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Journal of the Royal Society of Medicine Mar 2017The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service.... (Review)
Review
The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.
Topics: Diabetic Foot; Humans; Mass Screening; Risk Factors; Wound Healing
PubMed: 28116957
DOI: 10.1177/0141076816688346 -
Australian Journal of General Practice May 2020Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and...
BACKGROUND
Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and treated in a timely manner.
OBJECTIVE
The aim of this article is to review the current evidence for preventing and managing diabetic foot ulcers, with the aim to increase clinicians' confidence in assessing and treating these complex medical presentations.
DISCUSSION
All patients with diabetes should have an annual foot review by a general practitioner or podiatrist. A three-monthly foot review is recommended for any patient with a history of a diabetic foot infection. Assessment involves identification of risk factors including peripheral neuropathy and peripheral vascular disease, and examination of ulceration if present. It is essential to identify patients with diabetes who are 'at risk' of ulceration, assess for any early signs of skin breakdown, initiate appropriate management to prevent progression and refer the patient if indicated.
Topics: Diabetic Foot; Humans; Physical Examination; Risk Factors
PubMed: 32416652
DOI: 10.31128/AJGP-11-19-5161 -
European Review For Medical and... Apr 2019Diabetic foot ulcers (DFUs), a micro-vascular complication, are associated with a substantial increase in morbidity and mortality. DFUs are a complicated mixture of... (Review)
Review
Diabetic foot ulcers (DFUs), a micro-vascular complication, are associated with a substantial increase in morbidity and mortality. DFUs are a complicated mixture of neuropathy, peripheral arterial diseases, foot deformities, and infections. Foot infections are frequent and potentially devastating complications. Infection prospers in more than half of all foot ulcers and is the factor that most often leads to lower extremity amputation. The complications of microbial flora span the spectrum from superficial cellulitis to chronic osteomyelitis and gangrenous extremity lower limb amputations. Wounds without confirmed soft tissue or bone infections do not require antibiotic therapy. Mild and moderate infections need empiric therapy covering Gram-positive cocci, while severe infections caused by drug-resistant organisms require broad-spectrum anti-microbials targeting aggressive Gram-negative aerobes and obligate anaerobes.
Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Diabetes Complications; Diabetic Foot; Humans; Osteomyelitis
PubMed: 30977868
DOI: 10.26355/eurrev_201904_17471 -
Annals of the New York Academy of... Jan 2018Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development... (Review)
Review
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.
Topics: Amputation, Surgical; Anti-Bacterial Agents; Bandages; Combined Modality Therapy; Debridement; Diabetic Foot; Humans; Hyperbaric Oxygenation; Hypoglycemic Agents; Intercellular Signaling Peptides and Proteins; Microbial Collagenase; Negative-Pressure Wound Therapy; Patient Care Team; Peripheral Arterial Disease; Physical Therapy Modalities; Practice Guidelines as Topic; Shoes; Skin Transplantation; Wound Healing; Wound Infection
PubMed: 29377202
DOI: 10.1111/nyas.13569 -
Medicina 2020Diabetic foot attack has an acute and severe presentation that threatens the affected limb and the patient's life. It is a term that arises from the need to identify... (Review)
Review
Diabetic foot attack has an acute and severe presentation that threatens the affected limb and the patient's life. It is a term that arises from the need to identify those patients that require urgent intervention; it conveys a sense of urgency and severity, reminding the term of "time is tissue". The classic presentation is that of a severe infected foot with rapidly progressive necrosis that requires urgent surgery to debride all necrotic tissue and purulent collections, providing an adequate antibiotic treatment. Ischemic diabetic foot attack that demands urgent revascularization and the acute Charcot neuroarthropathy for which primacy is given to diagnostic confirmation and off-loading are also consid ered atypical presentations of diabetic foot attack. The aim of identifying these diabetic foot presentations is to promote rapid intervention to provide adequate and effective treatment, avoiding the most feared complication which is the limb amputation. In the present review, a description of the pathophysiology, clinical presentation, treatment and evolution of the three types of diabetic foot attack is made.
Topics: Amputation, Surgical; Diabetes Mellitus; Diabetic Foot; Foot; Humans; Necrosis; Treatment Outcome
PubMed: 33048798
DOI: No ID Found -
International Journal of Molecular... Jun 2016Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of... (Review)
Review
Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations.
