Smoking and diabetes related amputations

NewsBot · Oct 20, 2012

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A comparison of diabetic smokers and non-smokers who undergo lower extremity amputation: a retrospective review of 112 patients.
Anderson JJ, Boone J, Hansen M, Spencer L, Fowler Z.
Diabet Foot Ankle. 2012;3.

BACKGROUND:
A diabetic foot or lower extremity amputation may be exacerbated by or related to the smoking habits and history of the patient.

PATIENTS AND METHODS:
Of the 112 diabetic patients in this retrospective study, 46 were non-smokers and 66 were smokers. The smokers were further categorized into patients who: 1) did not cease smoking; 2) ceased in the immediate post-operative period but resumed within 3 months; and 3) ceased up to and at the 3-month post-operative period. The patients were also divided by their amputation level of forefoot, midfoot/rearfoot, and proximal leg.

RESULTS:
Smoking diabetic patients underwent more amputations, as well as more proximal amputations than those who did not smoke. The higher amount of smoking in pack years followed an increasing trend of more proximal amputations as well.

CONCLUSION:
Neither the amputation level nor the amputation itself was enough motivation for the patients to participate in smoking cessation.
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Admin2 · Oct 20, 2012

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NewsBot · Nov 17, 2016

Wound Closure in Smoking Peripheral Arterial Disease Patients With Treatment-Refractory Ulcerations
A 12-Month Follow-up Case Series
Jonathan Smedley et al
International Journal of Lower Extremity Wounds November 15, 2016

Despite ongoing smoking cessation efforts and optimized perfusion, failed wound closure in the presence of peripheral arterial disease (PAD) and diabetes are common. A clinical effectiveness review was conducted in actively smoking diabetic patients diagnosed with PAD, treated with serial applications of a viable intact cryopreserved human placental membrane (vCPM) (Grafix, Osiris Therapeutics Inc, Columbia, MD) for recalcitrant lower extremity ulcerations (n = 6). More than half of the patients were not candidates for revascularization. Baseline vascular status in 5 of 6 lower-extremity wounds remained unchanged throughout the entire course of vCPM treatment. Daily cigarette consumption averaged 18 cigarettes per patient. Mean wound duration and mean surface area was 53 weeks and 4.6 cm2, respectively. Mean number of vCPM applications and time to closure was 7.0 grafts in 7.8 weeks. There were no wound-related infections or amputations and no vCPM-related adverse events. All 6 wounds remained closed at the 12-month follow-up visit. In conclusion, vCPM demonstrated clinically effective outcomes in 6 previously nonhealing ulcerations despite ongoing smoking habits in the presence of PAD and diabetes.
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NewsBot · Feb 13, 2018

Smoking increases the risk of diabetic foot amputation: A meta-analysis.
Liu M, Zhang W, Yan Z, Yuan X.
Exp Ther Med. 2018 Feb;15(2):1680-1685. doi: 10.3892/etm.2017.5538.

Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.
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NewsBot · Oct 11, 2018

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A Review of the Role of Cigarette Smoking in the Diabetic Foot.
Xia N et al
J Diabetes Investig. 2018 Oct 9

Diabetic foot ulceration has been a serious issue over the past decades in Asia, causing economic and social problems. Therefore, it is important to identify and reduce risk factors of diabetic foot. Cigarette smoking has been reported to be associated with diabetes and its macrovascular complications, but the relationship between smoking and diabetic foot ulcers is still unclear. In this review, we summarizes the effects of cigarette smoking on diabetic foot ulcers with respect to peripheral neuropathy, vascular alterations and wound healing. One underlying mechanism of these impacts may be the smoking induced oxidative stress inside the cells. At the end of this review, the current mainstream therapies for smoking cessation are also outlined. We think that it is urgent for all diabetic patients to quit smoking so as to reduce chances of developing foot ulcers and improve prognosis of diabetic foot ulcers.
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NewsBot · Nov 28, 2018

Association Between Cigarette Smoking and Diabetic Foot Healing: A Systematic Review and Meta-Analysis
Xue-Lei Fu et al
The International Journal of Lower Extremity Wounds November 21, 2018

The role of smoking for wound healing in patients with diabetic foot has been unclear. This meta-analysis examined the relationship between cigarette smoking and diabetic foot wound healing. Observational studies for the association between smoking and diabetic foot wound healing of patients were systematically searched through PubMed and Wanfang Data, published up to June 2018. Healing rates of wounds were recognized as outcomes. Meta-analysis models were chosen by heterogeneity. A total of 3388 eligible studies were identified, of which 18 met all our inclusion criteria. In the smoking group, healing rate had an average of 62.1%, ranging from 20.0% to 89.6%; in the nonsmoking group, healing rate had an average of 71.5%, ranging from 40.2% to 93.8%. A significant association was found between smoking and the healing of diabetic foot wounds (z = 3.08; P = .002), with an odds ratio (OR) of 0.70 (95% CI = 0.56-0.88), based on a random-effects model. Meta-regression analyses indicated that the heterogeneity did not come from publication year (t = −0.50, P = .622) or overall healing rate (t = 0.16, P = .872). The leave-one-out sensitivity analysis was robust; sensitivity analysis for pooled estimate of adjusted ORs had an OR of 0.20 (95% CI = 0.07-0.56; z = 3.08; P = .002). Subgroup analysis had an OR of 0.62 (95% CI = 0.41-0.95; z = 2.21; P = .027) in retrospective cohort studies and had an OR of 0.75 (95% CI = 0.57-0.99; z = 2.02; P = .043) in prospective cohort studies. Our meta-analysis indicated that smoking had an overall negative effect on the wound healing of diabetic foot individuals. This study provides evidence for the harm of smoking to diabetic foot and may help reduce the medical and economic burden on poor healing of diabetic foot.
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NewsBot · May 11, 2020

