Does Cognitive Dysfunction Impact Diabetic Foot Ulcer Outcomes?

Introduction: 15-34 % of people with diabetes will experience a foot ulcer in their lifetime. The prevalence of cognitive dysfunction and diabetes is estimated to be between 24-33.7%. This can complicate adherence to self-care behaviors. There is little understanding about how cognitive dysfunction may impact outcomes. This study evaluated the effect of cognitive dysfunction on outcomes in individuals with diabetic foot ulcers.Methods: This is a six-year retrospective study at a large tertiary health system with a single electronic medical record utilizing a cohort discovery tool (DataDirect) using ICD-9/10 codes of patients seen in endocrinology, geriatrics and podiatry clinics. Patients without an ulcer and not seen by a podiatrist were excluded. For the cohort without cognitive dysfunction, patients were excluded if they screened positive for cognitive dysfunction within 5 years preceding the ulcer diagnosis. 631 charts of patients were consecutively reviewed. Chart review was completed evaluating ulcer outcomes including time to heal, rate of pedal or higher level (below knee or above knee) amputations and admissions.  Results:56 patients with ulcer and cognitive dysfunction (mean age 71.9 years and 75% male) and 68 patients with ulcer without cognitive dysfunction (mean age 56 years and 76% male) were eligible. At 6 months, 32%% (n=18) of patients with ulcer and cognitive dysfunction were healed compared to 72% (n=49) of patients with ulcer without cognitive dysfunction (p 0.001). 17.8 % (n=10) of patients with ulcer and cognitive dysfunction versus 5.9% (n=4) patients with ulcer without cognitive dysfunction underwent higher level amputations (p 0.05). 57.1% (n=32) of patients with ulcer and cognitive dysfunction versus 33.8% (n=23) of patients with ulcer without cognitive dysfunction required at least one foot-related admission (p = 0.01).Discussion: Individuals with a diabetic foot ulcer and cognitive dysfunction are at elevated risk of major amputation, hospitalization, and suffer from non-healing more often than those without cognitive dysfunction at 6 months after diagnosis.References: