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Plastic and Reconstructive Surgery.... Aug 2022Diabetic peripheral neuropathy (DPN) is a leading cause of morbidity. This systematic review and meta-analysis evaluate the efficacy of lower extremity nerve...
BACKGROUND
Diabetic peripheral neuropathy (DPN) is a leading cause of morbidity. This systematic review and meta-analysis evaluate the efficacy of lower extremity nerve decompression in reducing DPN symptoms and complications.
METHODS
A database search was performed using Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials. Articles addressing surgical decompression of lower limb peripheral nerves in patients with diabetes were screened for inclusion. Two independent reviewers undertook the assessment. Methodological quality measures were the Cochrane risk of bias and Newcastle-Ottawa scale.
RESULTS
The pooled sample size from 21 studies was 2169 patients. Meta-analysis of 16 observational studies showed significant improvement in the visual analog scale (VAS) ( < 0.00001) and two-point discrimination ( = 0.003), with strong reliability. Decompression of the tarsal tunnel region had the highest improvement in VAS [MD, 6.50 (95% CI, 3.56-9.44)]. A significant low-risk ratio (RR) of ulcer development and lower limb amputation was detected ( < 0.00001). Lowest RR of ulcer development was detected with tarsal tunnel release [RR, 0.04 (95% CI, 0.00-0.48)]. Improvements in VAS, two-point discrimination, and nerve conduction velocity were nonsignificant in the meta-analysis of five randomized controlled trials (RCTs). The RCT analysis was limited to only two studies for each outcome.
CONCLUSIONS
Meta-analysis of observational studies highlights the efficacy of lower extremity nerve decompression in reducing DPN symptoms, ulcerations, and amputations. Releasing the tibial nerve in the tarsal tunnel region was the most effective observed procedure. Nevertheless, high-quality RCTs are required to support the utility of this intervention in DPN.
PubMed: 35999882
DOI: 10.1097/GOX.0000000000004478 -
Journal of Clinical Medicine May 2020The amputation rate in patients with diabetes is 15 to 40 times higher than in patients without diabetes. To avoid major complications, the identification of high-risk... (Review)
Review
The amputation rate in patients with diabetes is 15 to 40 times higher than in patients without diabetes. To avoid major complications, the identification of high-risk in patients with diabetes through early assessment highlights as a crucial action. Clinician assessment tools are scales in which clinical examiners are specifically trained to make a correct judgment based on patient outcomes that helps to identify at-risk patients and monitor the intervention. The aim of this study is to carry out a systematic review of valid and reliable Clinician assessment tools for measuring diabetic foot disease-related variables and analysing their psychometric properties. The databases used were PubMed, Scopus, SciELO, CINAHL, Cochrane, PEDro, and EMBASE. The search terms used were foot, ankle, diabetes, diabetic foot, assessment, tools, instruments, score, scale, validity, and reliability. The results showed 29 validated studies with 39 Clinician assessment tools and six variables. There is limited evidence on all of the psychometric characteristics of the Clinician assessment tools included in this review, although some instruments have been shown to be valid and reliable for the assessment of diabetic neuropathy (Utah Early Neuropathy Scale or UENS); ulceration risk (Queensland High Risk Foot Form or QHRFF); diabetic foot ulcer assessment, scoring, and amputation risk (Perfusion, extent, depth, infection and sensation scale or PEDIS and Site, Ischemia, Neuropathy, Bacterial Infection, and Depth score or SINBAD); and diabetic foot ulcer measurement (Leg Ulcer Measurement Tool LUMT).
PubMed: 32429068
DOI: 10.3390/jcm9051487 -
BMJ Open Diabetes Research & Care Aug 2020The aims of this systematic review were to assess the clinical relevance and quality of previously published animal models of ischemic ulceration and examine the... (Meta-Analysis)
Meta-Analysis Review
The aims of this systematic review were to assess the clinical relevance and quality of previously published animal models of ischemic ulceration and examine the available evidence for interventions improving ulcer healing in these models. Publicly available databases were searched for original studies investigating the effect of limb ischemia on wound healing in animal models. The quality of studies was assessed using two tools based on the Animal research: Reporting of In Vivo Experiments (ARRIVE) guidelines and the clinical relevance of the models. A total of 640 wounds (ischemic=314; non-ischemic=326) were assessed in 252 animals (92 mice, 140 rats, 20 rabbits) from 7 studies. Meta-analyses showed that wound healing was consistently delayed by ischemia at all time-points examined (day-7 standard median difference (SMD) 5.36, 95% CI 3.67 to 7.05; day-14 SMD 4.50, 95% CI 2.90 to 6.10 and day-21 SMD 2.53, 95% CI 1.25 to 3.80). No significant difference in wound healing was observed between 32 diabetic and 32 non-diabetic animals with ischemic wounds. Many studies lacked methods to reduce bias, such as outcome assessors blinded to group allocation and sample size calculations and clinically relevant model characteristics, such as use of older animals and a peripheral location of the wound. Five different interventions were reported to improve wound healing in these models. The impaired wound healing associated with limb ischemia can be modeled in a variety of different animals. Improvements in study design could increase clinical relevance, reduce bias and aid the discovery of translatable therapies.
