New Study Identifies Priorities for Future Research: What Can We Learn?

Good work recently published in Diabetic Medicine by Kumlien and coworkers; they established what they found to be the top 10 research uncertainties for preventing and treating diabetic foot ulcers.¹ A pilot survey was completed by 53 persons living with diabetes and 49 clinicians in order to assess the relevance of various uncertainties surrounding the pathology of diabetic foot ulcer (DFU). After running statistical tests on all uncertainties evaluated, 28 moved on to discussion in a digital workshop. The final ten prioritized research uncertainties in this area were:¹
 
·      organization of diabetes care;
·      screening of diabetes,
·      screening for impaired blood circulation,
·      screening for neuropathy,
·      screening and grading of skin properties;
·      vascular surgical treatment;
·      importance of self-care;
·      importance of help from significant others;
·      prevention with pressure relief; and
·      prevention of infection.
 
This consensus could guide future research and potentially inform research funding allocation.
 
Some of the key factors that I agree with are summarized in this manuscript. One of the items that may not have been highlighted as much as it should be, is the development of companion diagnostics. I’ve covered this concept in my personal blogs before.^2-5 I believe that until we can measure what we manage, we are condemned to only using one product, which is a suboptimal plan. We wouldn’t think of doing the same thing if we were studying cardiovascular disease.
 
I am really enthusiastic about looking at extending ulcer-free days in remission. I am thrilled that patients and many other clinicians share that enthusiasm based on the results of this study.
 
Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).

Editor’s note: This blog originally appeared here. It is adapted with permission from the author.

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References
 
1.     Kumlien C, Acosta S, Bjorklund S, et al. Research priorities to prevent and treat diabetic foot ulcers – a digital James Lind Alliance Priority Setting Partnership. Diabetic Med. 2022. Doi:10.1111/dme.14947 .
2.     Armstrong DG. We should all be measuring wound pH. DF Blog.
3.     Armstrong DG. Skin autofluorescence for non-enzymatic glycation end products in Diabetic Foot Ulcers (DFUs)- A meta analysis. DF Blog.
4.     Armstrong DG. The Use of Point-of Care Bacterial Autofluorescence Imaging in the Management of Diabetic Foot Ulcers: A Pilot Randomized Controlled Trial. DF Blog.
5.     Armstrong DG. Changes in microRNA‐103 expression in wound margin tissue are related to wound healing of diabetic foot ulcers. DF Blog.