Incidence and Prevalence of Diabetes and Obesity in Relationship to Pressure Ulcer Healing

Introduction

Nowadays much attention is paid to the assessment of the effectiveness of the healing methodologies and the combining of healing methodologies of various health conditions for the determination of positive effect of this combination and reviling the interconnection between various health issues. The current work is aimed at examining the interconnection between diabetes, obesity, and pressure ulcers, and links between the treatment practices of these health issues. It will be performed on the background of PICOT model. The assessment of the existing interconnection will be made via testing the hypothesis and null hypothesis. The testing will be realized by using the sample size with similar health conditions of a particular age, collecting, analyzing and comparing the results of intervention within the certain time period. The performance, description and interpretation of the outcomes of healing of pressure ulcers, diabetes, and obesity will be supported by the theoretical information, i.e. the already available knowledge about these health issues. The understanding of interconnection of these diseases and their interventions will help develop and introduce more effective practices for their healing.

PICOT Question

This format of research is often used for the formulation and presentation of the research question that concerns to the treatment efficacy of particular health care issues.  It enables to assess the effectiveness of the performed therapy and perform accurate and relevant formulation of the research question. The PICOT is the abbreviation that means the following: population, intervention, comparison, outcome, and time (Riva et al., 2012). The first item refers to the sample size with some particular characteristics. Usually researchers try to find participants who have health conditions which are commonly observed in the real-life practice and who are more likely to respond to the provided treatment. In the current work the sample size will be presented by the participants aged 60 and older. The explanation of choosing this particular age group will be given below. Some of them will suffer from pressure ulcers, diabetes, and excessive weight. It will help to test both hypothesis and null hypothesis. The intervention will be represented by healing of pressure ulcers through the application of various methodologies. Their short description will be given below. The results of treatment will be compared, i.e. health care providers will compare the health indicators of patients connected with pressure ulcers, diabetes and obesity before and after the intervention. The outcomes will represent the evidence whether the diabetes and obesity interfere with treatment of pressure ulcers or not. It will be shown with the use of the following indicators: the rate of sugar in blood, the body mass index, the availability of new pressure ulcers in the body of the patients and the conditions of the old ones. The time period that depicted the duration of the information collection should be enough for the performance of preliminary assessment of the health conditions of patients and analysis of the obtained data, performance of special healing procedures, collecting of the final information about patients’ health condition and its analysis, and comparison of their primary and final conditions for understanding whether there is an interconnection between healing of pressure ulcers and diabetes with obesity. It is proposed to take one period as the time frame for testing the hypothesis and null hypothesis.

Hypothesis

The current work will be based on the two hypotheses. The first one is that diabetes and obesity have conditions connected with the healing of pressure ulcer. The relevance of this topic is based on the understanding that, every year, millions of people suffer from this health issue in different locations all over the world. About 60,000 US citizens are estimated to die from this condition and 2.5 million of patients are treated from the disease in the U.S. health care providing institutions annually (Yusla, 2010). In addition to the tremendous negative impact on the health and life of patients, this disease causes the significant rise of the healthcare costs on about $11 billion every year (Yusla, 2010).

The pressure ulcers are considered to be a “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction” (Lowe, 2009, p. 3). The major contribution factors in the development of pressure ulcer are the following: circulation, mechanical stress, temperature, humidity, infection, chemical stress on wounds, medications, disease, nutrition, age, and body build. Some of these risk factors are closely related to such issue as prevalence to diabetes and obesity. 

The pressure ulcer has the close connection with such health issue as diabetes. It should be noted that ulcer has several component causes, one of which is peripheral neuropathy (Singh, Armstrong, & Lipsky, 2005). One of the major causes of peripheral neuropathy is the nerve damage that occurs as the consequence of diabetes (Healthline Media, 2016). They are associated with pain, insufficient or even total loss of sensation in the patients’ extremities, and numbness. The official investigations performed by the Center of Peripheral Neuropathy of the University of Chicago reviled that about 60% of patients who suffer from diabetes also have nerve damages (Healthline Media, 2016). The figures supported by the research presented by Singh, Armstrong, & Lipsky (2005). The authors state that peripheral neuropathy can be diagnosed on about 50% of patients with diabetes who are 60 years and older (Singh, Armstrong, & Lipsky, 2005). However, they noticed that this health issue usually becomes apparent prior to the significant decreasing of sensation. Moreover, they presented the information that the excessive blood pressure can cause ulceration of foots. They described this process more precisely and noted the interconnection between the high blood pressure in foots and the ulceration. The last is related to deformities and significantly lowered motilities “at the ankle, sabtalar, and first metatsiohalangeal joints” (Singh, Armstrong, & Lipsky, 2005, p. 217). The last causes about one third cases of foot ulcers. In the context of the current work the additional attention should be paid to such causes of ulcer connected with diabetes as rubbing from footwear (in about 21% of reviled cases), falls connected with injuries (in 11% of cases), self-infected traumas, like cutting mails (4%) and “cellulitis complicating tinea pedis” (in about 4%) (Singh, Armstrong, & Lipsky, 2005, p. 217).

