scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

2021 ◽  
Vol 8 (12) ◽  
pp. 3553
Author(s):  
Bharti Saraswat ◽  
Kapil Kumar Gill ◽  
Ashok Yadav ◽  
Krishan Kumar

Background: A number of scoring systems and classifications are available for diabetic foot ulcers with intention to compare the treatment modalities and future outcomes. Many of them are complex and don’t predict future outcome within the patients. Aim and objectives of current study were to establish a wound-based clinical scoring systems (DUSS) as daily clinical practice by assessing the efficacy of diabetic ulcer severity score.Methods: A total of 73 diabetic patients with foot ulcers were included in this prospective observational study conducted at Dr. S.N. Medical college, Jodhpur and attached hospitals from July 2018 to August 2020. Ulcers were assessed and DUSS score created. Patients were followed up for six months or until healing or amputation if either.Results: In this prospective study of 73 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean age group was 58.57±12.66 years. Mean duration of diabetes was 7.61±5.72 years. Most commonly ulcers were of DUSS score 2. Mean DUSS score was 1.97±1.15. Majority of diabetic foot ulcer patients (37 out of 51) with DUSS score 0, 1 and 2 healed by primary intention after wound debridement. Those with score 3 & 4 majority of them (20 out of 22) had amputation.Conclusions: This is a very simple scoring system that provides an easily accessible and a streamlined approach in the clinical setting without need of any advanced investigative equipment. Hence this can be applied in any set up.


2018 ◽  
Vol 15 (1) ◽  
pp. 2-14 ◽  
Author(s):  
Zenith Khashim ◽  
Shila Samuel ◽  
Nallusamy Duraisamy ◽  
Kathiravan Krishnan

Background:Diabetic foot ulceration remains a major challenge and is one of the most expensive and leading causes of major and minor amputations among patients with diabetic foot ulcer. Hence the purpose of this review is to emphasize on potential molecular markers involved in diabetic foot ulcer physiology, the efficacy of different types of dressing materials, adjunct therapy and newer therapeutic approach like nanoparticles for the treatment of diabetic foot ulcer.Methods:We conducted a systematic literature review search by using Pubmed and other web searches. The quality evidence of diabetic foot ulcer biomolecules and treatments was collected, summarized and compared with other studies.Results:The present investigation suggested that impaired wound healing in diabetic patients is an influence of several factors. All the advanced therapies and foot ulcer dressing materials are not suitable for all types of diabetic foot ulcers, however more prospective follow ups and in vivo and in vitro studies are needed to draw certain conclusion. Several critical wound biomolecules have been identified and are in need to be investigated in diabetic foot ulcers. The application of biocompatible nanoparticles holds a promising approach for designing dressing materials for the treatment of diabetic foot ulcer.Conclusion:Understanding the cellular and molecular events and identifying the appropriate treatment strategies for different foot ulcer grades will reduce recurrence of foot ulcer and lower limb amputation.


2021 ◽  
Vol 5 (1) ◽  
pp. 13
Author(s):  
Sri Dewi Megayanti ◽  
Ns. Putu Inge Suantika, S.Kep.,M.Kep

ABSTRAKLatar Belakang: Diabetes self-care merupakan perilaku perawatan diri pasien diabetes yang meliputi pengaturan diet, penggunaan insulin, olahraga dan perawatan kaki. Diabetes self-care memiliki efek langsung pada kontrol glikemik dalam terjadinya ulkus kaki diabetic. Skor PEDIS merupakan form pemeriksaan yang digunakan perawat dalam menilai keparahan ulkus kaki. Keterbatasan intervensi ulkus kaki yang diberikan oleh perawat saat ini disebabkan oleh terbatasnya data tentang self-care pada pasien diabetes. Tujuan penelitian mengetahui self-care pasien diabetes dengan komplikasi ulkus kaki menggunakan metode pengukuran skor PEDIS yang teridiri dari pemeriksaan perfusi, luas luka, kedalaman luka, keberadaan infeksi dan sensasi kaki.Metode: Penelitian ini termasuk penelitian kuantitatif, dimana penentuan responden menggunakan teknik Convenience sampling dengan jumlah sampel adalah 125, analisa data yang digunakan dengan metode  deskriptif.Hasil: Pada penelitian ini 53,8 % reponden memiliki diabetes self-care yang adekuat dan rata- rata responden memiliki Skor PEDIS 2,08.Kesimpulan: dalam penelitian ini sebagian besar responden memiliki diabetes self-care yang tidak adekuat.  Nilai Diabetes self-care dapat digunakan oleh perawat untuk mengetahui tingkat kualitas perawatan diri pasien selama ini sehingga memudahkan dalam menentukan intervensi yang tepat untuk mencegah terajadinya perburukan ulkus kaki. Kata kunci: diabetes mellitus tipe 2, diabetes self-care, dan ulkus kaki diabetik. ABSTRACTBackground: Diabetes self-care is a diabetes patient self-care behavior that includes diet management, insulin use, exercise and foot care. Diabetes self-care has a direct effect on glycemic control in the occurrence of diabetic foot ulcers. The PEDIS score is an examination form that nurses use in assessing the severity of foot ulcers. The limitations of the foot ulcer intervention given by nurses at this time are due to limited data on self-care in diabetic patients. The aim of this study was to determine the self-care of diabetic patients with complications of foot ulcers using the PEDIS score measurement method which consists of examination of perfusion, wound area, wound depth, presence of infection and foot sensation.Methods: This research is a quantitative study, where the determination of the respondents using the convenience sampling technique with a sample size of 125, the data analysis used is the descriptive method.Results: In this study 53.8% of respondents had adequate diabetes self-care and the mean of respondents had a PEDIS score of 2.08. Conclusion: in this study most of the respondents had inadequate self-care diabetes. The value of diabetes self-care can be used by nurses to determine the level of quality of patient self-care so far, making it easier to determine the right intervention to prevent worsening of foot ulcers. Keywords: type 2 diabetes mellitus, diabetes self-care, and diabetic foot ulcers. 


