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1.
Clin Podiatr Med Surg ; 37(1): 151-169, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735265

RESUMO

Biomechanical changes to the lower extremity in patients with diabetes mellitus are typically greatest with peripheral neuropathy, although peripheral arterial disease also impacts limb function. Changes to anatomic structures can impact daily function. These static changes, coupled with kinetic and kinematic changes of gait, lead to increased vertical and shear ground reactive forces, resulting in ulcerations. Unsteadiness secondary to diminished postural stability and increased sway increase fall risk. These clinical challenges and exacerbation of foot position and dynamic changes associated with limb salvage procedures, amputations, and prostheses are necessary and can impact daily function, independence, quality of life, and mortality.


Assuntos
Pé Diabético/fisiopatologia , Pé Diabético/terapia , Amputação , Membros Artificiais , Fenômenos Biomecânicos , Pé Diabético/etiologia , Marcha , Humanos , Salvamento de Membro
2.
Angiol Sosud Khir ; 25(4): 28-33, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855198

RESUMO

BACKGROUND: Diabetes mellitus a commonly encountered pathology in the whole world and has a tendency towards steady growth of morbidity and development of vascular complications. The presence of haemostatic disorders and genetic susceptibility to thrombosis in patients with diabetes mellitus increases the risk for the development of thrombotic complications. AIM: The purpose of the study was to determine the incidence rate of thrombophilic conditions (TC) and thrombosis-associated gene carrier status (TAGCS) in patients suffering from neuroischaemic form of diabetic foot. PATIENTS AND METHODS: The study enrolled a total of 38 patients undergoing treatment at the Department of Vascular Surgery for critical ischaemia of lower limbs combined with diabetes mellitus during the period from 2016 to 2018. There were 29 (76.3%) men and 9 (23.7%) women. The mean age amounted to 58.9±7.3 years. The diagnosis of TC and TAGCS was made based on the study for the presence of the markers of antiphospholipid syndrome, level of homocysteine and antithrombin III, proteins C and S, as well as comprehensive genetic study in order to reveal gene polymorphisms (prothrombin, Leiden mutation, MTHFR gene, MTR gene and others). Based on the obtained findings we calculated the incidence rate of TC and TAGCS, as well as their combinations in the examined patients. RESULTS: In the studied group of patients we revealed various incidence of TC and TAGCS, and, most importantly, that of a combination of these conditions. All cases of thrombophilias were combined with TAGCS. Hyperhomocysteinemia was most commonly combined with the MTRR 66 A>G gene mutation, the presence of lupus anticoagulant - with PAI-1 675 5G>4G, whereas thrombophilic conditions - with MTRR 66 A>G and PAI-I - 675 5G>4G. Two patients were found to be carriers of the factor V Leiden mutation. CONCLUSION: The examined patients were diagnosed as having TC or TAGCS, as well as their combinations in one form or another, thus increasing the risk for the development of thromboses and embolisms in such patients.


Assuntos
Complicações do Diabetes/complicações , Pé Diabético/etiologia , Tromboembolia/etiologia , Trombofilia/complicações , Idoso , Complicações do Diabetes/genética , Pé Diabético/genética , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tromboembolia/genética , Trombofilia/genética
3.
Pan Afr Med J ; 33: 103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489081

RESUMO

Introduction: Foot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. Methods: The objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the "amputative and non-amputative foot deformities severity" variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. Results: From the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001). Conclusion: A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Deformidades do Pé/epidemiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Pé Diabético/etiologia , Feminino , Humanos , Modelos Logísticos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença
4.
Trials ; 20(1): 521, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439007

