The problem of classification and organization of medical care for diabetic patients with different forms of ulcerative-necrotic lesions of lower extremities

2016 ◽  
Vol 94 (8) ◽  
pp. 623-627
Author(s):  
Oleg V. Udovichenko
Keyword(s):  
Diabetic Foot ◽  
Venous Insufficiency ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Diabetic Patients ◽  
Epidemiological Surveys ◽  
Patients With Diabetes ◽  
Post Traumatic ◽  
High Level

Patients with diabetes mellitus (DM) are at risk of development of both diabetic foot syndrome and ulcers on the lower legs due to chronic venous insufficiency and other factors. The main group in this study was comprised of diabetic patients with ulcers of different etiology (venous, post-traumatic, mixed) treated at the Diabetic Foot Cabinet during 5 years (n=101). The group of comparison included simultaneously treated patients with diabetic foot syndrome (n=721). Patients of the main group was dominated by women (71%) and patients with type 2 DM. Ulcer healingdue to the treatment, persistent non-healing ulcers, and high-level amputations occurred equally often in the two groups: 60 and 58%, 18 and 15%, 4 and 5% respectively (р>0,05). Lower leg ulcers in DM are very persistent and constitute a serious medico-social problem to be addresses based at Diabetic Foot cabinets. The frequency of such ulcers and related amputations must be taken into consideration in epidemiological surveys.

scholarly journals Integrated surgical management of neuroischemic diabetic foot syndrome, abdominal aortic aneurysm and renal artery lesionsin patients with diabetes mellitus type 2

2011 ◽  
Vol 14 (4) ◽  
pp. 100-106
Author(s):  
Sergey Anatol'evich Terekhin ◽  
Victor Afanas'evich Kalashnikov ◽  
Valeriy Afanas'evich Mitish ◽  
Lyudmila Petrovna Doronina ◽  
Alla Yur'evna Tokmakova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Abdominal Aortic Aneurysm ◽  
Surgical Management ◽  
Diabetic Foot ◽  
Diabetes Mellitus Type 2 ◽  
Diabetic Foot Syndrome ◽  
Abdominal Aortic ◽  
Patients With Diabetes

The article presents a clinical example of integrated surgical management in patient with multifocal atherosclerosis, chronic kidney disease andneuro-ischemic form of diabetic foot syndrome

scholarly journals Epidemiological characteristics and organisation of care for patients with diabetic foot syndrome in Khanty-Mansiysk autonomous okrug–Yugra

2017 ◽  
Vol 20 (2) ◽  
pp. 99-107
Author(s):  
Yana Vladimirovna Girsh ◽  
Oksana Petrovna Davidenko
Keyword(s):  
Early Diagnosis ◽  
Diabetic Foot ◽  
Statistical Tests ◽  
Epidemiological Studies ◽  
Diabetic Foot Syndrome ◽  
Diabetic Patients ◽  
Organisation Of Care ◽  
Patients With Diabetes ◽  
Epidemiological Characteristics

Background. Epidemiological studies in regions of Russia have revealed significant differences in the prevalence of diabetic foot syndrome (DFS). Aims. To determine the epidemiological characteristics and associated complications of DFS in Khanty-Mansi Autonomous Okrug (KHMAO)-Yugra Materials and methods.The epidemiological indicators and complications of diabetes were determined in diabetic patients in KHMAO-Yugra. The statistical reporting form №12 was used. Data from patients diagnosed with type 1 or type 2 diabetes and DFS were gathered from the service area of hospitals, the state registry (20072014) and outpatient clinics in the city of Surgut (20092014). A prospective observational study with active screening and characterisation of DFS was conducted. Results.Of all patients, 43% were at high/very high risk of developing DFS. DFS was diagnosed in 4.1% of patients with diabetes and was characterised as neuropathic (57.3%), neuroischaemic (35.1%) and ischaemic (7.6%). Conclusions.Prevention and early diagnosis of DFS is crucial in the prevention and reduction of amputations in patients with diabetes. Given that DFS can present in various forms, programmes aimed at promoting DFS awareness are required to increase the identification and treatment of this syndrome. Additionally, improvements in the statistical tests used and better organisation of the flow patients referred to general physicians, endocrinologists, podiatrists and surgeons, are also important in the prevention and early diagnosis of DFS and its associated complications.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

