Computer-assisted measurement in diabetic patients with and without foot ulceration

1995 ◽  
Vol 85 (11) ◽  
pp. 679-684 ◽  
Author(s):  
PL Tassler ◽  
AL Dellon ◽  
NM Scheffler
Keyword(s):  
General Population ◽  
Measurement Technique ◽  
Computer Assisted ◽  
Diabetic Patients ◽  
Foot Ulceration ◽  
Pressure Threshold ◽  
Patients With Diabetes

Computer-assisted measurement of sensibility was done at four anatomical sites of the foot of patients with diabetes with (19) and without (40) foot ulceration. Cutaneous pressure threshold measurements of patients with diabetes were compared with measurements on 30 patients without diabetes who had nonulcerated feet. Both groups had mean one-point static and moving touch, and two-point discrimination thresholds significantly different from the general population. Computer-assisted sensibility testing demonstrated significantly higher pressure thresholds for one-point static and moving touch and two-point discrimination in the ulcerated compared with the nonulcerated foot of patients with diabetes. This measurement technique is valid for documenting diminished sensation in the foot.

scholarly journals Validation of computer-aided diagnosis of diabetic retinopathy from retinal photographs of diabetic patients from Telecamps

2021 ◽  
Author(s):  
Dr SHEILA JOHN ◽  
Dr Sangeetha Srinivasan ◽  
Dr Prof Natarajan Sundaram
Keyword(s):  
Diabetic Retinopathy ◽  
Tamil Nadu ◽  
Characteristic Curve ◽  
Posterior Pole ◽  
Computer Assisted ◽  
Diabetic Patients ◽  
Fundus Images ◽  
Automated Algorithm ◽  
Screening Performance ◽  
Patients With Diabetes

Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR),  in fundus images of diabetic patients from telecamps to examine the screening performance for DR. Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR   Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017. Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer. Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer. Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist. Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.

What You Can’t Feel Can Hurt You

2010 ◽  
Vol 100 (5) ◽  
pp. 349-352 ◽  
Author(s):  
Andrew J. M. Boulton
Keyword(s):  
At Risk ◽  
Peripheral Neuropathy ◽  
Medical Training ◽  
Management Plan ◽  
Sensory Loss ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Foot Ulceration ◽  
High Incidence ◽  
Patients With Diabetes

Throughout our medical training, we are taught how to manage patients who present with symptoms: perform a clinical examination, make a diagnosis, and develop a management plan. However, virtually no time is spent on teaching us how to manage patients who have no symptoms because they have lost the ability to feel pain, that is, patients with peripheral neuropathy. The lifetime incidence of foot ulceration in people with diabetes has been estimated to be as high as 25%, and a variety of contributory factors result in a foot being at risk for ulceration. Most important among these factors is peripheral neuropathy, or the loss of the ability to feel pain, temperature, or pressure sensation in the feet and lower legs. Up to 50% of older type 2 diabetic patients have evidence of sensory loss, putting them at risk for foot ulceration. If we are to succeed in reducing the high incidence of foot ulcers, regular screening for peripheral neuropathy is vital in all patients with diabetes. Those found to have any risk factors for foot ulceration require special education and more frequent review, particularly by podiatric physicians. The key message is, therefore, that neuropathic symptoms correlate poorly with sensory loss and that their absence must never be equated with lack of risk of foot ulceration. If we are to succeed in reducing the high incidence of foot ulceration and particularly recurrent ulceration, we must realize that with loss of pain there is also diminished motivation in the healing and prevention of injury. (J Am Podiatr Med Assoc 100(5): 349–352, 2010)

scholarly journals Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Montserrat Dòria ◽  
Verónica Rosado ◽  
Linda Roxana Pacheco ◽  
Marta Hernández ◽  
Àngels Betriu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Foot Ulceration ◽  
Patients With Diabetes ◽  
Artery Disease

Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain.Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression.Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p=0.004andp=0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p=0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations.Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

scholarly journals Protocol for a prospective, international cohort study on the Management and Outcomes of Perioperative Care among European Diabetic Patients (MOPED)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044394
Author(s):  
Donal J Buggy ◽  
Rachel Nolan ◽  
Mark Coburn ◽  
Malachy Columb ◽  
Jeroen Hermanides ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
General Population ◽  
Adverse Events ◽  
Perioperative Care ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Ethical Approval ◽  
Major Adverse Events

