{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:22:22Z","timestamp":1787775742752,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Diabetes mellitus (DM) affects millions globally and is associated with high morbidity, risk of infection, and potential for severe outcomes. In India, where the prevalence of diabetic foot complications is notably high, data on factors influencing the severity and outcomes of diabetic foot ulcers (DFUs) in specific regions, particularly Eastern India, remain sparse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This hospital-based cross-sectional study included Type 2 DM patients aged over 18 years, excluding those unwilling to participate and those with ulcers classified as Wagner grade less than 2. The study involved the complete enumeration of eligible patients presenting with DFUs. Clinical and demographic data were collected, including glycemic control, physical activity levels, and microbial cultures from ulcer specimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study included 90 patients with a mean age of 56.1 years. Most participants were male (76.7%), with 47.8% receiving regular diabetes treatment and only 10% achieving good glycemic control. Positive swab cultures were found in 68.9% of patients, predominantly mono-microbial. Higher grade ulcers were associated with male gender (AOR 5.715), and positive swab cultures (AOR 17.470). Moderate-to-severe physical activity (AOR 9.683) and paresthesia (AOR 0.101) were significant predictors of gangrene, with absent distal pulses (COR 13.818) also indicating a higher risk for gangrene. Good glycemic control was associated with a reduced risk of gangrene (COR 0.125).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Maintaining good glycemic control is crucial in preventing complications such as gangrene. Physical activity is generally beneficial in DM; however, excessive or high-impact activities may exacerbate existing foot ulcers and increase the risk of gangrene.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_1703_24","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:01:05Z","timestamp":1745575265000},"page":"1431-1436","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with severity and outcomes of diabetic foot ulcers: A single center hospital-based cross-sectional observational study in Eastern India"],"prefix":"10.4103","volume":"14","author":[{"given":"Anjani","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of General Medicine, All India Institute of Medical Sciences, Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijay Nanda","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, All India Institute of Medical Sciences, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishnu Shankar","family":"Ojha","sequence":"additional","affiliation":[{"name":"Department of General Medicine, All India Institute of Medical Sciences, Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratnadeep","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of General Medicine, All India Institute of Medical Sciences, Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, AIIMS Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prathyusha","family":"Kokkayil","sequence":"additional","affiliation":[{"name":"Department of Microbiology, AIIMS Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Jyoth","sequence":"additional","affiliation":[{"name":"Department of General Surgery, AIIMS Patna, Phulwari Sharif, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajdeep","family":"Porel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"issue":"Suppl 1","key":"R1-20250515","first-page":"S62","volume":"32","year":"2009","journal-title":"Diabetes Care"},{"key":"R2-20250515","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"R3-20250515","first-page":"28","article-title":"Diabetic foot ulcers--effects on QOL, costs, and mortality and the role of standard wound care and advanced-care therapies","volume":"55","author":"Snyder","year":"2009","journal-title":"Ostomy Wound Manage"},{"key":"R4-20250515","doi-asserted-by":"crossref","first-page":"e2075","DOI":"10.1002\/hsr2.2075","article-title":"Early intervention and care for diabetic foot ulcers in low and middle income countries:Addressing challenges and exploring future strategies:A narrative review","volume":"7","author":"Swaminathan","year":"2024","journal-title":"Health Sci Rep"},{"key":"R5-20250515","doi-asserted-by":"crossref","first-page":"563","DOI":"10.4103\/1947-2714.103315","article-title":"Bacteriological and resistance profile in isolates from diabetic patients","volume":"4","author":"Rawat","year":"2012","journal-title":"N Am J Med Sci"},{"key":"R6-20250515","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/107110078100200202","article-title":"The dysvascular foot:A system for diagnosis and treatment","volume":"2","author":"Wagner","year":"1981","journal-title":"Foot Ankle"},{"issue":"Suppl 1","key":"R7-20250515","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.2337\/dc23-S002","article-title":"2. Classification and diagnosis of diabetes:Standards of care in diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"R8-20250515","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/j.1365-2648.2004.03331.x","article-title":"Men and health help-seeking behaviour:Literature review","volume":"49","author":"Galdas","year":"2005","journal-title":"J Adv Nurs"},{"key":"R9-20250515","first-page":"30","article-title":"Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons:A cross-sectional trial","volume":"6","author":"Navarro-Peternella","year":"2016","journal-title":"J Clin Transl Endocrinol"},{"key":"R10-20250515","doi-asserted-by":"crossref","first-page":"e0281886","DOI":"10.1371\/journal.pone.0281886","article-title":"Sex differences in diabetic foot ulcer severity and outcome in Belgium","volume":"18","author":"Vanherwegen","year":"2023","journal-title":"PLoS One"},{"key":"R11-20250515","doi-asserted-by":"crossref","first-page":"8081670","DOI":"10.1155\/2018\/8081670","article-title":"A Comparison of Gender Differences in Smoking Behaviors, Intention to Quit, and Nicotine Dependence among Thai University Students","volume":"2018","author":"Chinwong","year":"2018","journal-title":"J Addict"},{"key":"R12-20250515","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/jdi.12952","article-title":"Review of the role of cigarette smoking in diabetic foot","volume":"10","author":"Xia","year":"2019","journal-title":"J Diabetes Investig"},{"key":"R13-20250515","doi-asserted-by":"crossref","first-page":"8550","DOI":"10.1038\/s41598-024-59158-5","article-title":"The association between tobacco smoking and systolic toe pressures in active foot ulceration","volume":"14","author":"Bechara","year":"2024","journal-title":"Sci Rep"},{"key":"R14-20250515","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1128\/CMR.14.2.244-269.2001","article-title":"Wound microbiology and associated approaches to wound management","volume":"14","author":"Bowler","year":"2001","journal-title":"Clin Microbiol Rev"},{"key":"R15-20250515","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0022034509359125","article-title":"Factors affecting wound healing","volume":"89","author":"Guo","year":"2010","journal-title":"J Dent Res"},{"key":"R16-20250515","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5662\/wjm.v12.i3.132","article-title":"Nature and mechanism of immune boosting by Ayurvedic medicine:A systematic review of randomized controlled trials","volume":"12","author":"Vallish","year":"2022","journal-title":"World J Methodol"},{"key":"R17-20250515","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2522\/ptj.20160124","article-title":"Physical training and activity in people with diabetic peripheral neuropathy:Paradigm shift","volume":"97","author":"Kluding","year":"2017","journal-title":"Phys Ther"},{"key":"R18-20250515","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.nic.2013.03.023","article-title":"Peripheral neuropathy \u2013Clinical and electrophysiological considerations","volume":"24","author":"Chung","year":"2014","journal-title":"Neuroimaging Clin N Am"},{"key":"R19-20250515","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1177\/1534734611417352","article-title":"Characteristics of peripheral arterial disease and its relevance to the diabetic population","volume":"10","author":"Faglia","year":"2011","journal-title":"Int J Low Extrem Wounds"},{"key":"R20-20250515","first-page":"e47525","article-title":"A comprehensive review of the vascular consequences of diabetes in the lower extremities:Current approaches to management and evaluation of clinical outcomes","volume":"15","author":"Yachmaneni","year":"2023","journal-title":"Cureus"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1703_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:41:12Z","timestamp":1787773272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1703_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1703_24","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-10-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}