Timely wound management improves lives of patients with DFU

Patients with ¹/₈diabetic foot ulcer (DFU) tend to have a poorer health-related quality of life (HRQoL) at baseline, but this significantly improves as the ulcers heal over time, according to a Singapore study involving a multi-ethnic population.

“These findings highlight the substantial impact of DFUs on patients’ lives and underscore the importance of timely wound management in improving HRQoL,” the researchers said.

A total of 257 patients from the Diabetic Foot in Primary and Tertiary (DEFINITE) Care program were included in this cross-sectional and longitudinal study. 

The research team assessed the participants’ HRQoL using the EuroQoL Five-Dimensional Questionnaire (EQSD) and Diabetic Foot Ulcer Scale-Short Form (DFS-SF) at baseline and at 3-month intervals. They also obtained the health states of each patient based on a nine-state Markov model.

At baseline, DFU patients had a mean EQ5D utility value of 0.736. In the DFS-SF, the mean scores for each domain were 73.8 for “leisure,” 84.6 for “physical health,” 89.5 for “dependence/daily life,” 81.0 for “negative emotions and worry,” 85.4 for “bothered by ulcer care,” and 82.5 for “total.” [Proc Singap Healthc 2025;doi:10.1177/20101058251326709]

The EQ5D showed a significant improvement as ulcers healed, increasing from 0.807 to 0.903 (p<0.001). Likewise, most DFS-SF domains improved, except for the “bothered by ulcer care” domain.

“[H]ealed ulcers demonstrated improvements in all domains and had better HRQoL scores as compared to ulcers that did not heal during the 12 months assessed,” the researchers said. 

Similar findings were noted in other literature. For instance, a 2005 study involving 294 patients found that healing of DFUs led to significant improvements in SF-36, while nonhealed ulcers resulted in diminished HRQoL. [Diabetologia 2005;48:1906-1910]

"Less reliance on off-loading devices, decrease in pain sensation, and reduced need for wound management may be some of the reasons why healed ulcers are associated with higher HRQoL,” according to the researchers. [J Am Geriatr Soc 2009;57:1175-1183; Health Qual Life Outcome 2007;5:44]

Other countries

Patients with DFU in Singapore demonstrated a better HRQoL at first presentation when compared to the findings in international literature.

The mean DFS-SF scores of patients in DEFINITE Care at baseline were higher than those of other countries, including Thailand, Bahrain, Greece, Poland, India, and Indonesia. [Sage Open Nurs 2019;5:2377960819825751; J Tissue Viability 2023;32:465; Hormones (Basel) 2016;15:394-403; Health Qual Life Outcome 2017;15:15; Cent Eur J Nurs Midw 2023;14:833-838]

In addition, the mean EQ5D score of 0.736 at baseline in the current study was higher than that of Bahrain, Poland, Iran, and Europe, except for Thailand, which had a higher mean EQ5D score. [Value Health 2013;16:A445-A446; Int J Low Extrem Wounds 2022;21:41-49; Diabet Med 2013;30:1382-1387; Diabet Med 2006;23:1100-1105]

“Taken together, this strongly suggests that Singaporeans are less affected by their DFUs than their counterparts, with Singapore’s high ranking in overall health system performance a probable explanation for this disparity,” the researchers said. “Low income and education are also reported to be predictors of poorer HRQoL.” [Int J Public Health 2009;54:241-249]