Implementing a Smoking Cessation Protocol in Type 2 Diabetics in a Podiatry Clinic
Using the Five A’s Model
Thesis Submitted by Guerlyne Henson

Smoking is an independent risk factor for DMT2 making it essential for providers to
address smoking cessation consistently. The purpose of this quantitative, quasiexperimental quality improvement (QI) project was to evaluate if or to what degree the
implementation of a tobacco cessation protocol using the Five A’s model would impact
the patient’s motivation, nicotine dependence, and provider compliance with assessing
tobacco use in adult diabetic smokers in a podiatry clinic for four weeks in the
northeastern United States. The transtheoretical model (TTM) was utilized to evaluate
patient motivation to quit smoking and determine appropriate cessation interventions.
Data on the motivation to quit was measured by TTM and nicotine dependence was
measured by the Fagerstrom Test for Nicotine Dependence (FTND) questionnaire in
diabetic adult smokers aged 18 years and older, (n=16) were compared at baseline, two
weeks, and four weeks post-implementation of the Five A's model. A paired t-test
showed that there was a statistically significant improvement in patient's motivation to
quit smoking (M=-2.86; SD=1.29; p=0.003), a substantial decrease in nicotine
dependence (M= -1.86; SD=1.41; p=0.001), and 100% of the providers (n=6) were
compliant in assessing tobacco use. Based on the results, the Five A's model may result in
increased patient motivation to quit smoking as well as a decrease in nicotine
dependence. Recommendations include continuation of the program and possible
repetition of the project at another clinical site over an extended monitoring period as
well as with a larger sample size.
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NewsBot · Nov 2, 2020

The Association Between Smoking Status and Severity Degree of Diabetic Foot.
Nadhea Debrinita Surya et al
Source

Diabetes mellitus is a chronic metabolic
disease which happens to be the 7th leading cause of death worldwide. In Indonesia, 6.9% of population aged  15 years
old suffers from this disease. Diabetic foot is one of the complication of diabetes mellitus which has high mortality and
morbidity level. Smoking is an addictive behavior that is really common in Indonesia. Components inside a cigarette, such
as nicotine, can contribute in determining the prognosis of diabetic foot through various mechanism. This study aims to
investigate the association between smoking status and the severity degree of diabetic foot. This study is an
observational analytic study using a cross-sectional approach. Data collection was conducted on January 2019 until July
2019 in RSUK Pesanggrahan and Atma Jaya Hospital Jakarta. The research data was obtained through interviews with
diabetic foot patients and medical record reading. Data was analyzed using the chi-square method. There were 40
patients eligible to be the subject of this study. The smoker status with the most distribution was moderate smoker
(27.5%) and severity degree of diabetic foot with most distribution was Wagner 3 (25%). Bivariate analysis showed that
there was a significant association between smoking status and severity degree of diabetic foot (p < 0.001). In
conclusion, there is a significant association between smoking status and the severity degree of diabetic foot. Therefore,
education regarding the importance of smoking cessation to diabetic foot patients should be done in order to improve
the prognosis of diabetic foot patients.
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NewsBot · Jun 30, 2022

The Effects of Tobacco Smoking on Healing of Foot Ulcers and Lower Limb Amputation: A Systematic Review
Jun 30, 2022

Cigarette smoking is well known to increase the risk of peripheral arterial disease (PAD). Whether current smoking has additional effects upon healing or amputation risk after a foot ulcer is present is unclear. Aim: We reviewed the literature to evaluate associations between tobacco smoking and the effects on healing of foot ulceration and upon the rates of lower limb amputation (LLA). Methods: The Cochrane Library, Embase, Medline and PubMed were searched for studies published prior to July 2021. Manuscripts that reported only smoking and the effect on PAD were excluded. Articles that assessed the effect of smoking and reported outcomes of foot ulceration or LLA were included. Results: Fourteen studies met the inclusion criteria and were included in this review. Overall, there is a surprising lack of outcome data for the association between active tobacco use and healing of foot ulceration or LLA. Conclusion: Further research should specifically look healing and LLA in those who are current smokers compared to non-current smokers. If current smoking increases risk of new ulcers, impairs healing or increases LLA this may enhance efforts by clinicians to assist patients to cease, and may encourage patients to stop.
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NewsBot · Apr 28, 2024 at 9:36 PM

The association between tobacco smoking and systolic toe pressures in active foot ulceration
Nada Bechara et al
Sci Rep. 2024 Apr 12;14(1):8550

Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine whether toe pressures differed in smokers with a foot ulcer, when compared to non-smokers and ex-smokers, as well as ulcer outcomes at 12 months, among patients attending Blacktown Hospital High Risk Foot Service (HRFS). This study is a retrospective analysis of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or a minimum of 12 months. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .002) and tended towards lower socioeconomic status (p = .067). Current smokers were significantly more likely to have ischaemic grade 3 toe pressures (< 30 mmHg) of their left foot (p = .027), suggestive of reduced perfusion. At the end of follow up period, smokers had the numerically highest rates of minor amputations. In conclusion, smokers ulcerate younger and are more likely to have grade 3 ischaemia. Collecting information about the brachial artery pressures and the time since the last cigarette may clarify any relationship between smoking and toe pressures.
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