Prospective Exploration of the Effect of Adiposity and Associated Microbial Factors on Healing and Progression of Diabetic Foot Ulcers in Tanzania.

The overall primary objective is to determine the effect of adiposity and associated microbial factors on healing and progression of diabetic foot ulcers (DFUs) in people with T2DM.

The specific objectives are to:

Determine the proportion of complete ulcer healing at 24 weeks, in T2DM patients with normal and high adiposity.
Determine the proportion of improving or worsening DFUs at 24 weeks, in T2DM patients with normal and high adiposity
Determine whether there is an association between baseline adiposity (normal and high) and ulcer healing (complete healing at weeks, and/or healing time)
Determine whether baseline adiposity and microbial characteristics have dependent and/or combined associations with ulcer healing at 24 weeks
Evaluate whether there is an association between adiposity and adverse outcomes in people with DFUs (amputation and death).

Secondary objectives

To evaluate the validity of various baseline surrogate markers and measures of obesity/adiposity (BMI, waist circumference (WC), LBM and phase angle) in predicting wound prognosis (healing, worsening, amputation or death) in people with DFUs.
To evaluate the validity of baseline measures of peripheral arterial function (Peripheral pulses, ankle-brachial index (ABI), toe brachial index (TBI), toe pressure and Doppler waveforms) in predicting wound prognosis (healing, worsening, amputation or death) in people with DFUs.
To determine whether microbial characteristics (type, load, dominance/diversity and their antibiotic susceptibility patterns) differ in different stages/classifications of DFUs
To evaluate whether there is an association between microbial characteristics (type, load, dominance/diversity and their antibiotic susceptibility patterns) body composition, arterial status, and glycaemic control.
To evaluate whether baseline microbial characteristics (type, dominance, diversity and antibiotic susceptibility patterns) predict wound prognosis (healing, worsening, amputation or death) in people with DFUs.

Project Expected Outcomes:

The intern should have a strong background in mathematical statistics and be able to

Develop a clear and detailed statistical plan for the study
Learn and implement inference statistics as well as survival analysis to address the primary objective of the study
Learn and implement statistical analysis to validate the utility of various surrogate markers in predicting wound healing and progression
Produce relevant figures and tables based on a statistical analysis
Draft a manuscript based on study results and analysis.