RESUMO

BACKGROUND: Early detection of diabetic foot ulcerations (DFUs) can avoid or delay any progression into more severe stages, which may require limb amputation or lead to infectious sequelae and death. However, frequent clinical screening would be too intrusive and costly, and self-examination may be hampered by concomitant diseases and social disabilities. In addition, it requires professional knowledge and experience using specialized devices. Researchers reported that skin temperature monitoring could reduce the risk of DFUs in high-risk patients. The main research objects in this field are effective and convenient means of temperature measurement, accurate and reasonable early warning mechanisms, and timely and appropriate interventions. This trial aims to investigate the effectiveness of daily home-based foot temperature measurements in the prevention of DFUs with the aid of intelligent sensor-equipped insoles combined with photo documentation. METHODS/DESIGN: In this open-label, prospective, randomized, 24-month trial, 300 patients with diabetes mellitus (type 1 or 2) and severe diabetic peripheral neuropathy (vibration sensation ≤ 4/8), aged 18-85 years, will be recruited and assigned to control and intervention groups in a ratio of 1:1. Main inclusion criteria to be eligible for study participation encompass in particular risk group 2 or 3 for the development of DFUs using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Feet [IWGDF]) and the ability to use a mobile phone. INTERVENTIONS: Participants in both groups will receive education about regular foot care at the beginning of the study (visit 0). In the intervention group, every patient will receive a pair of slippers with the inserted sensor-equipped insole as well as a smartphone with the corresponding smartphone application (Smart Prevent Diabetic Feet Application). The insole is a tool that records the temperature variabilities of the plantar foot. Patients will measure their foot temperature twice a day at home with a time interval > 4 h during the entire course of the study (24 months). The measured data will be initially analyzed and visualized, and further transferred to a remote server that allows the physician to perform specific interpretations. In case of temperature differences > 1.5 °C between left and right corresponding sites lasting > 32 h (assigned alarm level 4), the physician will start an intervention phase, which requires the patient to reduce daily activities and relax his feet for five days. At the same time, photo documentation is encouraged to be performed by the patient. Possibly, additional visits to a private doctor or clinical examinations will be arranged for the patient during this intervention period. OUTCOMES: The primary outcome is foot ulceration, evaluated by a physician, and occurring at any point during the study. DISCUSSION: This study addresses principal aspects in the prevention of DFUs. First, the sensor-equipped insole will be evaluated for daily performance in home-based measurements of foot temperatures. Second, a telemedicine structure is tested that evaluates sensor data automatically and proposes suitable intervention measures under the supervision of a physician. Third, predictive models for DFUs will be built using the collected sensor data allowing for interpretations, which in the future may support medical care providers. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00013798 . Registered on 18 January 2018.


Assuntos
Pé Diabético/prevenção & controle , Pé Diabético/fisiopatologia , Fotografação/instrumentação , Tecnologia de Sensoriamento Remoto , Sapatos , Temperatura Cutânea , Telemedicina/instrumentação , Termografia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Telefone Celular , Pé Diabético/diagnóstico , Pé Diabético/etiologia , Diagnóstico Precoce , Desenho de Equipamento , Feminino , , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Adulto Jovem
5.
Diabetes Metab Syndr ; 13(4): 2431-2435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405655

RESUMO

BACKGROUND: Diabetes in Sudan is real health challenge for health authorities especially optimum glycemic control and complications in particular diabetic septic foot. This is study aimed to assess knowledge of individuals with diabetes about self-foot care. METHODS: This is descriptive cross sectional, health facility-based study conducted in diabetes center in Khartoum, Sudan. The study recruited 150 individuals with diabetes. Data was collected using a standardized pretested questionnaire. RESULTS: Among the participants 64.7% were females and 35.3% were males, 36% of the participants were between the age of 51-60 years old. Good glycemic control (HbA1c) were achieved by 41.3% only. The participants who had good knowledge about diabetic foot self-care were 46.7%, poor knowledge 29.3% and moderate knowledge 24%. Good self-practice toward diabetic foot self-care was reported by 42.6%, moderate by 36.7% and poor practice by 20.7%. The awareness and practices significantly correlated with an increase in ages (≥51 years), higher level of education, medium income, unemployment, longer duration of diabetes > 10years, family history, controlled diabetes mellitus and education about diabetes complications and diabetic foot care (P value < 0.05). CONCLUSIONS: Only (46.7%) of participants address good awareness and practices about self-foot care. Accordingly, there is a great need to provide continuous health education to the patients about diabetic foot self-care and this knowledge-application gap must be narrowed down.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/terapia , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Autocuidado/estatística & dados numéricos , Autocuidado/normas , Adulto , Estudos Transversais , Pé Diabético/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Sudão/epidemiologia , Inquéritos e Questionários
6.
PLoS One ; 14(7): e0219537, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31295292

