Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis

Objective: The aim of this study was to assess the relationship between diabetes and pressure ulcer (PU) risk in patients with hip fractures. Method: Searches of MEDLINE (1966-), ISI Databases (1965-) and Scopus (1996-) were performed for English language studies. The search data was 29 July 2016. Odds ratio (OR) for PUs were calculated for hip fracture patients with or without diabetes and a meta-analysis was carried out following meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Results: A total of 8 studies with 22,180 patients were included in this study. The mean PU incidence was 15.1% in group with diabetes compared with 7.5% in the group without diabetes. When comparing with and without diabetes meta-analysis showed the summary OR was 1.825 [95% confidence interval (CI): 1.373-2.425; z=4.15, p<0.00001]. No significant publication bias was found. Sensitivity analysis included prospective studies [OR: 1.383, 95% CI: 1.035-1.847] and pooled the adjusted OR [OR: 1.282, 95% CI: 1.054-1.560] showed the result was robust. Subgroup analysis by PU stage showed the summary OR was 1.474 [95% CI 0.984-2.207] for >= category II PU, and 2.814 [95% CI: 2.115-3.742] for >= category I PU. The meta-regression showed PU incidence explained 27.77% proportion of between-study variance, but statistical test showed no significance (t=-1.96, p=0.097). Conclusion: Our meta-analysis indicates that diabetes increases the PU risk in hip fracture patients. Therefore, specific recommendations should apply for the management of diabetic patients with hip fractures at risk of PU.