Application of metabolic therapy in pathogenetic treatment of patientes with diabetic foot syndrome

According to modern recommendations concerning the treatment of diabetic foot syndrome, it is necessary along with intensive control of carbohydrate and lipid metabolism, to use the strategy of early application of agents that promote pathogenetic correction of diabetic polyneuropathy and angiopathy, the main links in the development of lesions of lower extremity tissues. Means of metabolic therapy can counteract the influence of such pathogenetic factors as chronic hyperglycemia, activation of the polyol pathway, oxidative stress, glycation of structural, transport and receptor proteins, disruption of nerve growth and regeneration. Timely administration of alpha-lipoic acid, aldose reductase inhibitors, B-group vitamins, antithrombotics, prevention of glycation and stimulation of nerve growth factors can slow or prevent the passage of SDS into a purulent-necrotic form, reducing the risk of trophic ulceration and amputation.

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Vascular endothelial growth factor at diagnosing diabetic polyneuropathy and prevention of diabetic foot syndrome

Medical almanac ◽

10.21145/2499-9954-2018-6-134-136 ◽

2018 ◽

pp. 134-136

Author(s):

Т.А. Filimonova ◽

Yu.V. Karakulova ◽

А.О. Karakulov

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Diabetic Foot ◽

Diabetic Polyneuropathy ◽

Diabetic Foot Syndrome ◽

Vascular Endothelial ◽

Endothelial Growth Factor

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Stellenwert von mikrozirkulatorischen Untersuchungsmethoden bei Patienten mit diabetischem Fuß-Syndrom

VASA ◽

10.1024/0301-1526.29.3.191 ◽

2000 ◽

Vol 29 (3) ◽

pp. 191-197 ◽

Cited By ~ 6

Author(s):

Lawall ◽

Amann ◽

Rottmann ◽

Angelkort

Keyword(s):

Diabetic Foot ◽

Reactive Hyperemia ◽

Diabetic Polyneuropathy ◽

Capillary Density ◽

Diagnostic Methods ◽

Diabetic Foot Syndrome ◽

Type I ◽

Additional Information ◽

Type Ii Diabetics

Background: Diabetic foot syndrome (DFS) is a frequent complication of long-standing diabetes mellitus, occurring in 10 to 30 percent of all diabetics with a vital risk for the affected limb and high mortality rates. Macroangiopathy, diabetic polyneuropathy and infections are trigger factors for DFS. Recent results imply a pathogenic role of functional and structural microcirculatory changes. The exact role of microangiopathy and the value of microcirculatory diagnostic methods in DFS have not yet been defined. Patients and methods: 78 patients with DFS (28 type I, 50 type II diabetics, mean age 63 years) were evaluated with video capillary microscopy, transcutaneous partial oxygen tension (tcpO2) measurement and laser Doppler fluxmetry (LDF) at the forefoot of the affected leg at admission and after revascularisation. Mean hospital stay was 28 ± 11.7 days. Patients were stratified according to the etiology of DFS in patients with neuropathic lesions, macroangiopathic ulcers and mixed neuropathic-angiopathic lesions. Results: All groups had impaired microcirculation, and significant differences between groups were found in respect to capillary density. Reactive hyperemia, LDF pattern and tcpO2 did not differ significantly. Microcirculatory examinations did not yield additional information to clinical and Doppler sonographic results. Conclusion: In clinical practice, the role of microcirculation evaluation techniques for diabetic foot syndrome is limited.

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The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies

Journal of restorative medicine and rehabilitation ◽

10.38025/2078-1962-2021-20-2-80-87 ◽

2021 ◽

Vol 20 (2) ◽

pp. 80-87

Author(s):

Denis V. Frolov

Keyword(s):

Diabetes Mellitus ◽

Physical Therapy ◽

High Mortality ◽

Physical Training ◽

Diabetic Foot ◽

Vascular Complications ◽

Lower Extremities ◽

Diabetic Polyneuropathy ◽

Diabetic Foot Syndrome ◽

Diabetic Angiopathies

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.

