Background
The current understanding of diabetic foot disease is based on a biomedical model of predominantly non-modifiable risk factors, including neuropathy, vascular disease, foot deformity, and ulcer history. For that reason, ulcer risk stratification systems only incorporate these traditional risk factors, not taking important, novel, and modifiable biomechanical and patient-behaviour parameters, or any personalised, gender or cultural differences into account.
While some of these parameters are proven as independent risk factors for ulceration, there are no risk stratification systems incorporating these. The consequence is a significant variation in ulcer risk within current risk strata, and stratification systems that are not specific, not novel, and not intervention oriented. These systems do not guide personalised medicine, nor stimulate efficient use of resources for screening and treatment. In this DIALECT project we aim to assess groups of people at high risk of ulceration and amputation for modifiable biomechanical, behavioural, and other personalised outcomes to improve risk stratification and create starting points for personalised treatment approaches in ulcer and amputation prevention.
Approach
This project will focus on examinations of the lower extremity, physical functioning, biomechanics, and mobility. Data on a comprehensive set of disease-specific, biomedical, and behavioural parameters, as well as clinical outcomes from three existing, unique, and large datasets that have not yet been used for this purpose will be analysed (the Steno Diabetic Foot Cohort, the Maastricht study, and the Safe Haven diabetes registry).
Using a variety of statistical methods, the doctoral candidate will determine risk factors for ulcer development, its recurrence and amputation and will build and validate a personalised risk factor model for ulcer and amputation risk. The aim of this project is to update existing risk stratification systems.
Our research team
Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region. SDCC is organised in four departments (Patient Care, Clinical Research, Health Promotion, and Education) that work closely together around the unifying focus of translational research, care, and prevention.
The doctoral candidate will be part of the Clinical Epidemiological Research group which is embedded within the department of Clinical Research and the candidate will learn from, and collaborate with a multidisciplinary team of clinicians, epidemiologists, and statisticians. The doctoral candidate will also work together with another doctoral candidate from DIALECT at SDCC who focuses on patient involvement and shared decision-making.
Steno Diabetes Center Copenhagen
Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region. The ambition of SDCC is to improve the entire field of diabetes in the Capital Region, but also to contribute with inspiration and new knowledge nationally and internationally.
SDCC is focused on clinical care, research and teaching and currently has more than 400 employees. The clinical staff in the center includes doctors, nurses, dieticians, patient coordinators, podiatrists, and lab technicians. More than half of the employees are involved full-time or part-time in research. In 2021, World Economic Forum’s Global Coalition for Value in Healthcare nominated SDCC as one of the best hospitals in the world in relation to developing a value-based healthcare system for the benefit of people with diabetes and other chronic diseases. For more information, please visit www.sdcc.dk and follow us on LinkedIn and Twitter.
Doctoral Candidate
Abhilasha Akerkar
Recruiting organisation: Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
Hosts: A/Prof. Dorte Vistisen, Prof. Kirsten Lomborg
Duration: 36 months
Secondments: The Glasgow Caledonian University, Glasgow, Scotland (2 months); Maastricht University, Maastricht, The Netherlands (2 months)
Summary: The current understanding of diabetic foot disease is based on a biomedical model of predominantly non-modifiable risk factors. For that reason, current ulcer risk stratification systems only incorporate these traditional risk factors, not taking important, novel, and modifiable biomechanical and behavioural parameters, or any personalised, gender or cultural differences into account. Using data on a comprehensive set of disease-specific, biomedical, and behavioural parameters, as well as clinical outcomes from three existing, unique, and large datasets, this DIALECT project aims to assess groups of high-risk patients for modifiable biomechanical, behavioural, and other personalised outcomes to improve risk stratification and create starting points for personalised treatment approaches in ulcer and amputation prevention.