Texas has one of the highest rates of diabetes in the United States. More than 2.7 million Texans have been diagnosed with diabetes. In San Antonio, about one out of every six people has type 2 diabetes, and one in three residents is prediabetic. Type 2 diabetes is a long-lasting condition where the body either does not make enough insulin or cannot use insulin properly.
When this condition is not well controlled, blood sugar stays high, which can harm many parts of the body. Over time, high blood sugar can lead to heart problems and kidney failure. It also makes the feet very vulnerable to injuries.
Many people with diabetes develop foot ulcers—open wounds on the feet—that are dangerous because almost half of them become infected. Infections can lead to hospital stays and sometimes force doctors to amputate part of the foot or even a lower limb.
A recent study from The University of Texas Health Science Center at San Antonio looked at what happens after a person with diabetes is treated for a foot infection. The study, published in November 2024 in the International Wound Journal, is the first to show the factors that increase the risk of getting another infection after treatment.
The study found that nearly half of the patients treated for diabetic foot infections had a second infection later on. By understanding what makes a reinfection more likely, doctors can better care for patients and help them heal properly.
The study was led by Dr. Lawrence A. Lavery, a specialist in diabetic foot problems and a professor in the Division of Podiatry at the Joe R. and Teresa Lozano Long School of Medicine. Dr. Lavery returned to UT Health San Antonio after 30 years away, coming back to serve the high-risk communities of San Antonio and South Texas.
One important fact is that about 50% of people with diabetes develop a condition called peripheral neuropathy. This condition damages the nerves in the feet and sometimes the hands. When nerves are damaged, a person may feel little or nothing in their feet. Because of this loss of feeling, small cuts, blisters, or rough spots might go unnoticed.
These minor injuries can become open wounds, which then may turn into ulcers. Diabetes also slows down the healing process. This means that wounds may stay open for a long time, giving bacteria a chance to enter the body and cause an infection.
Dr. Lavery explained, “When a wound does not heal, it becomes an open door for bacteria. Once bacteria enter, they can cause a second infection.” To study this problem, the research team looked back at eight years of patient records. They gathered information from 294 patients who had been hospitalized with moderate to severe diabetic foot infections.
These patients ranged in age from 18 to 89, with the average age being 53, and 75% of them were men. The team then followed these patients for another 12 months to see if they developed new infections in the soft tissue or bones of the foot.
The study found that the strongest sign of a future infection was if the original wound took three months or longer to heal. Patients with wounds that took this long were three times more likely to suffer from another infection.
In addition, patients who had bone infections were more than twice as likely to get a new infection compared to those who had infections only in the soft tissue. In contrast, patients whose wounds healed completely were much less likely to have another infection.
Beyond the infection risks, patients with wounds that did not heal well experienced many other problems. They often needed to return to the hospital more than once, had longer hospital stays, and faced a longer overall recovery time. This cycle of infection and reinfection can lead to repeated hospitalizations, multiple amputations, and, in severe cases, even early death.
Diabetic foot problems are not only physically painful but can also cause great emotional and financial stress for families. For example, diabetic men are more likely to lose a limb than women, and many of these men are still working and have children to support.
They often face a difficult choice between staying at home to properly heal and returning to work, which may delay healing and increase the risk of another infection.
There is also a growing concern among doctors about younger adults. Recent years have seen more cases of diabetic complications among people in their 30s, partly because conditions like obesity and high blood pressure are being diagnosed earlier.
In the past, nerve damage in the feet usually took a decade to develop, but now, younger patients are showing up with serious foot infections. Dr. Lavery mentioned that it is not just about how old a person is but how much disease their body has experienced over time.
To help prevent these dangerous foot infections, UT Health San Antonio has set up special prevention clinics in San Antonio. These clinics use a team approach that combines education, preventive care, and efforts to remove barriers to good health.
Dr. Lavery called for more aggressive treatment of complex wounds, better methods to monitor infections, and the use of new technology to prevent problems before they start. He sees this as a chance to bring the best, evidence-based care to patients and their families.
Review and Analysis
The study sheds light on a critical issue facing many people with diabetes, especially in regions like Texas where the condition is widespread. It emphasizes the importance of proper wound healing in preventing reinfections, showing that delayed healing significantly increases the risk of further complications.
The findings also reveal that bone infections pose an even greater risk compared to soft tissue infections. By identifying these risk factors, the study provides valuable information that can help guide treatment and preventive strategies.
This research underscores the need for early and effective management of diabetic foot wounds to reduce hospitalizations, amputations, and the overall burden on patients and their families. It also highlights the growing challenge of diabetic complications in younger adults, calling for urgent attention to preventive care and innovative treatment approaches.
If you care about diabetes, please read studies about 5 vitamins that may prevent complication in diabetes, and how to manage high blood pressure and diabetes with healthy foods.
For more health information, please see recent studies about vitamin D and type2 diabetes, and to people with type 2 diabetes, some fruits are better than others.
The research findings can be found in the International Wound Journal.
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