To investigate the impact of pre-hospital practices on clinical characteristics, metabolic profiles, and healing outcomes in diabetic foot ulcer (DFU) patients.
Approach:
Study Design: A retrospective cohort study of DFU patients treated at a tertiary center from 2021 to 2024, stratifying patients into timely medical care group (TMCG, ≤ 7 days) and delayed medical care group (DMCG, 7–30 days).
Data Analysis: Comparative analysis of metabolic parameters and lesion severity, Kaplan-Meier analysis for healing outcomes, and multivariable Cox regression to identify predictors of DFU healing.
Key Findings:
Patients in the DMCG had more severe Wagner grades (≥ 3: 38.8% vs. 18.4%, p = 0.02) and higher rates of hypoalbuminemia (< 35 g/L: 62.7% vs. 40.8%, p = 0.02).
The DMCG had a significantly higher risk of non-healing compared to the TMCG (p = 0.002).
Delayed medical care (7–30 days) and higher Wagner grade were identified as independent predictors of impaired DFU healing.
Interpretation:
Inappropriate pre-hospital practices commonly delay definitive care and worsen outcomes, emphasizing the importance of early medical intervention.
Limitations:
The study is retrospective and conducted at a single center, which may limit generalizability.
The sample may not represent the general population due to specific inclusion and exclusion criteria.
Conclusion:
The findings suggest that early medical intervention (≤ 1 week) is associated with improved therapeutic outcomes and a reduced risk of complications.
In an observational US target trial emulation, glucagon-like peptide-1 receptor agonist initiation was associated with about 3 to 4 more ischemic optic neuropathy cases per 10,000 patients over 18 months than two comparator drug classes.
