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Query: UMLS:C0011849 (diabetes)
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India has the highest number of people with diabetes in the world. Diabetic foot care is one of the most ignored aspects of diabetes care in India. Due to social, religious, and economic compulsions, many people walk barefoot. Poverty and illiteracy lead to usage of inappropriate foot wear and late presentation of foot lesions. Many nonphysicians are interfering in the treatment of diseases, including diabetes. Patients also try home remedies before visiting their physicians. We believe that rational improvisation is the key to success when working with diabetic foot patients in developing countries. We have developed several improvised techniques/approaches for diabetes care in general and specifically for foot care. Our techniques/approaches are based on four principles: 1) they are simple, 2) no special training is needed, 3) they are affordable, and 4) they are effective. Only simple and affordable methods are successful in the developing world.
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PMID:Diabetic foot problems in India: an overview and potential simple approaches in a developing country. 1899 Mar 1

Diabetic foot disease is an important cause of morbidity and mortality in persons with diabetes mellitus. The commonest presentation of diabetic foot is an ulcer. Neuropathy, ischaemia and infection are the main pathogenic factors involved. Clinical examination and investigations are focused on identifying the aetiology as well as the extent of foot disease. The monofilament test is a simple, bedside test that can predict the risk of neuropathic ulceration. Treatment of diabetic foot ulcer should focus on antibiotic therapy, dressings, debridement and timely surgery. Glycaemic control and management of systemic comorbid conditions is important. Necrotizing fasciitis is a life-threatening situation where early diagnosis and therapy is important. In ulcers associated with peripheral vessel disease, revascularization, when feasible, can improve blood flow and hasten wound healing. Amputation is reserved for life-threatening situations as well as for severe, non-resolving cases. The majority of amputations are preventable by diabetes education, foot care and appropriate footwear.
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PMID:Approach to a patient with a diabetic foot. 1900 46

Management of diabetic foot ulcers presents a major clinical challenge. The response to treatment is often poor and the outcome disappointing, while the costs are high for both healthcare providers and the patient. In such circumstances, it is essential that management should be based on firm evidence and follow consensus. In the case of the diabetic foot, however, clinical practice can vary widely. It is for these reasons that the International Working Group on the Diabetic Foot has published guidelines for adoption worldwide. The Group has now also completed a series of non-systematic and systematic reviews on the subjects of soft tissue infection, osteomyelitis, offloading and other interventions designed to promote ulcer healing. The current article collates the results of this work in order to demonstrate the extent and quality of the evidence which is available in these areas. In general, the available scientific evidence is thin, leaving many issues unresolved. Although the complex nature of diabetic foot disease presents particular difficulties in the design of robust clinical trials, and the absence of published evidence to support the use of an intervention does not always mean that the intervention is ineffective, there is a clear need for more research in the area. Evidence from sound clinical studies is urgently needed to guide consensus and to underpin clinical practice. It is only in this way that patients suffering with these frequently neglected complications of diabetes can be offered the best hope for a favourable outcome, at the least cost.
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PMID:Unresolved issues in the management of ulcers of the foot in diabetes. 1904 35

One of the most important chronic complications of diabetes mellitus is diabetic foot. Severe progression of diabetes can lead to lower limb amputations. However, since evolution of the disease is slow, it is possible to implement prevention and control measures. The scope of the Family Health Program (in terms of the possibility of early diagnosis of diabetes mellitus and diabetic foot) favors epidemiological studies to determine the problem's magnitude. This article aimed to identify the proportion of individuals with diabetic foot treated at family health units in the city of Recife, Pernambuco State, Brazil. An epidemiological survey was conducted with a probabilistic sample of medical charts of diabetic patients (N = 1,374) enrolled in six health districts in the city, analyzing relations between socioeconomic variables, health conditions, and the occurrence of amputation. Diabetic foot was observed in 9% of the sample. There was a positive and statistically significant association with the variables alcoholism and amputation (p < 0.001). The prevalence of lower limb amputations was 25.6% among individuals with complications and 2.3% of the total sample.
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PMID:[Prevalence of diabetic foot and associated factors in the family health units of the city of Recife, Pernambuco State, Brazil, in 2005]. 1908 77

Diabetic foot is complex and difficult to treat. More aggressive treatment using peripheral distal by-pass frequently combined to minor amputations has greatly improved limb salvage in most patients. However, diabetes-related amputations are at high risk of non-healing or superinfection, thus requiring a second-step surgical revision treatment more frequently than in non-diabetic patients. Several advanced technologies have been developed to improve the treatment of diabetic foot wounds including Vacuum Assisted Therapy: we present 3 cases of diabetic patients treated with preliminary surgical peripheral revascularization, subsequent minor amputation in combination with Vacuum Assisted Therapy performed in a day-surgery regime.
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PMID:Two-stage treatment for diabetic foot: surgical peripheral revascularization and minor amputation in day-surgery admission. 1912 14