IntroductionDiabetes is common (about 20 million patients in Europe) and patients with diabetes have more surgical interventions than the general population. There are plausible pathophysiological and clinical mechanisms suggesting that patients with diabetes are at an increased risk of postoperative complications. When postoperative complications occur in the general population, they increase major adverse events and subsequently increase 1-year mortality. This is likely to be worse in patients with diabetes. There is variation in practice guidelines in different countries in the perioperative management of patients with diabetes undergoing major surgery and whether this may affect postoperative outcome has not been investigated on a large scale. Neither is it known whether different strata of preoperative glycaemic control affects outcome.Methods and analysisA prospective, observational, international, multicentre cohort study, recruiting 5000 patients with diabetes undergoing elective or emergency surgery in at least n=50 centres. Inclusion criteria are any patient with diabetes undergoing surgery under any substantive anaesthetic technique. Exclusion criteria are not being a confirmed diabetic patient and patients with diabetes undergoing procedures under monitored sedation or local anaesthetic infiltration only. Follow-up duration is 30 days after surgery. Primary outcome is days at home at 30 days. Secondary outcomes are Comprehensive Complications Index, Quality of Recovery (QoR-15) score on Day 1 postoperatively, 30-day mortality, length of hospital stay and incidence of specific major adverse events (Myocardial Infarction (MI), Myocardial Injury after Non-cardiac Surgery (MINS), Acute Kidney Injury (AKI), Postoperative Pulmonary Complications (PPC), Cerebrovascular Accident (CVA), Pulmonary Embolism (PE), DVT, surgical site infection, postoperative pulmonary infection). Tertiary outcomes include time to resumption of normal diabetes therapy, incidence of diabetic ketoacidosis or hypoglycaemia, incidence and duration of use of intravenous insulin infusion therapy and change in diabetic management at 30 days.Ethics and disseminationThis study will adhere to the principles of the Declaration of Helsinki (amendment 2013) by the World Medical Association and the ICH-Good Clinical Practice (GCP) Guidelines E6(R2). Specific national and local regulatory authority requirements will be followed as applicable. Ethical approval has been granted by the Institutional Review Board of the Mater Misericordiae University Hospital, Dublin, Ireland (Reference: 1/378/2167). As enrolment for this study is ongoing, ethical approval from additional centres is being added continuously. The main results of Management and Outcomes of Perioperative Care among European Diabetic Patients and its substudies will be published in peer-reviewed international medical journals and presented at Euroanaesthesia congress and other international and national meetings.Trial registration numberNCT04511312.

scholarly journals Knowledge of Risk Factors for Foot Ulceration among Patients with Diabetes Mellitus Attending a Tertiary Health Facility in Nigeria

2021 ◽  
Author(s):  
Martins Ehizode Emuze ◽  
Taoreed Adegoke Azeez ◽  
Arinola Esan ◽  
Jokotade Adeleye ◽  
William Balogun ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Health Facility ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Foot Ulceration ◽  
Validated Questionnaire ◽  
Patients With Diabetes

Objective: Diabetic foot ulcer (DFU) is a relatively common complication of diabetes mellitus and constitutes a major cause of mortality. This study aimed to assess the knowledge of risk factors for foot ulceration among patients with diabetes in a tertiary health facility in South Western Nigeria. Materials and Methods: This cross-sectional study was initiated with participation of 100 diabetic patients. Diabetic patients were attending the medical outpatient clinic of the University College Hospital, Ibadan. A structured and validated questionnaire was administered and data was analyzed using SPSS 22. Association between sociodemographic characteristics and knowledge of risk factors for foot ulceration was evaluated by chi-square test. Results: Most of respondents were female (66%). The mean age of the patients was 58.77 (±11.8) years and 51% of patients did not know that it is possible to develop foot ulcer without feeling pain and 30% did not know that features suggestive of neuropathy could be associated with development of foot ulcer. 75% did not know that surgical vascular repair could play any role in the healing of a diabetic foot ulcer. 11% of patients were walking barefooted at home and as much as 63% of respondents did not know that poor longterm glycemic control could be a risk factor for the development of diabetic foot ulcers. Conclusion: The knowledge of the patients attending the diabetes clinic of a tertiary hospital in south-western Nigeria on foot care is generally poor. Education in this direction is very paramount to correct this defect.

scholarly journals Depression and anxiety disorders in people with diabetes

2017 ◽  
Vol 18 (4) ◽  
pp. 360-366
Author(s):  
Aleksander Araszkiewicz ◽  
Izabela Mirlak
Keyword(s):  
General Population ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Psychological Treatment ◽  
Cardiovascular Complications ◽  
Bibliographic Databases ◽  
Diabetic Patients ◽  
Depression And Anxiety ◽  
Increased Risk ◽  
Patients With Diabetes

AbstractIntroduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journalsResults: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

2010 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Dimitrios Bliagos ◽  
Ajay J Kirtane ◽  
Jeffrey W Moses ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Ageing Population ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Asymptomatic Diabetic Patient ◽  
Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

Sign in / Sign up

Export Citation Format

Share Document