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Detection of skin microvascular vasodilation disorders in patients with diabetic foot syndrome during the local heating test

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2015-14-3-27-33 ◽

2015 ◽

Vol 14 (3) ◽

pp. 27-33 ◽

Cited By ~ 1

Author(s):

N. A. Zubareva ◽

S. Y. Podtaev ◽

A. A. Parshakov

Keyword(s):

Wavelet Analysis ◽

Diabetic Foot ◽

Healthy Subjects ◽

Local Heating ◽

Diabetic Polyneuropathy ◽

Limb Ischemia ◽

Diabetic Foot Syndrome ◽

Time Frequency ◽

Plantar Surface ◽

Heating Test

Introduction and purpose. The aim of investigation was to evaluate the possibility of using the method of wavelet analysis of skin temperature during the local heating test for the study of the microvascular tone regulation in patients with diabetic foot syndrome (DFS). Materials and methods. The study was performed in 15 healthy subjects and 10 patients with neuro-ischemic form of DFS complicated by trophic ulcers. The temperature of the plantar surface of the hallux was recorded by «Microtest» (Perm, Russia) with temperature resolution 0,002°C. Time-frequency analysis of temperature fluctuations was performed using wavelet analysis. For the reconstruction of the oscillations in endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges we used inverse wavelet transform. Results. In healthy people, indexes of vasodilation (relative changes in the oscillation amplitudes) in the myogenic, neurogenic, and endothelial frequency ranges were 3.04, 4.01 and 2.25 respectively. In patients with DFS the values were significantly lower than in healthy subjects (0.60, 0.67 and 0.51, respectively). Conclusion. In contrast to healthy subjects, the combination of diabetic polyneuropathy with endothelial dysfunction and macroangiopathy in patients with neuro-ischemic form of DFS leads to the progression of mutually aggravating pathological processes and lower limb ischemia. Further implementation of the local heating test at the early stages of diabetic foot is of interest for the prognosis of the disease, evaluating the effectiveness of conservative treatment and endovascular interventions.

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Collateral Glucose-Utlizing Pathwaya in Diabetic Polyneuropathy

International Journal of Molecular Sciences ◽

10.3390/ijms22010094 ◽

2020 ◽

Vol 22 (1) ◽

pp. 94

Author(s):

Hiroki Mizukami ◽

Sho Osonoi

Keyword(s):

Diabetic Polyneuropathy ◽

Polyol Pathway ◽

Product Formation ◽

Pentose Phosphate ◽

Global Changes ◽

Ulcer Formation ◽

Hexosamine Biosynthetic Pathway ◽

Abnormal Glucose Metabolism ◽

Chronic Hyperglycemia ◽

Rate Limiting

Diabetic polyneuropathy (DPN) is the most common neuropathy manifested in diabetes. Symptoms include allodynia, pain, paralysis, and ulcer formation. There is currently no established radical treatment, although new mechanisms of DPN are being vigorously explored. A pathophysiological feature of DPN is abnormal glucose metabolism induced by chronic hyperglycemia in the peripheral nerves. Particularly, activation of collateral glucose-utilizing pathways such as the polyol pathway, protein kinase C, advanced glycation end-product formation, hexosamine biosynthetic pathway, pentose phosphate pathway, and anaerobic glycolytic pathway are reported to contribute to the onset and progression of DPN. Inhibitors of aldose reductase, a rate-limiting enzyme involved in the polyol pathway, are the only compounds clinically permitted for DPN treatment in Japan, although their efficacies are limited. This may indicate that multiple pathways can contribute to the pathophysiology of DPN. Comprehensive metabolic analysis may help to elucidate global changes in the collateral glucose-utilizing pathways during the development of DPN, and highlight therapeutic targets in these pathways.

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