Prevalence of Diabetic Foot Lesions in Patients With Diabetes Mellitus Under Chronic Hemodialysis in El Gharbia Government Hospitals

Objective: Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was toevaluate the surgical management in diabetic foot patients presenting with different grades of infection. Design: Descriptive study. Place andduration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December2010. Patients and methods: A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgicaloutpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years andwere of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete bloodexaminations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesionswere raded according to Wagner classification and appropriate medical and surgical treatment carried out. Results: This study was carried outon 120 diabetic patients, out of which ninety six (80.0%) were male and twenty four (20%) were female. Male to female ratio was 4:1. Majority ofthe patients (n=66) were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,.Patients were grouped into five grades according to the severity of infection. Twenty six (21.6%) patients were managed with antibiotics anddressings, thirteen (10.8%) patients needed debridement and skin grafting while eighty-one needed amputations of different types.Staphylococcus aureus was the commonest organism isolated. Conclusions: Majority of the diabetic foot lesions were in grade II to V. Lessergrade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades neededamputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus andwound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity

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Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diseases ◽

10.3390/diseases9010016 ◽

2021 ◽

Vol 9 (1) ◽

pp. 16

Author(s):

Giulia Casadei ◽

Marta Filippini ◽

Lorenzo Brognara

Keyword(s):

Diabetes Mellitus ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Glycated Hemoglobin ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Glycemic Variability ◽

Future Research ◽

Patients With Diabetes ◽

Axonal Dysfunction ◽

Biomarker Research

Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4–10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology. Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were “glycated hemoglobin” OR “HbA1c” AND “diabetic neuropathies” AND “Foot”. Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.

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Quantifying dermal microcirculatory changes of neuropathic and neuroischemic diabetic foot ulcers using spatial frequency domain imaging: a shade of things to come?

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001815 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001815

Author(s):

Grant A Murphy ◽

Rajinder P Singh-Moon ◽

Amaan Mazhar ◽

David J Cuccia ◽

Vincent L Rowe ◽

...

Keyword(s):

Diabetes Mellitus ◽

Spatial Frequency ◽

Oxygen Saturation ◽

Diabetic Foot ◽

Clinical Course ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

Spatial Frequency Domain Imaging ◽

Patients With Diabetes ◽

Spatial Frequency Domain

IntroductionThe use of non-invasive vascular and perfusion diagnostics are an important part of assessing lower extremity ulceration and amputation risk in patients with diabetes mellitus. Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to determine tissue oxygen saturation and hemoglobin distribution within the superficial and deep dermis, showing distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration.Research designs and methods35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI.ResultsPatient 1 developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration 3 months prior. Patient 2 developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations.ConclusionsWounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. Before predictive models can be developed from SFDI, biomarker data must be correlated with the clinical course of patients who ulcerate while being followed longitudinally.Trial registration numberNCT03341559.

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Nomogram analysis of the influencing factors of diabetic foot in patients with diabetes mellitus

HORMONES ◽

10.1007/s42000-020-00263-1 ◽

2021 ◽

Author(s):

Mingming Li ◽

Tao Yuan ◽

Supeng Li ◽

Qizheng Sun

Keyword(s):

Diabetes Mellitus ◽

Influencing Factors ◽

Diabetic Foot ◽

Patients With Diabetes

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Surgical Off-loading of the Diabetic Foot

Journal of the American Podiatric Medical Association ◽

10.7547/1000369 ◽

2010 ◽

Vol 100 (5) ◽

pp. 369-384 ◽

Cited By ~ 12

Author(s):

Robert G. Frykberg ◽

Nicholas J. Bevilacqua ◽

Geoffrey Habershaw

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Diabetic Foot ◽

Surgical Intervention ◽

Surgical Decompression ◽

Foot Ulcers ◽

Foot Surgery ◽

Patients With Diabetes

Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers. (J Am Podiatr Med Assoc 100(5): 369–384, 2010)

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

Diabetes Mellitus ◽

10.14341/2072-0351-5412 ◽

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.

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A Microbiological Study of Diabetic Foot Lesions

Diabetic Medicine ◽

10.1111/j.1464-5491.1985.tb00640.x ◽

1985 ◽

Vol 2 (3) ◽

pp. 213-216 ◽

Cited By ~ 36

Author(s):

Emyr W. Jones ◽

Richard Edwards ◽

Roger Finch ◽

William J. Jeffcoate

Keyword(s):

Diabetic Foot ◽

Microbiological Study ◽

Foot Lesions ◽

Diabetic Foot Lesions

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DIABETIC FOOT AMPUTATION;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.02.501 ◽

2017 ◽

Vol 24 (02) ◽

pp. 302-307

Author(s):

Naveed Akhtar ◽

Sultan Ahmed ◽

Hassan Mahmood Tabassum ◽

Sadaf Lanjar

Keyword(s):

Diabetic Nephropathy ◽

Diabetic Foot ◽

Cross Sectional Study ◽

Study Data ◽

Cross Sectional ◽

Surgical Department ◽

Foot Complications ◽

Qualitative Variables ◽

Foot Lesions ◽

Diabetic Foot Lesions

Introduction: Diabetic foot lesions have remained a major cause of morbidity inpatients with kidney failure. Foot complications are more than twofolds in diabetic nephropathypatients, and the rate of amputation is 6 to 10 times higher in diabetic nephropathy patientsin comparison to the general diabetic population. Objectives: To determine the frequencyof diabetic nephropathy in patients undergoing diabetic foot amputation. Study Design:Observational cross-sectional study. Setting: Surgical Department Unit-II, Sheikh ZayedMedical College and Hospital Rahim Yar khan. Material and Methods: The duration of thestudy was 2 years from Dec-2013 to Dec-2015. A total number of 73 patients were includedin this study. Patients who were admitted to the department of surgery for amputation of thefoot or the leg having the history of diabetes regardless of their age and sex were selectedfor this study. Data analyses were carried out using SPSS Version17 software. Quantitativevariables were presented as Mean and standard deviations. Frequency and percentages werecomputed for qualitative variables. Results: The mean age of the patients was 57.51±7.61years. Out of 73 cases, there were 43(58.9%) males and 30 (41.1%) females. Previous historyof amputation was observed in 26 (35.62%) cases, 48 (65.75%) patients were hypertensive.Out of 73 patients, Forty (54.79%) had controlled diabetes and 33 (45.21%) had uncontrolleddiabetes. Twenty seven patients (36.99%) were diagnosed for diabetic nephropathy. Theincidence of nephropathy was high in patients with advancing age. This incidence was in 26(56.62%) patients with age 51 to 60 years and 18 (39.13%) in patients having age more than 60years. Conclusions: Lower extremity amputations are strongly associated with nephropathy indiabetic patients. It is very important to check and improve the renal function in patients withdiabetic foot ulcers who are hypertensive, increasing age and long duration of DM to preventlower limb amputations.

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The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619890814 ◽

2019 ◽

Vol 19 (1) ◽

pp. 34-43 ◽

Cited By ~ 1

Author(s):

Elisabetta Salutini ◽

Enrico Brocco ◽

Roberto Da Ros ◽

Luca Monge ◽

Luigi Uccioli ◽

...

Keyword(s):

Clinical Judgment ◽

Diabetic Foot ◽

Best Practice ◽

Diabetes Complications ◽

Public Health Issue ◽

Life Threatening ◽

Foot Lesions ◽

Diabetic Foot Lesions ◽

Wound Bed Preparation ◽

Leg Amputation

Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.

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