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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic foot ulcers are a significant clinical problem. Lyophilized type I collagen (LC) can stimulate wound healing by promoting platelet adhesion and aggregation and acting as a chemotactic factor for macrophages. The aim of the present study was to evaluate the efficacy of LC in the treatment of diabetic ulcers. Twenty patients (twelve males and eight females, age range 60-78 years) affected by non-insulin-dependent diabetes and ulcers (19 foot ulcers and 1 post-traumatic wrist ulcer) were, consecutively and at random, treated with LC or hyaluronic acid medicated gauze. The two groups were comparable in age, sex, size and etiopathogenesis of ulcers, metabolic state. The mean time for wound healing in the group treated with LC was 32.4 +/- 8.6 days, and in the group treated with hyaluronic acid medicated gauze was 49.0 +/- 11.0 days (p less than 0.001). The data suggest that LC significantly improves wound healing and is more active than medicated gauze in the treatment of diabetic ulcers.
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PMID:Lyophilized collagen in the treatment of diabetic ulcers. 179 3

Persons with diabetes, because of compromised circulation and sensation, are highly susceptible to slow-healing lesions of the lower extremities. Diabetic foot lesions often begin with a minor trauma and end in amputation; however, proper management of these lesions can avoid this progression. The major principles of foot lesion management include optimizing blood glucose control, controlling sepsis, debriding necrotic tissue, using appropriate dressings, treating local edema, restricting ambulation, wearing protective footwear, and educating patients in proper footcare. This article discusses these principles and gives specific recommendations for primary care practice.
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PMID:The care of lower extremity lesions in patients with diabetes. 184 Sep 73

Diabetic foot lesions most commonly result from a combination of neuropathy and vascular disease in the lower extremity, and may be the presenting feature of diabetes in the older patient. Insufficient attention previously has been given to the careful clinical assessment of the foot, which enables the physician to recognize those patients who are at particular risk of ulceration. The high-risk patient requires education and frequent follow up to reduce the risk of lesions developing. If ulceration develops, healing is likely to occur if the vascular supply is adequate, infection and the blood glucose are controlled, and pressures that may have caused the ulcer are relieved. The ischemic foot requires full vascular assessment, involving colleagues from vascular surgery. The key to a future reduction in the incidence of diabetic foot ulceration is the setting up of a foot care team in which the skills of nurses, podiatrists, orthotists, physicians, and surgeons are combined. The most important members of the team, however, are the patients, who must be convinced that regular foot care will reduce their chances of developing ulceration and other catastrophic consequences, such as amputation.
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PMID:The diabetic foot. 305 65

Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community.
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PMID:Gangrene of the lower limbs in diabetic patients: a malignant complication. 363 9

Diabetic foot disease is a severe complication to diabetes mellitus. Preventive measures can reduce its occurrence and consequences. The present study was performed in order to assess the prevalence of diabetic foot disease in an urbanized area with well developed medical facilities. The study was based on a mail questionnaire to a stratified, randomized sample of 742 diabetics living in the Stockholm county. Only one third of these patients were free of diabetic foot symptoms. Many patients with severe signs found it difficult to take care of their feet, were living alone and did not seek professional help for their foot problems. Only 66% of the patients with severe foot disease utilized hospitals for their diabetes care. Furthermore, only half of them relied on some type of professional care for their feet.
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PMID:An epidemiological survey of diabetic foot problems in the Stockholm County 1982. 659 59

In order to determine the microbiological characteristics of diabetic foot infection, 60 diabetic patients (21 women, 39 men; age between 43 and 89 years with a duration of diabetes from 0.5 to 37 years) were investigated. Immediately after the hospitalisation specimens from infected foot lesions were taken using Port-A-Cul special transport medium. Aerobic cultures were done in all cases according to conventional methods while anaerobic cultures were carried out when clinical signs indicated to perform it. Out of 60 lesions only 2 proved to be sterile. In the remaining 58 patients a total of 138 isolates were found resulting in an average of 2.3 organisms per lesions. Only aerobic isolates were identified in 45 patients whereas anaerobic species were also found in 12 patients. Only Candida was found in 1 patient while Candida in combination with bacterial strains was observed in 3 patients. In antimicrobial susceptibility testing beta-lactamase-stable antibiotics with broad spectrum, covering enterococcus and anaerobic organisms proved to be most effective. Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be based on the results of microbiological investigation of diabetic foot.
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PMID:[Experience with microbiological studies of the diabetic foot]. 756 49