2021 ◽  
Vol 4 (5) ◽  
pp. 01-03
Author(s):  
Suen Enrique

Aims: According to the World Health Organization, between 1980 and 2014 the total number of people with diabetes in the world increased from 108 million to 422 million and by the end of 2020, the total number was approximately 463 million. The most frequent complication in this type of patient is diabetic foot ulcer, where conventional treatments generally fail to solve the problem and in many cases the condition ends with amputation. In 1998, an electrical stimulator was developed, called Stimul W, whose application in the healing of pressure and venous ulcers has yielded satisfactory results, allowing not only to obtain the Medical Registry by health entities in Cuba and other countries and even patent the mentioned equipment, but it has been achieved, in more than two decades of work, the healing of 1,191 ulcers of both types, with 94.5% effectiveness, a healing time that ranges between 21 and 42 days , according to the characteristics of the ulcer and without recurrence in any case treated. Starting in 2015, the application of this technique began in diabetic foot ulcers with the objectives of measuring the effectiveness and achieving an alternative treatment for this type of injury. In the present work a brief compilation of the results achieved in the treatment of diabetic foot ulcer using electrical stimulation is shown. Statistical Model: 31 diabetic patients, over 40 years old, with a total of 38 diabetic foot ulcers (some patients had more than one lesion) were treated, with times with the ulcer ranging between 1 and 6 months. The treatment consisted of a daily application for 30 minutes, using the Stimul W electrical stimulator, through the use of self-adhesive electrodes, conveniently placed around the affected area and on healthy skin, with current values ​​corresponding to scale 8 of the stimulator, approximately 1.5 mA and using the two stimulation channels Results: Results: In 27 of the 31 patients treated, the ulcer was healed with an effectiveness of 87%. In relation to ulcers, 33 ulcers healed in total, for 86.8% effectiveness. Average healing times were between 30 and 42 days, considering a daily session. Conclusion: Acceleration of healing was achieved with respect to conventional treatments, reducing healing times, and not producing adverse events during and after the application of the treatment.


2018 ◽  
Vol 108 (5) ◽  
pp. 419-429
Author(s):  
Isabelle J. Dumont ◽  
Marc Lepeut ◽  
Coralie Segalen ◽  
Yannis Guillemin ◽  
Jean Noel Gouze

The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (>44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients.


2008 ◽  
Vol 29 (11) ◽  
pp. 1074-1078 ◽  
Author(s):  
David Boutoille ◽  
Alexis Féraille ◽  
Dominique Maulaz ◽  
Michel Krempf

