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Diabetic Foot Ulcer Recurrence: Pilot Study (DFUCO)

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ClinicalTrials.gov Identifier: NCT03479242
Recruitment Status : Recruiting
First Posted : March 27, 2018
Last Update Posted : April 7, 2020
Sponsor:
Collaborator:
Stanford University
Information provided by (Responsible Party):
Chandan Sen, Indiana University

Brief Summary:
In this prospective pilot study, patients with DFU visiting the Ohio State University Comprehensive Wound Center will be enrolled. Patients enrolled in the study will be followed for 16 weeks for wound closure(Phase A), and will then begin Phase B where TEWL measurements and wound recurrence will be followed up for up to 12 weeks.

Condition or disease Intervention/treatment
Diabetic Foot Ulcer Foot Other: no interventions

Detailed Description:

Diabetes impairs immune defenses such that the ability to fight wound infection is weakened. Thus, infection is a major problem in diabetic foot ulcers (DFUs) . Biofilms are estimated to account for 60% of chronic wound infections6. In biofilm bacteria are encased within extra polymeric substance (EPS) and become recalcitrant to antimicrobials and host defenses.In the biofilm form, bacteria may not form colony. Thus, standard clinical techniques like CFU to detect infection may not detect biofilm infection. Thus, biofilm infection may be viewed as a silent threat in wound care. Using a preclinical swine model of mixed species wound biofilm infection, we struck an unusual observation. Although biofilm infection may or may not influence the rate of wound closure as measured by standard planimetry, it inevitably compromises the functional property of the repaired skin. The wound may close as evaluated visually, but that closed wound lacks barrier function. Such pathology is caused by the perturbation of epithelial junctional proteins in response to biofilm infection. While detecting the biofilm directly is readily not possible at present in the wound clinics, compromised barrier function of the repaired skin can be detected at the point of care of the measurement of trans-epidermal water loss (TEWL). This pilot study, we propose, many DFUs that are currently served with a CLOSED clinical decision may have had a history of biofilm infection and therefore remained functionally open.

Considering that such incomplete wound closure may have a higher risk of wound recidivism, it becomes critically important that wound closure decisions be guided by functional tests in addition to factors currently considered. Importantly, substantial change in health impact may be achieved by a simple functional test as implemented by the measurement of trans epidermal water loss (TEWL). TEWL can be performed by clinical staff at the point of care within 15 minutes with minimum training using inexpensive hand- held pen like commercial gadgets approved for clinical use.

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Study Type : Observational
Estimated Enrollment : 30 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: To Study Diabetic Foot Ulcer Recurrence With Trans Epidermal Water Loss Measured With Derma Lab
Actual Study Start Date : January 25, 2019
Estimated Primary Completion Date : December 31, 2021
Estimated Study Completion Date : December 31, 2021

Resource links provided by the National Library of Medicine



Intervention Details:
  • Other: no interventions
    no interventions are planned


Primary Outcome Measures :
  1. Functional skin closure in DFU in relation to biofilm infection [ Time Frame: 7 months ]
    TEWL will be measured to check for functional wound closure and see if DFU recidivism is high in subjects with a history of biofilm infection



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
30 clinically diagnosed infected DFU patients will be recruited for this study in Phase A.Based on the expectation that 89% of these wounds will heal within 16 weeks of enrollment, 26 of these patients will continue with the study for Phase B.
Criteria

Inclusion Criteria:

  1. Age ≥ 18
  2. Willing to comply with protocol instructions, including all study visits and study activities.
  3. Diabetic foot ulcers
  4. Adequate arterial blood flow as evidenced by at least one of the following:

    1. TCOM > 30 mmHg
    2. Ankle-brachial index ≥0.7
    3. Toe pressure > 30 mmHg

Exclusion Criteria:

  1. Individuals who are deemed unable to understand the procedures, risks and benefits of the study, (i.e. unable to provide informed consent)
  2. Wounds closed or to be closed by flap or graft coverage
  3. Prisoners

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03479242


Contacts
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Contact: Jennifer Mohnacky 317-278-2715 jmohnack@iu.edu
Contact: Sashwati Roy, PhD 3172782706 roysa@iu.edu

Locations
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United States, Indiana
IU Health Methodist Hospital Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Jennifer Mohnacky, RD    317-278-2715    jmohnack@iu.edu   
Sponsors and Collaborators
Indiana University
Stanford University
Investigators
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Principal Investigator: Chandan K Sen, PhD Professor
Additional Information:
Publications:
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Responsible Party: Chandan Sen, Professor, Indiana University
ClinicalTrials.gov Identifier: NCT03479242    
Other Study ID Numbers: 1808823394
First Posted: March 27, 2018    Key Record Dates
Last Update Posted: April 7, 2020
Last Verified: April 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Diabetic Foot
Foot Ulcer
Ulcer
Recurrence
Pathologic Processes
Disease Attributes
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Leg Ulcer
Skin Ulcer
Skin Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies
Foot Diseases