The additional emphasis should be made on the fact that the health issues connected to diabetes serve as the contributing factors for the formation and development of pressure ulcers. The individuals who have diabetes have two times higher rates of is atherosclerotic peripheral vascular disease than the individuals who do not suffer from diabetes (Singh, Armstrong, & Lipsky, 2005). In addition, the skin disruption can be formed under the influence of the increased rates of toe web tinea infections and onychomicosis. These health issues are associated with diabetes (Singh, Armstrong, & Lipsky, 2005). 

The diabetic foot ulcers have the tremendous negative influence on the life and heath of patients and the whole medical system. For example, only in the USA, the financial burden associated with the treatment of patients with this health issue is about $ 45000 for every patient (Wu et al., 2007). However, this figure is even underestimated because the researchers did not calculate the expenses on treatment of psychological trauma from the partial loss of mobility and productivity and the related financial losses. Thus, the timely prevention of pressure ulcers for saving the funds of health care provided to the patients can be considered as one of the top priorities for health care providers.

One of the primary methods of prevention of the formation of ulcers (especially foot ulcers) is the screening of patients who suffer from diabetes. Additional attention should be paid to patients who suffer from diabetes for the long-term period, i.e. ten years and more. Special screening should be especially performed on patients who already had ulcers. Health care providers should perform examination of the condition of patients’ body and extremities for the presence of any abnormalities (for example, bunions and flat feet), pay attention to the extremely dry and fissured skin, identify the presence of peripheral vascular disease and neuropathy, and assess the mobility of patient as well as understand whether it was lowered (Singh, Armstrong, & Lipsky, 2005). Furthermore, it may be necessary to perform screening for lowering of the protective sensation. They can be performed with the use of monofilament, biothesiometry, and tuning fork (Singh, Armstrong, & Lipsky, 2005). The screening of patients with diabetes showed significant positive results in the prevention of the amputation (on more than 47%), hospital admissions (on more than 37%), and decreased the average stay of patients in health care providing institutions (on more than 20 %) (Wu et al., 2007).

Among other methods are the following: acknowledgement of patients concerning their disease and making recommendations to use certain foot wear, rendering of the periodic pediatric care, and in the extreme cases, evaluation of the patients’ condition and making the recommendations for surgical interventions (Singh, Armstrong, & Lipsky, 2005).

Additional attention should be paid to the fact that these methods of healing are closely connected with the methods of diabetes treatment, as numerous theoretical and practical researches proved the close interconnection between ulcers and diabetes. For the current study, only some of these methods may be chosen, like preliminary screening, raise of the patients’ acknowledgement about their health conditions, and rendering of the periodic and pediatric care.

In addition, the presented hypothesis assumes that pressure ulcers are connected with the patients’ obesity. This assumption is based on several statements. The first one is that obesity is closely connected with diabetes. According to the official statistics, the majority of patients who have type II diabetes suffer from obesity (Eckel et al., 2011). The obesity society announced that at the current moment this figure is 90% (Lowe, 2009). These two health issues are linked with each other by the following factors: resistance to insulin, “proinflammatory cytokines…deranged fatty acid metabolism and cellular processes such as mitochondrial dysfunction and endoplasmic reticulum stress” (Eckel et al., 2011, p. 1654).