Topics: Diabetic Foot; Diabetic Neuropathies; Evidence-Based Medicine; Humans; Interprofessional Relations; Standard of Care; Treatment Outcome; Wound Healing
PubMed: 27294922
DOI: 10.3390/ijms17060917 -
International Wound Journal Feb 2019Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot-related... (Meta-Analysis)
Meta-Analysis Review
Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot-related behaviours, yet many individuals with diabetes do not adhere to foot care recommendations. The aim of this paper was to synthesise the findings of qualitative papers exploring diabetic people's perceptions and experiences of DFU in order to identify how they could be better supported to prevent ulceration or manage its impact. Five databases (MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science) were searched in May 2016 to identify eligible articles. Findings were synthesised using a meta-ethnographic approach. Forty-two articles were eligible for inclusion. Synthesis resulted in the development of five overarching themes: personal understandings of diabetic foot ulceration; preventing diabetic foot ulceration: knowledge, attitudes, and behaviours; views on health care experiences; development of diabetic foot ulceration and actions taken; and wide-ranging impacts of diabetic foot ulceration. The findings highlight various barriers and facilitators of foot care experienced by people with diabetes and demonstrate the significant consequences of ulcers for their physical, social, and psychological well-being. The insights provided could inform the development of interventions to promote foot care effectively and provide appropriate support to those living with ulceration.
Topics: Adult; Aged; Aged, 80 and over; Diabetic Foot; Female; Guideline Adherence; Humans; Male; Middle Aged; Patients; Qualitative Research; Self Care
PubMed: 30393976
DOI: 10.1111/iwj.13010 -
Advanced Science (Weinheim,... Jan 2023Diabetic foot ulcers (DFU), one of the most serious complications of diabetes, are essentially chronic, nonhealing wounds caused by diabetic neuropathy, vascular... (Review)
Review
Diabetic foot ulcers (DFU), one of the most serious complications of diabetes, are essentially chronic, nonhealing wounds caused by diabetic neuropathy, vascular disease, and bacterial infection. Given its pathogenesis, the DFU microenvironment is rather complicated and characterized by hyperglycemia, ischemia, hypoxia, hyperinflammation, and persistent infection. However, the current clinical therapies for DFU are dissatisfactory, which drives researchers to turn attention to advanced nanotechnology to address DFU therapeutic bottlenecks. In the last decade, a large number of multifunctional nanosystems based on the microenvironment of DFU have been developed with positive effects in DFU therapy, forming a novel concept of "DFU nanomedicine". However, a systematic overview of DFU nanomedicine is still unavailable in the literature. This review summarizes the microenvironmental characteristics of DFU, presents the main progress of wound healing, and summaries the state-of-the-art therapeutic strategies for DFU. Furthermore, the main challenges and future perspectives in this field are discussed and prospected, aiming to fuel and foster the development of DFU nanomedicines successfully.
Topics: Humans; Diabetes Mellitus; Diabetic Foot; Hyperglycemia; Nanomedicine; Wound Healing; Cellular Microenvironment
PubMed: 36424137
DOI: 10.1002/advs.202203308 -
The Journal of Cardiovascular Surgery Oct 2018The diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and... (Review)
Review
The diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and its incidence has increased. The ulceration is the initial cause of a dramatic process leading, if not correctly treated, to amputations. Both neuropathy, neuro-ischemia and infections have a role in determining healing or worsening of the lesions and 85% of all amputations in diabetic patients are preceded by a foot ulceration deteriorating to a severe gangrene or infection. The different causative agents and the different clinical presentations of diabetic foot ask a multidisciplinary approach in order to address treatments to the final goals, the prevention of the amputations and the maintenance of a functional foot able with weight-bearing ability. Many professional figures, diabetologists, surgeons (both general and vascular and orthopedics), interventional radiologists, infectious diseases specialists, specialized nurses, podiatrists, orthotic technicians, are called to apply their knowledges to the diabetic patients affected by diabetic foot in a virtuous circle leading to reach the goals, with the imperative action of the multidisciplinary team. The so organized center will allow both a correct and rapid diagnosis, the use in ambulatorial environments of modern tools, or the hospitalization in multitasking wards, in which all the complications and the necessary treatments are possible, both in emergencies or in elective way, considering both revascularizations and surgery.
Topics: Combined Modality Therapy; Diabetic Foot; Humans; Interdisciplinary Communication; Patient Care Team; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 29808982
DOI: 10.23736/S0021-9509.18.10606-9 -
BMJ (Clinical Research Ed.) Nov 2017
Topics: Amputation, Surgical; Checklist; Diabetic Foot; Disease Management; Humans; India; Mass Screening; Patient Education as Topic; Practice Guidelines as Topic; Primary Health Care; Referral and Consultation
PubMed: 29146579
DOI: 10.1136/bmj.j5064