Treatment Strategies Against Diabetic Foot Ulcer: Success so far and Road Ahead

2020 ◽  
Vol 16 ◽  
Author(s):  
Ankit Awasthi ◽  
Sachin Kumar Singh ◽  
Bimlesh Kumar ◽  
Monica Gulati ◽  
Rajesh Kumar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Treatment Strategies ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Current Status ◽  
Limb Amputation ◽  
Bibliographic Databases ◽  
Inflammatory Phase

Background: Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It isassociated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. Basically, there are four stages of wound healing namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Traditionally the dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer from many years. Introduction: In this review the global prevalence as well as etiopathogenesis related to diabetic foot ulcer has been discussed. Potential role of various synthetic and herbal drugs as well as their conventional dosage form for the effective management of diabetes foot ulcer has been highlighted. Methods: Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was culminated in terms of various approaches that are used for the treatment of diabetic foot ulcer. Results: About 142 papers including both, research and review articles, were included in this review in order to produce a comprehensive as well as readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. Conclusion: DFU has become one of the most common complications in patients having more than ten years of diabetes. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as judicious selection of drug as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemics or, they have been repositioned. Moreover, in clinical practice, much focus has been given towards dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that a combination therapy of herbal and synthetic drug with multiple treatment pathway could be able to overcome the disease.

Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage

2021 ◽  
pp. 153473462110270
Author(s):  
Ahmed Azhar ◽  
Magdy Basheer ◽  
Mohamed S. Abdelgawad ◽  
Hossam Roshdi ◽  
Mohamed F. Kamel
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Negative Impact ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Cross Sectional ◽  
Peripheral Arterial

Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD −ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender ( P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD ( P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation ( P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.

scholarly journals Diabetic foot ulcer and its surgical management

2019 ◽  
Vol 8 (1) ◽  
pp. 25
Author(s):  
Darshan J. Lakhani ◽  
Jignesh P. Dave ◽  
Jignesh K. Ramani ◽  
Kartik K. Agrawal ◽  
Chirag R. Makadiya ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Surgical Management ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Class ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Surgical Approaches ◽  
Female Ratio

Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years.  Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer.

Avoidance of lower limb amputation from a diabetic foot ulcer: The importance of multidisciplinary practice and patient collaboration

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 19-27
Author(s):  
Margaret Mungai ◽  
Emmy Sirmah
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Amputation ◽  
Nursing Interventions ◽  
Multidisciplinary Practice ◽  
Sugar Levels ◽  
Care Nursing

This article explores wound care nursing interventions and inter-professional collaboration for a patient referred with a stage 3 diabetic foot ulcer (DFU). To the patient’s distress, he had been informed that he may require an amputation due to the severity of his DFUs. On initial presentation, the patient was symptomatic for peripheral neuropathy, infection and hyperglycaemia. The left lower limb was oedematous and there was a DFU at the metatarso-phalangeal joint of the big toe on his left foot secondary to haemorrhagic callus. Progressive healing of the DFU was realised over time by repetitive debridement; incision and drainage of the DFUs; antibiotic therapy; appropriate footwear; dietary instructions; control of the blood sugar levels (BSLs); and patient and family education. Wound care nursing interventions were applied in conjunction with medical management of the DFUs. The DFUs were managed using a locally made, two-part zinc oxide gauze dressing known as the Unna boot. A family member was instructed how to continue applying the dressings at home in between clinic visits. Complete wound healing was eventually achieved within four months, thus avoiding the need for amputation.

Jaloukavacharana in diabetic foot ulcer - A Case Study

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Nivedita Rampure ◽  
Channabasavanna B. M. ◽  
Mallikarjun Mallikarjun
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Large Sample Size ◽  
Prolonged Stay ◽  
Bloodletting Therapy

Diabetic foot is the one of the commonest chronic complications of diabetes. It is leading indication for hospital admission and prolonged stay. A classical triad of neuropathy, ischemia and infection characterizes the diabetic foot. The presence of infection rapidly worsens the clinical picture, often requiring limb amputation. Diabetic foot ulcers are common and estimated to effect 15% of all diabetics. Mainstay of treatment includes antibiotics, debridement. and local wound care and footwear improvisation. In spite of all advances in health sciences, statistics reveals that about 3% patients yet have to undergo lower limb amputation. In Sushruta Samhita. we get the most scientific description of wound and its management. Similarly, Sushruta has given the importance to Bloodletting therapy and considered Leech as the most unique and effective method of bloodletting even in infected wounds and abscesses. Patient with Diabetic foot ulcer was advised to continue anti diabetic medicine along with weekly application of Leech around the ulcer which was followed by washing the wound with Panchavalkala Kashaya and dressing with Jatyadi Ghrita. This Leech therapy proved very effective and the ulcer healed completely within 30 days. However, further evaluation is required to be done by taking a large sample size to prove its significance in treating Diabetic foot ulcer and avoiding lower limb amputation.