Topics: Animals; Diabetic Foot; Mice; Models, Animal; Rabbits; Rats; Ulcer; Wound Healing
PubMed: 32847840
DOI: 10.1136/bmjdrc-2020-001676 -
Medicine Sep 2022In the context of the novel coronavirus disease 2019 (COVID-19) pandemic, people have had to stay at home more and make fewer trips to the hospital. Furthermore,...
BACKGROUND
In the context of the novel coronavirus disease 2019 (COVID-19) pandemic, people have had to stay at home more and make fewer trips to the hospital. Furthermore, hospitals give priority to the treatment of COVID-19 patients. These factors are not conducive to the treatment of diabetic foot, and even increase the risk of amputation. Therefore, how to better treat patients with diabetic foot during the COVID-19 epidemic, prevent further aggravation of the disease and reduce the risk of amputation in patients with diabetic foot has become an urgent problem for doctors around the world.
METHODS
The researchers searched PubMed, the Cochrane Library, and the Embase database. The retrieval time was set from the database establishment to October 2021. All studies on treatment of diabetic foot in the COVID-19 pandemic were included in our study.
RESULTS
A total of 6 studies were included in this study. In the 6 protocols for treating patients with diabetic foot, the researchers classified patients according to the condition of their diabetic foot. Diabetic foot patients with general conditions received treatment at home, and doctors can guide the wound dressing change and medication treatment of patients through telemedicine. Patients with severe conditions of diabetic foot were admitted to hospital for treatment. Patients were screened for COVID-19 before hospitalization, those infected or suspected of COVID-19 were treated in isolation, and those not infected with COVID-19 were treated in a general ward.
CONCLUSION
Through this systematic review, we proposed a new protocol for the treatment of patients with diabetic foot in the context of the COVID-19 pandemic. It provided reference for the treatment of diabetic foot in the context of COVID-19 epidemic. However, the global applicability of the treatment protocol for diabetic foot in the context of COVID-19 epidemic proposed in this study needs further clinical testing.
Topics: Amputation, Surgical; COVID-19; Diabetes Mellitus; Diabetic Foot; Humans; Pandemics; Telemedicine
PubMed: 36107573
DOI: 10.1097/MD.0000000000030139 -
Pain Physician Jan 2021Diabetic peripheral neuropathy (DPN) is a most common devitalizing complication of diabetes mellitus, which is primarily characterized by sensory loss, paresthesia,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetic peripheral neuropathy (DPN) is a most common devitalizing complication of diabetes mellitus, which is primarily characterized by sensory loss, paresthesia, prickling, pain, or allodynia.
OBJECTIVES
To evaluate the relative efficacy and safety of the interventions used in the DPN pain management and rank their order.
STUDY DESIGN
A systematic review and Bayesian network meta-analysis (NMA).
METHODS
Randomized, controlled trials were identified through a comprehensive, systematic literature exploration, primarily utilizing the PubMed, EMBASE, Ovid, and Cochrane Library databases. The efficacy and safety outcomes consist of the proportion of patients reporting either 30% or 50% pain reduction and overall withdrawal or withdrawal due to adverse drug events, respectively. Effect estimates from Bayesian NMA were presented as odds ratio (OR) with 95% credible intervals (CrI). Heterogeneity and convergence were assessed by using I2 and deviation information criteria. The risk of bias was evaluated by using Pedro Scale.