Background: Diabetic foot complications result in huge costs for both society and individual patients. Because our team performs numerous amputations each year for complicated diabetic foot ulcers, we conducted a study comparing the quality of life of diabetic amputees with a non-amputee group experiencing a diabetic foot ulcer. The aim of this study was to get better comprehension of the influence of amputation on physical and social aspects of our patients' quality of life. Materials and Methods: This study evaluated the influence of amputation for a diabetic foot ulcer on quality of life. We compared patients having experienced an amputation for a diabetic foot ulcer at least 1 year before the study, and outpatients experiencing regular visits for a current foot ulcer with no previous history of amputation. Quality of life was reported using the Medical Outcome Study Short Form 36 item health survey (MOS SF-36). Results: Most of the chronic ulcers were neuroischemic (8/9). Except for the bodily pain, which was significantly higher in the ulcer group, no difference was found between the amputee and the ulceration-group, when considering the different items of the MOS-SF 36 scales. The ulceration-group had significantly more physical limitations and pain than the toe-or-transmetatarsal-amputation-group, whereas physical limitations were identical between the transtibial-amputation-group and the ulceration-group. Median scores were quite low in both groups, reflecting strong social and psychological consequences of diabetic foot ulcers. Global prognosis was bad with 56% of the amputees having experienced another major cardiovascular event within 20 months after amputation. Conclusion: Better understanding of the consequences of diabetic foot complications is important for the general population and especially general practitioners. Psychological evaluation and support is important before and after amputation since it is a traumatic step for patients. Level of Evidence: III, Retrospective Case Control Study


2021 ◽  
Vol 17 ◽  
Author(s):  
Mariya Dmitriyeva ◽  
Zhanar Kozhakhmetova ◽  
Saltanat Urazova ◽  
Saken Kozhakhmetov ◽  
Dulat Turebayev ◽  
...  

: Diabetic foot ulcer infection is a crucial complication associated with lower-limb amputation and postoperative mortality in individuals with diabetes mellitus. Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Early detection of infected diabetic foot ulcers can reduce the frequency of hospitalizations, the occurrence of disability, and chances of mortality. Inflammatory biomarkers are predictors of infected diabetic foot ulcers and lower-limb amputation. Procalcitonin, CRP, pentraxin-3, interleukin-6, and calprotectin may help to distinguish uninfected from mildly infected diabetic foot ulcers and diagnose soft tissue infections, bone lesions, and sepsis in diabetic patients. Moreover, these biomarkers may be predictors of lower-limb amputation and postoperative mortality. The current management of infected diabetic foot ulcers is disappointing and unsatisfactory, both in preventing its development and in halting and modifying its progression. The use of new (molecular) techniques for the identification of the IDFU have not yet proven superior to classic cultural techniques for the management of such patients. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients the hospitalization, disability, and mortality rate will be reduced. For practical application of these biomarkers, it is important to correlate these quantitative parameters with clinical symptoms. Based on clinical observations and inflammatory biomarker evaluation, it can be used to guide clinical treatment methods. This review details clinical information published during the past several decades and discusses inflammatory biomarkers that may determine the risk and level of infection of diabetic foot ulcers.


2019 ◽  
Author(s):  
Henok Mulugeta ◽  
Fasil Wagnew ◽  
Haymanot Zeleke ◽  
Bekele Tesfaye ◽  
Haile Amha ◽  
...  

AbstractBackgroundDiabetic foot ulcer (DFU), devastating complications of diabetes mellitus, is a major public health problem, and one of the leading reasons for hospital admission, amputations, and even death among diabetic patients in Ethiopia. Despite its catastrophic health consequences, the national burden of diabetic foot ulcer remains unknown in Ethiopia. Hence, the objective of this systematic review and meta-analysis was to estimate the national prevalence of diabetic foot ulcer and investigate the association with duration of illness and patient residence among diabetic patients.MethodsWe searched PubMed, Google Scholar, Cochrane Library, CINAHL, EMBASE, and PsycINFO databases for studies of diabetic foot ulcers prevalence that published from conception up to June 30, 2019. Quality of each article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for Windows, and meta-analysis was carried out using a random-effects method. The pooled national prevalence of diabetic foot ulcers was presented using a forest plot.ResultsA total of 10 studies with 3,029 diabetic patients were included. The pooled national prevalence of diabetic foot ulcers among Ethiopian diabetic patients was 11.27% (95% CI 7.22, 15.31%, I2=94.6). Duration of illness (OR: 3.91, 95%CI 2.03, 7.52, I2=63.4%) and patients’ residence (OR: 3.40, 95%CI 2.09, 5.54, I2=0.0%) were significantly associated with a diabetic foot ulcer.ConclusionIn Ethiopia, at least one out of ten diabetic patients had diabetic foot ulcers. Healthcare policymakers (FMoH) need to improve the standard of diabetic care and should design effective preventive strategies to improve health care delivery for people with diabetes and reduce the risk of foot ulceration.


Author(s):  
Ghazanfar Ali Shah ◽  
Niaz Hussain Keerio ◽  
Aftab Alam Khanzada ◽  
Muhammad Rafique Joyo ◽  
Nizam Ahmed ◽  
...  