Inflammatory Biomarkers as Predictors of Infected Diabetic Foot Ulcer

2021 ◽  
Vol 17 ◽  
Author(s):  
Mariya Dmitriyeva ◽  
Zhanar Kozhakhmetova ◽  
Saltanat Urazova ◽  
Saken Kozhakhmetov ◽  
Dulat Turebayev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Inflammatory Biomarkers ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers

: 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.

scholarly journals A Review of Diabetic Foot Ulcer Infections and Lyophilized Wafer Formulation

2021 ◽  
pp. 13-25
Author(s):  
Rupalben Kaushalkumar Jani ◽  
Goswami Kaushal Puri ◽  
Shrestha Ubana
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Drug Release Profile ◽  
Scanning Calorimetry ◽  
Patients With Diabetes

Diabetic foot difficulties are the most usually occurring problems globally, resulting in economic disasters for the patients, families, and society. In patients with diabetes, the risk of emerging foot ulcers is 25% high. It has also been in the record that one lower limb amputation occurs every 30 seconds in patients with diabetes worldwide. Novel methods of drug delivery and wound dressing have to develop to solve the lower limb amputation crisis. One such novel method is "Lyophilized wafer formulation." It is an upcoming medicated dressing material that can enhance wound healing and the potential to ingest vast quantities of exudates from Chronic wounds. That can have been formulating by lyophilizing hydrogel of absorbent polymers such as Calcium Alginate, Carrageenan, Thiolated Chitosan, and plasticizer to enhance flexibility withstand the day to day mechanical stress, covered with some adhesive and protective backing layer. Unless it passes evaluation tests such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), Scanning electron microscopy (SEM), Exudate handling property, Folding endurance, In-vitro, In-vivo drug release profile, and Gamma-irradiation sterilizes wafer formulation, and it should not administrate directly. Lyophilized wafer formulation will be the most acceptable medicated dressing material in the future that will be useful to treat the normal wound. The wound formation because of diabetic foot ulcer (DFU) infections as there will be site-specific delivery of the drug, packed with an advantage to self administer and easy termination of the drug that can achieve just by removing the wafer case of drug toxicity.

Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

2020 ◽  
Vol 16 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Mutasem Ababneh ◽  
Mousab Y. Al Ayed ◽  
Asirvatham A. Robert ◽  
Mohamed A. Al Dawish
Keyword(s):  
Diabetic Foot ◽  
Statistical Significance ◽  
Ankle Brachial Index ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Screening Tests ◽  
Cross Sectional ◽  
Toe Brachial Index

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

ICD-10 Diagnostic Coding for Identifying Hospitalizations Related to a Diabetic Foot Ulcer

2021 ◽  
Vol 44 (4) ◽  
pp. E11-16
Author(s):  
Muzammil H. Syed ◽  
Mohammed Al-Omran ◽  
Jean Jacob-Brassard ◽  
Joel G. Ray ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Reference Standard ◽  
Diagnostic Coding ◽  
Icd 10

Purpose: To estimate the positive predictive value (PPV) of Canadian ICD-10 diagnostic coding for the identification of hospitalization related to a diabetic foot ulcer (DFU). Methods: Hospitalizations related to a neuropathic and/or ischemic DFU were identified from the Discharge Abstract Database (DAD) records of a single Canadian tertiary care hospital between April 1, 2002 and March 31, 2019. The first coding approach required a most responsible diagnosis (MRDx) code for diabetes-specific foot ulceration or gangrene (DSFUG group). Three alternative coding approaches were also considered: MRDx code for lower-limb osteomyelitis (osteomyelitis group); lower-limb ulceration (LLU group); or lower-limb atherosclerotic gangrene (atherosclerosis group)—each in conjunction with a non-MRDx DSFUG code on the same DAD record. From all eligible DAD records, random samples were drawn for each coding group. DAD records were independently compared by a masked reviewer who manually abstracted data from the entire hospital record (reference standard). The PPV and 95% CI were generated. Results: Out of 1,460 hospitalizations, a total of 300, 50, 33 and seven records were included from the DSFUG, osteomyelitis, LLU and atherosclerosis samples, respectively. Compared to the reference standard, the PPV for all 390 records was 88.5% (95% CI 84.9 to 91.5). The DSFUG group had the highest PPV (90.0%, 95% CI 86.0 to 93.2), followed by the atherosclerosis (85.7%, 95% CI 42.1 to 99.6), LLU (84.9%, 95% CI 68.1 to 94.9) and osteomyelitis (82.0%, 95% CI 68.6 to 91.4) groups. Conclusion: Based on data from a Canadian tertiary care hospital, the specified coding algorithms can be used to identify and study the management and outcomes of people hospitalized with a DFU in Ontario.

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