RESULTS
A total of 3,246 potentially relevant trials were identified and screened, finally 43 trials consisting of 7,877 randomized patients met the inclusion criteria. Statistically significant treatment difference for 50% pain reduction was reported for duloxetine vs. placebo (OR: 2.50; CrI: 1.62-3.91), mirogabalin vs. placebo (OR: 3.25; CrI: 1.16-9.35), pregabalin vs. placebo (OR: 2.33; CrI: 1.69-3.27), duloxetine vs. carbamazepine (OR: 3.37; CrI: 1.07-10.90), mirogabalin vs. carbamazepine (OR: 4.39; CrI: 1.01-19.63), mirogabalin vs. lamotrigine (OR: 4.05: CrI: 1.07-15.77), pregabalin vs. lamotrigine (OR: 2.90, CrI: 1.19-7.22) and pregabalin vs. nortriptyline (OR: 4.10, CrI: 1.13-5.28). Nortriptyline reported the highest possibility of achieving 30% and 50% pain reduction. Sodium valproate and benztropine reported the highest probability of total withdrawals and withdrawals due to adverse drug events, respectively.
LIMITATION
The different follow-up time of the included studies can result in the variation of intended results.
CONCLUSION
Nortriptyline reported the advantage relative to other drugs in achieving 30% and 50% pain reduction from the baseline. Gabapentin reported a significance of 50% pain reduction relative to placebo.
Topics: Bayes Theorem; Diabetic Neuropathies; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic
PubMed: 33400429
DOI: No ID Found -
Journal of Diabetes Science and... Mar 2022The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily...
OBJECTIVE
The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily living (ADL), postural stability, and risk of falls.
METHODS
A systematic electronic search strategy was conducted on PubMed/MEDLINE database, Cochrane Library, and Embase in March 2020. This narrative review included clinical cross-sectional studies assessing ADL, postural balance, and falls in adults with DN. All studies underwent a quality assessment based on the Newcastle Ottawa scale developed to assess cross-sectional studies.
RESULTS
Forty-two studies were identified. A total of 37 studies evaluated postural stability in DN, 10 studies assessed fall accidents, and three studies assessed ADL in individuals with DN. Seven studies assessed both postural stability and fall accidents, and one study assessed postural stability and ADL. Each of the studied outcome variables was assessed separately. Based on a quality assessment, eight studies were excluded resulting in an evaluation of 34 studies.
CONCLUSIONS
Diabetic neuropathy has a negative impact on postural balance and gait kinematics combined with an increased fall risk. Because of the few number of studies available, we were unable to evaluate the impact of DN on ADL. Our findings are in concordance with previous reviews, supporting the evidence for DN as a critical measure negatively impacting postural stability and fall risk in individuals with diabetes. Further clinical investigative studies are needed.
Topics: Accidental Falls; Activities of Daily Living; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Neuropathies; Humans; Postural Balance
PubMed: 33719603
DOI: 10.1177/1932296821997921 -
Medicina (Kaunas, Lithuania) Dec 2021: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic... (Review)
Review
: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic review aims to examine the literature on patient and provider perspectives of smart wearable devices in DFU prevention. : PubMed, Scopus, and Web of Science were systematically searched up to October 2021. The selected articles were assessed for methodological quality using the quality assessment tool for studies with diverse designs. A total of five articles were identified and described. The methodological quality of the studies ranged from low to moderate. Two studies employed a quantitative study design and focused on the patient perspective, whereas three studies included a mixed, quantitative/qualitative design and explored patient or provider (podiatrist) perspectives. Four studies focused on an insole system and one included a smart sock device. The quantitative studies demonstrated that devices were comfortable, well designed and useful in preventing DFU. One mixed design study reported that patients did not intend to adopt an insole device in its current design because of malfunctions, a lack of comfort. and alert intrusiveness, despite the general perception that the device was a useful tool for foot risk monitoring. Two mixed design studies found that performance expectancy was a predictor of a podiatrist's behavioural intention to recommend an insole device in clinical practice. Disappointing participant experiences negatively impacted the podiatrists' intention to adopt a smart device. The need for additional refinements of the device was indicated by patients and providers before its use in this population. The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, thus, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes.
Topics: Diabetes Mellitus; Diabetic Foot; Foot; Foot Orthoses; Humans; Shoes; Wearable Electronic Devices
PubMed: 34946304
DOI: 10.3390/medicina57121359 -
Sensors (Basel, Switzerland) Mar 2023It is considered that 1 in 10 adults worldwide have diabetes. Diabetic foot ulcers are some of the most common complications of diabetes, and they are associated with a... (Review)
Review
It is considered that 1 in 10 adults worldwide have diabetes. Diabetic foot ulcers are some of the most common complications of diabetes, and they are associated with a high risk of lower-limb amputation and, as a result, reduced life expectancy. Timely detection and periodic ulcer monitoring can considerably decrease amputation rates. Recent research has demonstrated that computer vision can be used to identify foot ulcers and perform non-contact telemetry by using ulcer and tissue area segmentation. However, the applications are limited to controlled lighting conditions, and expert knowledge is required for dataset annotation. This paper reviews the latest publications on the use of artificial intelligence for ulcer area detection and segmentation. The PRISMA methodology was used to search for and select articles, and the selected articles were reviewed to collect quantitative and qualitative data. Qualitative data were used to describe the methodologies used in individual studies, while quantitative data were used for generalization in terms of dataset preparation and feature extraction. Publicly available datasets were accounted for, and methods for preprocessing, augmentation, and feature extraction were evaluated. It was concluded that public datasets can be used to form a bigger, more diverse datasets, and the prospects of wider image preprocessing and the adoption of augmentation require further research.
