Eureka! Institutional Repository

Pressure ulcers are a major health issue with social and economical impact. All hospitalized patients are at increased risk for pressure ulcers, but some groups, like diabetics being more prone. Objective To study the relationship between diabetes mellitus (DM), as an aggravating factor in pressure ulcer development, in rehabilitation patients, and provide answers to the following questions:  Are diabetic patients at greater risk for pressure ulcers?  Are neuropathy and vasculopathy risk factors?  Patient history is associated with pressure ulcers?  Is diabetes associated with more sites of pressure ulcers in one patient?  Does comorbidity correlate with pressure ulcers?  Does Braden Score (for Predicting Pressure Ulcer Risk) correlate with pressure ulcer presentation?  Does functional score correlate with pressure ulcer presentation? Method The study included 50 patients of “Anagennisi” Rehabilitation Center, that during admission had pressure ulcers. The inclusion criteria were independent of age, sex and admission diagnosis. Somatometric characteristics of the patients were registered, and also the pressure ulcers, their location and staging according to EPUAP/NPUAP 2009. The presence or not of aggravating factors was also registered: neuropathy, vasculopathy, smoking, hypertension, anemia, chronic kidney disease, chronic obstructive pulmonary disease, polypharmacy, serious infection, use of cortisone, diabetes mellitus and duration of diabetes. Nutritional status of the patients was assessed using Mini Nutritional Assessment, while mental status was assessed with Mini Mental State examination. Functional status 4 was assessed with FIM scale. Concomitant diseases were registered and scored with the help of Charlson Comorbidity Index, whereas the risk of developing pressure ulcer was examined with Braden Index. Results The 87,5% of patients with diabetes, has type II, while 12,5% has type I. The 92% of the patients had diabetes >6 years. Concerning nutrition, the non diabetic group had normal nutritional status in 36% while diabetic group had 72%. Neuropathy is present in 50% of patients with diabetes. Vasculopathy presents in both groups, with 60% in diabetics and 28% in non diabetics. Diabetic group was characterized with multiple sites of ulcer on the same patient compared to non diabetic group. 64% of diabetic patients had more than 3 site, while 100% of non diabetics had <3 sites of ulcers. Chronic kidney disease, incontinence and low mini-mental score have negative association with statistical significance p=0.036, p=0.025, p=0.019 respectively. Braden Index and Charlson Index present statistical significant difference between two groups p<0.05. Conclusion The results of the study suggest that many factors (diabetes mellitus, chronic kidney disease, nutritional status, mental state and incontinence) contribute to the development of pressure ulcers. This proves the multifactorial pathogenesis of pressure ulcers and the cause of the difficulty in their treatment and healing.