2011 ◽  
Vol 101 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Aynur Gulcan ◽  
Erim Gulcan ◽  
Sukru Oksuz ◽  
Idris Sahin ◽  
Demet Kaya
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Essential Components ◽  
Patients With Diabetes ◽  
Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Martyna Schönborn ◽  
Patrycja Łączak ◽  
Paweł Pasieka ◽  
Sebastian Borys ◽  
Anna Płotek ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Arterial Disease ◽  
Angiogenic Factors ◽  
Diabetic Foot Syndrome ◽  
Tissue Loss ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

scholarly journals Clinical efficacy of oxidative stress correction by actovegin in diabetic polyneuropathy at type 2 diabetic patients with arterial hypertension

2010 ◽  
Vol 13 (2) ◽  
pp. 84-89
Author(s):  
Ivan Petrovich Gorshkov ◽  
Vladimir Ivanovich Zoloedov ◽  
Anna Petrovna Volynkina
Keyword(s):  
Oxidative Stress ◽  
Arterial Hypertension ◽  
Diabetic Polyneuropathy ◽  
Oxidative Capacity ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Patients With Diabetes ◽  
Total Antioxidant

Aim. To study Actovegin efficacy in oxidative stress (OS) correction at diabetic polyneuropathy (DPN) in patients with diabetes mellitus type 2 (DM2)and arterial hypertension (AH).Materials and Methods. 51 patients (24 women and 27 men) aged 53.4?0.7 with the average duration of DM2 5.6?0.2 years, DPN - 4.9?0.2years and AH - 6.0?0.2 years were examined. Daily albuminuria, glomerular filtration rate (GRF) were evaluated, standard methods for diagnosisof DPN were used. 26 patients took Actovegin therapy during 6-8 weeks, the rest 25 patients were in the control group. Parameters of the OS werestudied. Results. The increase of total oxidative capacity, the decrease of total antioxidant capacity and the rise of levels of antibodies to oxidated LDL wererevealed in patients with DM2, DPN and AH. Antioxidant and anti-hypoxic effects of 400 mg/day of Actovegin were established in this group of patients.Conclusions. Actovegin impacts oxidative stress parameters and improves the clinical manifestation of diabetic polyneuropathy.

scholarly journals Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy

2021 ◽  
Vol 24 (1) ◽  
pp. 32-44
Author(s):  
T. A. Zelenina ◽  
V. V. Salukhov ◽  
A. B. Zemlianoi ◽  
S. G. Zheleznjak ◽  
O. A. Klitsenko
Keyword(s):  
Type 2 Diabetes ◽  
Blood Flow ◽  
Autonomic Neuropathy ◽  
Diabetic Foot ◽  
Microvascular Complications ◽  
Cold Test ◽  
Microvascular Blood Flow ◽  
Diabetic Patients ◽  
History Of

BACKGROUND: Diabetic autonomic neuropathy is the reason for early morbidity and mortality on diabetic patients. The pathology not only cardiac innervation but microvascular is presented.AIMS: We estimated the parameters of skin microvascular blood flow in accordance with cardiovascular autonomic neuropathy (CAN) staging in diabetic patients. We also assessed other risk factors of CAN in patients with diabetes.MATERIALS AND METHODS: We included 76 patients with type 2 diabetes in the study (24 patients with resent-onset diabetes and/or diabetes without microvascular complications, 26 with diabetic sensorimotor neuropathy (SMN) and 26 with SMN and previous history of diabetic foot amputation). The SMN was diagnosed on the basis of patients complaints, anamnesis and data of clinical neurological examinations. CAN was detected using several cardiovascular autonomic reflex tests (CART) as a gold standard of diagnosis: the tilt-table test, a deepbreathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction. According to the Toronto Diabetic Neuropathy Expert Group Recommendation all patients was separated on the groups: CAN 0 (all CARTs were normal), CAN 1 (possible/early CAN — one abnormal CART was presented), CAN 2 (definite/confirmed CAN –at least two abnormal CARTs were found), CAN 3 (severe/advanced CAN — in the cases of orthostatic hypotension in addition to CARTs abnormalities). Microvascular blood flow of skin at the nail roller of fingers skin was valuated at rest as well as in functional cold test by the method of High-frequency Ultrasonic Dopplerography using the “Minimax Doppler K” device (LLC JV “Minimax”, St. Petersburg, Russia).RESULTS: CAN 1 was found in 8% diabetic patients without microvascular complications, 42 and 21% patients with SMN and diabetic foot amputations respectively. CAN 2 was diagnosed in 27% patients with SMN and 58% patients history of diabetic foot amputations. CAN 3 in 8% and 19% cases in patients with SMN and history of diabetic foot amputations respectively. The parameters of microvascular blood flow at rest were significantly decreased in patients with confirmed/severe CAN in comparison with early staging of CAN and patients without CAN (Vm=2.5±0.66 sm/sec vs. 4.4±0.54 sm/sec and 5.1±1.01 sm/sec respectively; p=0.0033). The abnormal result of cold test was detected in 94% patients with confirmed/ severe CAN and 26% patients with CAN 1.CONCLUSIONS: This investigation has demonstrated in a cohort with type 2 diabetes patients with/without SMN and with/ without history of previously foot amputations that decrease the Vm (the variable of microvascular blood flow assessed by High-frequency Ultrasonic Dopplerography) lower than 2.4 sm/sec is associated with 6.4 times increased likelihood of confirmed/severe CAN as well as positive cold test result. That the patients with positive cold test results were 28.6 times more likely have confirmed/severe CAN.