Moreover, the obesity alone can be associated with the pressure ulcer. That means that the patients who are overweight and in the same time do not have diabetes can suffer from ulcers. It is explained by the fact that individuals who have excessive weight have high possibility of the development of SIRS (also known as systematic inflammatory response syndrome) (Lowe, 2009). This syndrome can cause the MODS (abbreviation for the multiple organ dysfunction syndrome) (Lowe, 2009). The last causes significant harm to the human body. The person suffers from hypotension, hypoxia, and hypo perfusion” (Lowe, 2009). These conditions are also considered to be connected with other health issues. These are tissue perfusion and significantly higher risk of breakdown of human skin. Special researches were performed for the creating the interconnection between the raise of the body mass index and the increasing risk of pressure ulcers formation. According to Lowe (2009), the individuals who have body mass index from 30 to 30.9 can suffer from pressure ulcers in 1.5 times rapidly than individuals with normal body index; and people who have body mass index 40 or higher suffer from pressure ulcers in 3 times more frequently than people who have normal body mass index (Lowe, 2009).

The obesity is closely connected with the chronic venous insufficiency (or hypertension). Patients who suffer from this negative reflection of obesity are also found to have ulcers. The combination of the chronic venous diseases and the excessive weight are among the most critical factors for the formation of changes on the human skin. In this case, the health issues can be addressed by the elevation of extremities, use and changing of wraps, and compression with the use of clothes or garments (Lowe, 2009).

Additional attention should be paid to the fact that ulcers in obese patients can develop not only in common areas, like feet. The adipose tissue can pressure by its weight on different body parts. It may even occlude capillaries and change tissue in the uncommon places. That is why health care providers should pay additional attention for checking the skin folds. The examples of such uncommon places are the following: under breasts, posterior neck, gluteal and perineal locations, etc. (Lowe, 2009). They should use special equipment and be extremely careful to avoid skin breakdown. The health care providers may face differences in the identification and assessment of skin folders of patients who have bigger body size. Additional attention should be paid to the fact that the excessive tissue load connected with obesity can lead to ulcers of different depths of injuries, skin microcircularotory dysfunction, and spinal cord injuries (Lowe, 2009).

Currently, there are various initiatives directed on the prevention of ulcers formation in the obese patients. For example, the healing of patients with excessive weight should be performed with keeping their heads with more than 30 degrees (Lowe, 2009). It helps to prevent the ventilator acquired pneumonia. Consequently, the patients are obliged to share forces on their skin. Moreover, the health care providers should put the individuals with the high risk of formation of pressure ulcers in the special anti-pressure surfaces. Nowadays, the components for these surfaces are freely and widely presented on the mass market (Lowe, 2009).

The pressure ulcers can be developed under the effect of such risk factor connected with the excessive weight as unhealthy nutrition. Patients who suffer from the excessive weight usually tend to consume the below average amount of products full of minerals, vitamins, and micronutrients (Lowe, 2009). In addition, they usually tend to consume food with high density of fats and sugar. The assessment of necessary amount of fats, sugar, minerals, vitamins, and micronutrients from the particular person and creating the appropriate diet can lead to the significant lowering of the risk of formation of ulcers and decreasing of the extent of overweight.   Moreover, other preventive measures which were described above (screening, increasing of people’s awareness about their disease, etc.) can be effective in the prediction and prevention of the ulcers formation. This statement is based on the understanding that the diabetes is closely connected with the excessive weight.  In the current work only several healing methodologies will be used for testing the hypothesis and null hypothesis. They are preliminary screening of the patients and following special diet.

Null Hypothesis

Testing of the above mentioned hypothesis, which assumed that the pressure ulcers are closely connected with diabetes and obesity, thus their healing is closely interconnected with the treatment of these health issues, should be conducted together with the null (or opposite) hypothesis. This hypothesis states that diabetes and obesity are the two health conditions of the patients which are not interfering with the healing of pressure ulcers. Consequently, the formation of all three conditions is independent from each other. The testing of the null hypothesis should be performed in the same conditions, i.e. on the sample of patients with the same characteristic of health condition and disease formation. It is extremely necessary for providing the relevant results of testing hypothesis and null hypothesis.

Conclusion

To summarize, the current work provides the description of theoretical information concerning the interconnection between pressure ulcers, diabetes, and obesity, and linkage between the healing practices of these health issues. Various researchers state that diabetes can be considered one of the reasons for the formation and development of pressure ulcers. Some theoretic and practical examples also prove the existing interconnection between the excessive weight and the pressure ulcers. These health issues have the interrelated healing practices. This theoretical information forms the background for the understanding that healing of pressure ulcers is connected with the diabetes and obesity, i.e. it supports the first hypothesis. It is proposed to perform the additional real-life investigation for testing of the hypotheses. This research should be performed by analyzing the health condition of individuals aged 60 and older who suffer from one or all the above mentioned health issues.