Diabetic foot infections, a common source of morbidity and mortality, often have been related to vasculopathy and neuropathy in its etiopathogenesis, especially in the elderly person with diabetes. However, blood flow in the neuropathic diabetic foot has not been evaluated extensively, and there is evidence of abnormal blood flow patterns in the neuropathic diabetic foot unrelated to ischemia. The authors studied young persons with diabetes, with varying degrees of neuropathy, to assess the extent of vasculopathy in their lower limbs. Twelve young persons with insulin-dependent (Type I) diabetes (mean age, 36.1 +/- 1.975 years) and peripheral neuropathy, all of whom had previous surgery for diabetic foot infections, were identified. Confirmatory evidence of neuropathy was made using electromyographic studies and clinical tests that showed severe peripheral neuropathy. The results of vascular assessment of both lower limbs did not reveal any change in the pulse wave velocities from the popliteal to the digital vessels of the big toe as compared with correspondingly matched controls. There also was no significant stenosis in any of the vessels studied as far as the level of the dorsalis pedis and posterior tibial vessels. The normal triphasic pattern of arterial blood flow was lost. A monophasic pattern was present in all patients with prolonged diastolic flow at the level of the dorsalis pedis and posterior tibial arteries and distally. The pulsatility index was 3.14 +/- 0.81 as compared with 9.85 +/- 4.2. Mean toe pressures in the patient with diabetes was 64.17 +/- 20.87 mm Hg as compared with 98.23 +/- 10.12 mm Hg in controls. A linear correlation of decreasing toe pressures with increasing severity of neuropathy was seen (R = 0.7). The data suggest that changes exist in the blood flow patterns in young patients with diabetes and neuropathy, even in the absence of lower limb ischemia.
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PMID:Vascular assessment in the neuropathic diabetic foot. 758 48

Diabetic foot disease results from two common pathologies: peripheral vascular disease and diabetic neuropathy. If these pathologies are not identified, ulceration may occur in the foot. Ulcers can lead to infection and finally amputation. This article discusses the components of the physical exam, current treatment for both pathologies, and client education. Because the two pathologies are similar in presentation, it is important for clinicians to distinguish between the two pathologies. Careful attention to the feet during the physical exam and assessment for symptoms can help distinguish the two pathologies. There are new treatments available for peripheral vascular disease to improve the client's circulation. Treatment of peripheral neuropathy is usually palliative, but can improve the client's quality of life. Through early identification and treatment of peripheral vascular disease and diabetic neuropathy, clients with diabetes can avoid ulceration. Client education is central to the treatment plan.
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PMID:Preventing diabetic foot disease. 823 44

Diabetic foot wounds are consequences of the neuropathy and the small and large vessel disease that complicate diabetes. At the cellular level, the result is hypoxia which impairs wound healing. Hyperbaric oxygenation (HBO) may be a useful adjuvant to wound care. It leads to enhanced oxygenation of the affected tissues, has an antiseptic effect, reduces edema, and accelerates collagen production and angiogenesis, thus enhancing tissue repair. 14 diabetics with chronic nonhealing wounds which did not respond to treatment for at least 3 months were treated by HBO. All had palpable pedal pulses. Transcutaneous measurements of tissue pO2 showed elevation from 20 +/- 10 mm Hg during air breathing to 643 +/- 242 mm Hg while breathing pure oxygen at 2.5 ATA. They were treated with HBO in 56 +/- 10 consecutive HBO sessions. In 11 there was complete wound healing, while in 1 there was partial response, in 1 minimal response, and in 1 a transient response. HBO is useful in chronic nonhealing wounds of the diabetic foot and of the diabetic foot with impending amputation. It is a safe mode of therapy, but further studies are required to establish its efficacy and to ascertain which diabetic patients and wounds will benefit the most from it.
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PMID:[Treatment of the diabetic foot by hyperbaric oxygen]. 834 24

Diabetic foot ulcers are common. If treatment is delayed or is inappropriate, the lesions can become infected, resulting in gangrene and amputation. Physicians and clinics that perform aggressive therapy for these ulcers, provide revascularization when indicated, practice a team approach, suggest the use of therapeutic shoes, and repeatedly educate patients in foot care have reduced their amputation rates by 50% or greater. Goals of the United States Department of Health for the year 2000 include a 40% reduction in the amputation rate in patients with diabetes. This should be the goal of everyone providing care for patients with diabetes.
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PMID:Foot lesions in patients with diabetes mellitus. 879 9


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