Topics: Humans; Diabetic Foot; Artificial Intelligence; Wound Healing; Ulcer; Diabetes Mellitus
PubMed: 37050678
DOI: 10.3390/s23073618 -
Frontiers in Pharmacology 2023The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful...
The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful diabetic neuropathy (PDN). We searched databases for randomized controlled trials (RCTs) of CHM in the treatment of PDN. Outcome indicators included nerve conduction velocity, clinical efficiency, pain score, TCM syndrome score, and adverse events. Stata 16.0 was used to carry out the Meta-analysis. A total of 21 RCTs with 1,737 participants were included. This meta-analysis found that using CHM as adjuvant treatment or as monotherapy for PDN can improve SCV of median nerve [mean difference (MD) = 3.56, 95% Confidence interval (CI) (2.19, 4.92) ], MCV of median nerve [ MD = 3.82, 95% CI (2.51, 5.12) ], SCV of common peroneal nerve [ MD = 4.16, 95% CI (1.62, 6.70) ], MCV of common peroneal nerve [ MD = 4.37, 95% CI (1.82, 6.93) ], SCV of gastrocnemius nerve [ MD = 4.95, 95% CI (3.52, 6.37) ], SCV of tibial nerve [ MD = 3.17, 95% CI (-2.64, 8.99) ], MCV of tibial nerve [MD = 6.30, 95%CI (5.00, 7.60)] and clinical effective rate [ odds ratio (OR) = 4.00, 95% CI (2.89, 5.52) ] and reduce pain score [standardized mean difference (SMD) = -2.23, 95% CI (-3.04, -1.41) ], TCM syndrome score [ MD = -4.70, 95% CI (-6.61, -2.80) ]. In addition, compared to the control group, adverse events of Chinese medicine intervention occurred less. CHM as adjuvant therapy or single treatment has a good curative effect and is safe for patients with PDN, which is worthy of clinical promotion and use, however; higher quality clinical studies are still needed to prove. https://www.crd.york.ac.uk/, identifier CRD42022327967.
PubMed: 36950007
DOI: 10.3389/fphar.2023.1072991 -
Frontiers in Medicine 2024Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, often causing pain or numbness in the patient's limbs and even leading...
BACKGROUND
Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, often causing pain or numbness in the patient's limbs and even leading to amputation and death. Elderly patients with DPN usually have higher morbidity and more severe results. Acupuncture has been widely used as an effective treatment for DPN in China. However, the efficacy of acupuncture in the treatment of DPN remains unclear. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of DPN.
METHOD AND ANALYSIS
Six databases were searched from inception to October 2023. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and three Chinese databases, namely China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang. All randomized controlled trials related to the effect of acupuncture on DPN will be included. There was no restriction in language or publication year. The primary outcome is the response rate. The secondary outcomes are the Toronto clinical scoring system (TCSS), nerve conduction velocities (NCVs), and blood glucose before and after the treatment. Two researchers will be responsible for the selection of study, data extraction, and assessment of study quality independently. RevMan V5.1.0 software will be used to assess the risk of bias and generate data.
RESULTS
We searched 4518 studies, among which 9 RCTs were considered eligible. Overall, acupuncture treatment had a higher response rate than controls (relative risk (RR), -2.87 [95% confidence interval (CI), -5.27 to -0.48], = 0.02) and significantly alleviated the symptoms of DPN patients, reduced their blood glucose levels, and improved their NCVs compared to the control group. This study will provide a high-quality synthesis of current available evidence for the clinical treatment of DPN with this therapy.
CONCLUSION
The results suggested that acupuncture might be effective in improving symptoms of DPN in elderly patients. Owing to the overall low quality of the literature included, we need more large-sample, high-quality, and low-bias studies to prove it.
PubMed: 38947240
DOI: 10.3389/fmed.2024.1339747