Welcome again to another Diabetes Digest commentary. While looking at the published papers over the past 3 months, I found it difficult to decide which one or two papers to single out. The paper I have chosen reminded me in an oblique way of Darwin and one of his quests … ‘the missing link’! The paper I would like to comment on and encourage you to read is by Zha and colleagues, entitled ‘A bibliometric analysis of global research production pertaining to diabetic foot ulcers in the past ten years’. As the title suggests, it explores and reports on the published diabetic foot research activity over the past decade. The authors used a method of literature analysis by performing document co-citation and co-word visualisation analysis to reveal the research hotspots, frontiers and core literature. The literature in connection with diabetic foot ulcers (DFUs) from 2007 to 2018 was retrieved from the Web of Science Core Collection database (WoSCC). They used the WoSCC and CiteSpace software programme to analyse publication outcomes, journals, research direction, research hotspots and frontiers. Overall, 4,580 publications on DFUs were retrieved until March 22, 2018, although the data for 2018 was excluded as it only covered a 3-month period at the time of analysis. The authors report that the largest volume of diabetic foot ulcer literature was produced by the US (n=1,495), followed by the UK (n=463), China (n=336), Germany (n=318), Italy (n=267), Netherlands (n=198), India (n=187), France (n=162), Australia (n=157) and Canada (n=154). Regarding the areas of highest research interest, the most common was related to surgery, other key topics were dermatology, endocrinology, orthopedics, internal medicine, cell biology, engineering, cardiology and pharmacology.
From the analysis, three current ‘hot spots’ within the literature were identified: “complications”, “amputation” and “infection”. Furthermore, the authors have suggested that three potential areas that are future research frontiers that require investigation, namely, infection, wound management and prediction studies.
This paper is worthy of your attention and it is encouraging to see the growing trend of research and publications in our ‘less trendy’ area of medicine. However, like Darwin, my mind is more fixated upon finding and dealing with the ‘missing link’ — i.e. the huge gap between knowledge and clinical outcomes, such as amputations and ulcer relapse.
It is clear that our understanding of diabetic foot pathology, science, treatments etc is growing, but so too is the global amputation rate … every 20 seconds! Implementation of knowledge, skills and service structure does not seem to have had the same impact as research activity. Have we shifted our focus a little too much? Anyway, I recommend this paper, it is informative, encouraging and, hopefully, thought provoking.
