RESUMO
Cardiovascular disease (CVD) risk in those with diabetic foot disease is very high. Non-pharmacological interventions may improve this risk, though no previous evidence synthesis has been completed. This systematic review aimed to investigate the impact of non-pharmacological interventions on CVD risk factors in diabetic ulcer disease. Multiple databases and trials registers were searched from inception to December 6th 2023. We included reports of randomised controlled trials investigating the impact of non-pharmacological interventions on cardiovascular risk in those with type 1 or type 2 diabetes and current or previous diabetic foot disease. Twenty studies were included. Extracted data included: study design and setting; participant sociodemographic factors; and change in cardiovascular risk factors. Data were synthesised using random effects meta-analyses and narrative syntheses. Interventions included nutritional supplementation, collaborative care, hyperbaric oxygen therapy, patient education, nurse-led intervention, self-management, family support, relaxation and exercise, over a median duration of 12 weeks. Significant post-intervention changes were observed in fasting plasma glucose, serum insulin levels, insulin sensitivity and resistance, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol and C-reactive protein. No effects were detected in very low- or high-density lipoprotein-cholesterol or body mass index. Non-pharmacological interventions show promise in improving CVD risk in diabetic foot disease.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Pé Diabético , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/epidemiologia , Pé Diabético/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , HDL-Colesterol , Fatores de Risco de Doenças CardíacasRESUMO
Hypertension is not a recognized complication of circular external fixation. The aim of this study was to determine the incidence of hypertension following this procedure. A retrospective review of 57 patients was carried out between January 2006 and May 2010. At least three blood pressure readings were used to define hypertension. Five of the 41 qualifying patients (12.2%) developed hypertension. Three of these were found to have a sustained hypertension throughout the frame period, two requiring treatment for visual symptoms and left ventricular hypertrophy. A limb reconstruction surgeon needs to be alert to this potential complication to initiate prompt investigations and treatment.