Diabetic foot disease and ulceration is a major complication that may lead to the amputation of the lower limbs. Microangiopathy may play a significant role in the pathogenesis of tissue breakdown in the diabetic foot. However, the precise mechanisms of this process remain unclear and poorly understood. Microvasculature in the skin is comprised of nutritive capillaries and thermoregulatory arteriovenous shunt flow. It is regulated through the complex interaction of neurogenic and neurovascular control. The interplay among endothelial dysfunction, impaired nerve axon reflex activities, and microvascular regulation in the diabetic patient results in the poor healing of wounds. Skin microvasculature undergoes both morphologic changes as well as functional deficits when parts of the body come under stress or injury. Two important theories that have been put forward to explain the abnormalities that have been observed are the haemodynamic hypothesis and capillary steal syndrome. With advances in medical technology, microvasculature can now be measured quantitatively. This article reviews the development of microvascular dysfunction in the diabetic foot and discusses how it may relate to the pathogenesis of diabetic foot problems and ulceration. Common methods for measuring skin microcirculation are also discussed.
Diabetes Metab Res Rev 2009 Oct
PMID:Microvascular dysfunction in diabetic foot disease and ulceration. 1968 Oct 35

Peripheral arterial occlusive disease (PAOD) of lower extremities is becoming more prevalent worldwide. The general prognosis is particularly negative with a high prevalence of coronary heart disease and cerebrovascular disease. Diabetic foot ulcers occur in 15% of all the patients with diabetes and proceed to lower-leg amputations. In diabetic ulcers, wound healing is impaired because of delayed angiogenesis. In both pathological conditions, therapeutic angiogenesis using angiogenic growth factors, particularly Vascular Endothelial Growth Factor VEGF, is expected to be a valuable treatment. The most used approaches are based on VEGF local delivery or gene therapy, but they failed to meet the expected primary goals of therapy. Adenosine receptor stimulation can induce VEGF expression in many types of cells and this may be achieved by stimulating the A(2A) or A(2B) receptor or both, following the signalling pathways activated by hypoxia. Polideoxyribonucleotide (PDRN) is obtained from sperm trout by an extraction process. The compounds hold a mixture of deoxyribonucleotides polymers with chain lengths ranging between 50 and 2000 bp. PDRN is able to stimulate VEGF production during pathological conditions of low tissue perfusion. It likely acts through the stimulation of A(2A) receptors. Furthermore, acute and chronic toxicity studies showed a good safety profile. PDRN has been shown to be effective in an experimental model of PAOD, hind limb ischemia, impaired wound healing and burn injury. Preliminary studies and ongoing clinical trials predict a significant therapeutic efficacy in patients. These data lead to hypothesize a role for PDRN in therapeutic angiogenesis.
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PMID:Polydeoxyribonucleotide (PDRN): a safe approach to induce therapeutic angiogenesis in peripheral artery occlusive disease and in diabetic foot ulcers. 1986 Jun 58

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus. A review of the literature confirms that the presence of an unhealed DFU negatively affects several domains of patient quality of life (daily and social activities) and increases the risk of infection, amputation, and death. Patients with diabetes mellitus and DFUs also have higher healthcare utilization rates than patients without DFUs and reported healing rates vary from 24% to 82% after 12 weeks of care. Guidelines for the expeditious healing of DFUs are available and include debridement, infection control, offloading, and the use of dressings that maintain a moist wound bed. Wound measurements to determine progress toward healing must be obtained because percent reduction in wound area during the first 4 weeks of care is a predictor of treatment outcome. If a wound fails to respond to standard care, the use of advanced treatment approaches such as cytokines, negative pressure therapy, and living skin equivalents may be beneficial. Clinical studies to further elucidate the effects of topical, systemic, and supportive regimens of care on outcomes and costs are needed.
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PMID:Diabetic foot ulcers--effects on QOL, costs, and mortality and the role of standard wound care and advanced-care therapies. 1993 61

Diabetic foot osteomyelitis (DFO) complicates about 20% of diabetic foot infections (DFIs) and increases the risk of lower extremity amputation. This contentious infection is important to discuss, given the frequency with which diabetes mellitus and its complications occur and the devastating consequences of amputation. The diagnosis and management of DFO is complicated by the diverse presentations, delayed recognition, poorly defined diagnostic criteria, and lack of validated treatment regimens. Major issues of concern include when to undertake bone resection surgery and which antimicrobial agents to use, by what route, and for how long. Patients in whom DFO is suspected are best cared for by a multidisciplinary team, including infectious disease physicians or clinical microbiologists, orthopaedic, plastic and vascular surgeons, diabetologists, primary care physicians, podiatrists and specialist (especially tissue viability) nurses. Such multidisciplinary teams have repeatedly been shown to improve disease outcomes. We herein analyse the limited, and recently published, literature on the pharmacotherapy of DFO and put it into the broader context of management of DFI and osteomyelitis.
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PMID:Pharmacotherapy of diabetic foot osteomyelitis. 1995 73

The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found.
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PMID:In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients. 2020 19


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