Adherence to at-Home Monitoring of Foot Temperatures in People with Diabetes at High Risk of Ulceration.

We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P < .001). Of 83 participants with a hotspot, 24 (28.9%) reduced ambulatory activity. Increasing age (P = .021, OR = 1.045) and better self-care (P = .007, OR = 1.513) were positively associated with adherence to measuring foot temperature. In conclusion, in people at high diabetes-related foot ulcer risk, adherence to measuring foot temperature was high in the first months after study commencing, but dropped over time. Adherence to reducing ambulatory activity when a hotspot was found was low over the entire study period.

Urine changing from clear to milky-white.

After sedation with propofol a young man developed milky-white urine. Urinalysis showed a high concentration of uric acid crystals as being responsible. This phenomenon appears to be dose-dependent and is explained in this report. Since it is harmless and self-limiting no extensive analysis is needed when observed.

[A multidisciplinary approach in diabetic foot disease is mandatory]. / De diabetische voet vereist multidisciplinaire aanpak.

The history of two patients (66- and 53-year-old males) with diabetes and peripheral neuropathy illustrates the variety of clinical presentations and pitfalls in treatment of diabetic foot ulcers. Peripheral arterial disease and mechanical stress as a consequence of peripheral neuropathy are important risk factors for developing an ulcer and eventually loss of a limb. Revascularisation of the limb should be considered in the presence of critical limb ischaemia or in the presence of mild to severe ischaemia in combination with a deep infection. Infection is a major threat to the affected limb and requires treatment directly after taking samples for culture. After healing, education, adequate offloading and frequent foot examinations are important for secondary prevention. Presentation of these patients to a special multidisciplinary team, including a vascular surgeon, endocrinologist, rehabilitation specialist, cast technician, shoe technician and a podiatrist is mandatory, according to the Dutch guidelines on the diabetic foot.