Background: Diabetic foot ulcer is a solitary most costly and severe complication of diabetes mellitus. Foot ulcers are the after-effect of a combination of various causes, counting peripheral arterial disease and peripheral neuropathy. Patients with diabetic foot ulcers for the most part require lower limb amputation. Objective: The purpose of this examination is to survey the outcomes and complications of diabetic foot ulcers in diabetic patients and to explore the impacts of certain hazard factors on ulcer healing. Place and Duration: In the Orthopedic unit, Dow University Of Medical and Health Sciences, SMBBIT Karachi, for nearly a two-year duration from March 2018 to April 2020. Methods: This study was conducted on 120 patients. All patients with diabetes and DFU 18 to 90 of age were selected. 120 grown-up patients with DFUs were selected for the analysis. The diabetes duration and demographic data were recorded. Clinical proof of infection has been accounted for, as indicated by the American Association for Infectious Diseases. At that point debridement and careful treatment were begun to evacuate all the dead tissue. Follow-up was done week by week for two-year. SPSS 22 was utilized for data collection and statistical analysis. Data are introduced as a percentage and p < 0.05 was considered as the significance level. The Fisher’s test and χ2 test were utilized to test the variables relationship. Multivariate logistic regression analysis was utilized to change different variables when testing the impact of each risk factor on the outcome of DFU. Results: A sum of 120 patients with diabetic foot ulcers were selected. 60% of patients had relieved ulcers, 8% still not resolved; In 27% of patients, minimum amputation, 7% more protuberant amputation, 2% repetitive ulcer and mortality rate was 1%. The investigation indicated that there is a measurably noteworthy connection between the foot ulcers healing with diabetes and the accompanying factors: HbA1c level, patients’ age, diabetes duration, diabetes complications (ulcer size and peripheral neuropathy). Conclusion: The outcomes and complications of diabetic foot ulceration can be anticipated by a few factors, some of which can be changed. Changing compatible factors, for example, better diabetes control, peripheral neuropathy treatment and early treatment of ulcers can reduce complications and encourage healing of ulcers.


2021 ◽  
Vol 15 (9) ◽  
pp. 2223-2225
Author(s):  
Ashfaq Nasir ◽  
Muhammad Najam Iqbal ◽  
Ghulam Hassan ◽  
Muhammad Arshad Abbas ◽  
Hafiz Jawad Abdul Raheem ◽  
...  

Background: Most of the diabetic patients present as diabetic foot in surgical outdoor and emergency department. Diabetic Foot infections are common and take long duration to be treated. Both Gram positive and Gram negative aerobic bacteria are involved in diabetic foot infection. Aim: To determine the frequency of most prevalent bacteria in wound of diabetic foot ulcers and to determine the antimicrobial susceptibility of isolated bacteria from diabetic foot ulcers so that an empirical antibiotics can be started before the report of culture and sensitivity. Methods: This cross sectional study was conducted in surgical unit 1 of Bahawal Victoria Hospital (BVH) Bahawalpur from 01-08-2020 to 31-07-2021. This study was conducted on 145 patients with diabetic foot ulcer from outdoor and emergency department of BVH. Data about patient’s demography, duration of diabetes, duration of DFUs, type of pathogen and its antibiotic susceptibility was entered on a proforma. Pus sample was obtained from wound under aseptic measures. Culture sensitivity to assess presence of type of pathogen and its antibiotic susceptibility of all the samples was done from the pathology department of the hospital. Results: The mean age of patients was 52.02±10.14 years. There were 77(53.1%) males and 68(46.9%) females. The foot ulcer’s mean duration was 3.81±1.43 months. There were 15(10.3%) patients with St. aureus, 12(8.3%) with E.coli, 12(8.3%) with Proteus mirabilis, 15(10.3%) with P. aeruginosa, 12(8.3%) with Enterobacter spp., 9(6.2%) with Morganella spp., 19(13.1%) with P. vulgaris, 18(12.4%) with P. Mirabilis, 16(11%) with K. pneumonia and 17(11.75) with Morganella pathogen in this study. There were 74(51%) patients sensitive to Amikacin, 73(50.3%) sensitive to Amoxicillin, 66(45.5%) sensitive to Aztreonam, 74(51%) sensitive to Ceftriaxone, 75(51.7%) sensitive to Cefuroxime and 68(49.6%) sensitive to Cephazolin. Conclusion: The most frequent organisms in DFUs, regardless of age, gender and comorbidity, were P. vulgaris, St. aureus and P. aeruginosa. The most sensitive antibiotic in these ulcers was Piperacillin and Meropenem and the most resistant was Cephazolin. Keywords: Diabetic Foot Ulcers, Antimicrobial Susceptibility, St. aureus, P. vulgaris, P. aeruginosa, Piperacillin


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