Decubitus Ulcers of Soft Tissues in Patients with Type 2 Diabetes Mellitus: Clinical Strategies, Insulin Resistance Indicators, Comprehensive Treatment Aspects

A.R. Vergun, M.R. Krasnyi, Ya.B. Chulovsky, O.M. Vergun, O.M. Moshchynska


Background. The causes of decubitus ulcers include ischaemia and neurotrophic tissue changes induced by their chronic compression, continuous pathologic moisture and shift of tissues that determine local ishaemia. The aim of the article: to study clinical options and suppurative complications of decubitus ulcers in patients with type 2 diabetes mellitus (DM) in terms of insulin resistance (IR) in the context of combined treatment optimization. Materials and methods. Total sample of retro- and prospective analyses involved results of comprehensive treatment of 112 patients. Type 2 DM was diagnosed in 37 patients, I comparison group included 27 patients with decubitus ulcers without complications (I–III stages) and DM, with decubitus ulcers stage IV — II comparison group; and the control group included other 75 individuals. Results. The patients with type 2 DM (I comparison group) had considerable decrease in HOMA index of β-cell function and increased HOMA index of IR (8.31 ± 0.02, р < 0.01). Patients with type 2 DM with complicated decubitus ulcers (II comparison group) had more significant increase of circulating insulin indexes (p2 < 0.01), HOMA index of IR (p2 < 0.05), and considerable decrease on HOMA index of β-cell function (p2 < 0.05). The correlation analysis of HOMA-IR indicators and element concentration in the blood revealed the correlation only in patients with type 2 DM (I and II comparison groups): potent negative correlation (r = –0.72; p < 0.001) was revealed between the HOMA-IR and Mg2+ content in erythrocytes; intermediate negative correlation (r = –0.66; p < 0.01) — between HOMA-IR and Zn2+ concentration in the blood serum; and a negative one (r = –0.69; p < 0.01) — between HOMA-IR and Cr3+ level in the blood serum. Conclusions. The advantage of the proposed classification of decubitus ulcers of soft tissue and a sequence of comprehensive treatment is considering the features of pathogenesis, morphogenesis and clinical course of ulcers with complications that affect the course of healing and require appropriate strategies for the treatment of purulent wounds — TIME and DOMINATE, which, in our opinion, determines the possibility of the introduction into clinical practice of palliative care departments, other inpatient and outpatient health care facilities.


decubitus ulcers; type 2 diabetes mellitus; indicators of insulin resistance; complex treatment


Risk profile characteristics associated with outcomes of hospital-acquired pressure ulcers: a retrospective review / J. Alderden, J.D. Whitney, S.M. Taylor [et al.] // Critical Care Nurse. — 2011. — ​Vol. 31, № 4. — ​P. 30-43.

The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds / D.E. Angel, P. Lloyd, K. Carville, N. Santamaria // Int. Wound J. — 2011. — ​Vol. 8(2). — ​Р. 176-185.

Biglari B. A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients / B. Biglari, A. Büchler, T. Reitzel // Spinal Cord. — 2014. — ​Vol. 52, № 1. — ​Р. 80-83.

Cowan L.J. Prevalence of wet-to-dry dressings in wound care / L.J. Cowan, J. Stechmiller // Adv. Skin Wound care. — 2009. — ​Vol. 22(12). — ​Р. 567-573.

Cullen Gill E. An exploration of fourth-year under graduate nurses knowledge of and attitude towards pressure ulcer prevention / E. Cullen Gill, Z. Moore // J. Wound Care. — 2013. — № 22(11). — ​Р. 618-619.

Factors associated with pressure ulcer risk in spinal cord injury rehabilitation / G. DeJong, C.H. Hsieh, P. Brown [et al.] // American Journal of Physical Medicine & Rehabilitation. — ​2014. — ​Vol. 93, № 11. — ​P. 971-986.

Survey of fungi and yeast in polymicrobial infections in chronic wounds / S.E. Dowd, J. Delton Hanson, E. Rees [et al.] // J. Wound Care. — 2011. — № 20(1). — ​Р. 40-47.

Factors associated with the development of pressure ulcers after spinal cord injury / V. Eslami, S. Saadat, R. Habibi [et al.] // Spinal Cord. — 2012. — ​Vol. 50, № 12. — ​P. 899-903.

Wound care outcomes and associated cost among patients treated in US outpatient wound centers: data from the US Wound Registry / C.E. Fife, M.J. Carter, D. Walker, B. Thomson // Wounds. — 2012. — ​Vol. 24(1). — ​Р. 10-17.

Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders / B.L. Goodman, A. Schindler, M. Washington [et al.] // Journal of Wound Care. — 2014. — ​Vol. 23, № 4. — ​P. 165-172.

Support surfaces for pressure ulcer prevention / E. McInnes, A. Jammali-Blasi, S.E. Bell-Syer [et al.] // Cochrane Database Syst. Rev. — 2011. — ​Vol. 34, № 4. — ​D001735.

Moore Z.E. Dressings and topical agents for preventing pressure ulcers / Z.E. Moore, J. Webster // Cochrane Database Syst. Rev. — 2013. — ​Vol. 8. — ​CD009362.

Saladin L.K. Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of four groups based on race-ethnicity / L.K. Saladin, J.S. Krause // NeuroRehabilitation — ​2009. — ​Vol. 24, № 1. — ​P. 57-66.

Saunders L.L. Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury / L.L. Saunders, J.S. Krause, J. Acuna // Archives of Physical Medicine and Rehabilitation — ​2012. — ​Vol. 93, № 6. — ​P. 972-977.

Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study / A. Scheel-Sailer, A. Wyss, C. Boldt [et al.] // Spinal Cord. — 2013. — ​Vol. 51, № 11. — ​P. 828-833.

Sibbald R.G. Increased bacterial burden and infection: the story of NERDS and STONES / R.G. Sibbald, K. Woo, E.A. Ayello // Adv. Skin Wound Care. — 2006. — № 19(8). — ​Р. 447-463.

Treadwell T. Site assessments: early steps on the journey toward outcomes / T. Treadwell, D.N. Keast // Wounds. — 2010. — ​Vol. 22. — ​Р.71-77.

Impact of pressure ulcers on outcomes in inpatient rehabilitation facilities / H. Wang, P. Niewczyk, M. Divita [et al.] // American Journal of Physical Medicine and Rehabilitation. — 2014. — ​Vol. 93, № 3. — ​P. 207-216.

Prospective, multicenter study of spinal cord stimulation for relief of Risk factors associated with pressure ulcer development in critically ill traumatic spinal cord injury patients / P. Wilczweski, D. Grimm, A. Gianakis [et al.] // J. Trauma. Nurs. — 2012. — ​Vol. 19, № 1. — ​P. 5-10.

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