2DM, accounting for approximately 66% of non-traumatic amputations in the United States annually. The presence of ulcers increases the self-care burden on the part of the patient, and also requires that the patient has sufficient cognitive demands to understand and execute medical recommendations. The purpose of this study was to compare the cognitive profiles of patients with diabetic foot ulcers with patients with T2DM without foot ulcers. The study performed neurocognitive evaluations of T2DM patients with foot ulcers and matched T2DM controls. At the conclusion of the study, patients with foot ulcers demonstrated significantly decreased scores across all cognitive domains tested compared to controls and demonstrated significant decline from their estimated pre-morbid cognition. This was one of the first studies to examine cognitive status in this patient population and suggests that patients with diabetic foot ulcers face larger challenges to self-care while possessing less cognitive resources than control subjects. However, the study is limited by the cross-sectional design, which limits the assessment of causality between diabetic foot ulcers and cognitive decline.

Click to read the study in Diabetes Care

Relevant Reading: The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes

In-Depth [case-control study]: Patients with T2DM and diabetic foot ulcers were recruited from in-hospital orthopedic departments and from diabetic foot clinics across two hospitals in Israel. Key exclusion criteria includes hepatic or renal failure, as well as patients with any visual, hearing, or cognitive impairment that could affect the neuropsychological testing. Cognitive testing assessed Glasgow Coma Scale, memory, attention, concentration, psychomotor efficiency, reaction time, executive function, and pre-morbid cognitive abilities. Overall, 99 patients with diabetic foot ulcers and 95 patients with T2DM without foot ulcers (matched for diabetes duration and gender) were recruited. At the conclusion of the trial, diabetic patients with foot ulcers had significantly lower cognitive scores than those without foot ulcers, in the cognitive domains for memory, reaction time, attention, executive function, psychomotor ability (p < 0.001). Additionally, patients with foot ulcers had a significantly higher difference between pre-morbid and current cognitive abilities compared to the patient population without foot ulcers.

Image: PD

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