scholarly journals Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

2009 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Valeriy Afanas'evich Mitish ◽  
I A Eroshkin ◽  
Gagik Radikovich Galstyan ◽  
Lyudmila Petrovna Doronina ◽  
Yu S Paskhalova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Lower Leg ◽  
Diabetic Foot Syndrome ◽  
Diagnostic Tools ◽  
Critical Ischemia ◽  
Adequate Treatment ◽  
Patients With Diabetes ◽  
Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

DYSLIPIDEMIA – TYPE2 DIABETES AND NON DIABETES POPULATION IN AND AROUND ERODE DISTRICT, TAMILNADU

2021 ◽  
pp. 8-9
Author(s):  
Murugesan Thinakaran ◽  
Thangadurai Chitra
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Lipid Status ◽  
Type2 Diabetes ◽  
Patients With Diabetes ◽  
Tertiary Hospitals ◽  
Low Hdl

Background and objects: Patients with diabetes mellitus are at high risk of cardiovascular events because of abnormal lipid status. Dyslipidemia is common in diabetes mellitus and is associated with cardiovascular complications. Early diagnosis and treatment is the main cornerstone in the prevention of its multiple complications. The aim of the study was to determine the prevalence of abnormal lipid prole levels. Materials and Method: The study population was made up of Eighty-ve (85) already diagnosed type 2 diabetic patients and Ninety-two (92) with an age range of 28 to 70 years, who come from routine health, follow up at various tertiary hospitals in Erode. The samples were analyzed using the chemical analyzer COBAS INTEGRA 400. Results and Conclusion: Dyslipidemia was found in 63.52% in type2 diabetes patients and 43.47% in non-diabetic patients. High TG, high LDL-C, high TC and low HDL-C exhibited an increasing trend in the proportion of patients with dyslipidemia. The following risk factors namely female sex, age above 50- years, BMI (overweight and obese), poor glycemic control, central obesity and physical inactivity were associated with diabetic dyslipidemia. This study presents some interesting and novel ndings which may be very important in the care and management of patients with type-2 diabetes.

scholarly journals Dyslipidemia: A Trigger for Coronary Heart Disease in Romanian Patients with Diabetes

Metabolites ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 195 ◽  
Author(s):  
Mihnea-Alexandru Găman ◽  
Matei-Alexandru Cozma ◽  
Elena-Codruța Dobrică ◽  
Nicolae Bacalbașa ◽  
Ovidiu Gabriel Bratu ◽  
...  
Keyword(s):  
Gender Differences ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Statin Prescription ◽  
And Gender ◽  
Internal Medicine Clinic

Previous studies have reported age and gender disparities in the occurrence and therapeutic approach of dyslipidemia and (or) coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate these differences in Romanian patients with T2DM. A cross-sectional, observational, retrospective study was conducted using the medical records of T2DM patients who attended the outpatient facility of the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania for routine check-ups in a six-month period. We analyzed the records of 217 diabetic patients (mean age 69 ± 11 years; 51.15% women). We found no significant gender differences in the occurrence of dyslipidemia, CHD or CHD + dyslipidemia or in terms of statin prescription. However; patients aged 65 years or older were significantly more affected by dyslipidemia, CHD or CHD + dyslipidemia, versus subjects aged <65 years. Further, they were more likely to be prescribed statin therapy (p < 0.0001 for all). Statins were prescribed to 67.24% of the patients with dyslipidemia; 61.01% of the subjects with CHD; and to 91.48% of the patients who had both conditions. e recorded no gender differences in the occurrence of CHD and (or) dyslipidemia in Romanian T2DM patients. Patients aged 65 years or older had a higher prevalence of CHD and/or dyslipidemia, and were more likely to be prescribed statins, versus younger counterparts. However, many T2DM patients with CHD and (or) dyslipidemia were undertreated: Nearly 33% of the subjects with dyslipidemia, and nearly 40% of the ones with CHD were not prescribed statins.

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