RESUMO

BACKGROUND: Therapeutic footwear becomes the first treatment line in the prevention of diabetic foot ulcer and future complications of diabetes. Previous studies and the International Working Group on the Diabetic Foot have described therapeutic footwear as a protective factor to reduce the risk of re-ulceration. In this study, we aimed to analyze the efficacy of a rigid rocker sole to reduce the recurrence rate of plantar ulcers in patients with diabetic foot. METHODS: Between June 2016 and December 2017, we conducted a randomized controlled trial in a specialized diabetic foot unit. PARTICIPANTS AND INTERVENTION: Fifty-one patients with diabetic neuropathy who had a recently healed plantar ulcer were randomized consecutively into the following two groups: therapeutic footwear with semi-rigid sole (control) or therapeutic footwear with a rigid rocker sole (experimental). All patients included in the study were followed up for 6 months (one visit each 30 ± 2 days) or until the development of a recurrence event. MAIN OUTCOME AND MEASURE: Primary outcome measure was recurrence of ulcers in the plantar aspect of the foot. FINDINGS: A total of 51 patients were randomized to the control and experimental groups. The median follow-up time was 26 [IQR-4.4-26.1] weeks for both groups. On an intention-to-treat basis, 16 (64%) and 6 (23%) patients in the control and experimental groups had ulcer recurrence, respectively. Among the group with >60% adherence to therapeutic footwear, multivariate analysis showed that the rigid rocker sole improved ulcer recurrence-free survival time in diabetes patients with polyneuropathy and DFU history (P = 0.019; 95% confidence interval, 0.086-0.807; hazard ratio, 0.263). CONCLUSIONS: We recommend the use of therapeutic footwear with a rigid rocker sole in patients with diabetes with polyneuropathy and history of diabetic foot ulcer to reduce the risk of plantar ulcer recurrence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02995863.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/terapia , Úlcera do Pé/terapia , Adolescente , Adulto , Idoso , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico por imagem , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/diagnóstico por imagem , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/fisiopatologia , Feminino , Pé/diagnóstico por imagem , Pé/fisiopatologia , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Sapatos , Resultado do Tratamento
7.
Medicina (B Aires) ; 79(3): 167-173, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284250

RESUMO

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Pé Diabético/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Pé Diabético/microbiologia , Quimioterapia Combinada , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia
8.
Acta Med Port ; 32(6): 459-465, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31292028

RESUMO

Diabetes is a serious, chronic disease with a rising prevalence worldwide. Its complications are a major cause of morbidity and mortality and contribute substantially to health care costs. In this article the authors review the most common and sensitive skin manifestations that can be present on patients with diabetes and prediabetes. The prompt recognition of these frequently underestimated entities is extremely important as it may trigger not only an adequate metabolic evaluation but also a timely referral and appropriate treatment, minimizing the secondary effects of long-term diabetes and improving the prognosis of diabetic patients.


Assuntos
Complicações do Diabetes/etiologia , Estado Pré-Diabético/complicações , Dermatopatias/etiologia , Acantose Nigricans/etiologia , Vesícula/etiologia , Angiopatias Diabéticas/complicações , Pé Diabético/etiologia , Granuloma Anular/etiologia , Humanos , Necrobiose Lipoídica/etiologia , Escleredema do Adulto/etiologia , Dermatopatias Infecciosas/etiologia , Dermatopatias Vasculares/etiologia , Xantomatose/etiologia
9.
Foot Ankle Int ; 40(1_suppl): 73S-74S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322951

RESUMO

RECOMMENDATION: Yes. Bone biopsies play both a crucial diagnostic and interventional role in the management of diabetic foot infection. Although bone biopsies are not required in every case of diabetic foot infection, their most important role is in guiding accurate antibiotic treatment, as they provide more accurate microbiological information than superficial soft tissue samples in patients with diabetic foot osteomyelitis. LEVEL OF EVIDENCE: Moderate. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Biópsia , Pé Diabético/patologia , Pé Diabético/terapia , Osteomielite/patologia , Osteomielite/terapia , Pé Diabético/etiologia , Humanos , Osteomielite/etiologia , Seleção de Pacientes
10.
Braz J Med Biol Res ; 52(7): e8432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314853

RESUMO

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.


Assuntos
Doenças das Artérias Carótidas/complicações , Espessura Intima-Media Carotídea/efeitos adversos , Pé Diabético/etiologia , Extremidade Inferior/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Estudos Transversais , Feminino , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
11.
Diabetes Metab Syndr ; 13(2): 1081-1085, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336448

RESUMO

AIMS: Stage 0 Acute Charcot's Neuroarthropathy (ACN)in Type 2 Diabetes patients is a challenging diagnosis with subtle clinical features and normal appearing plain radiographs of the affected foot. Delay in diagnosis can lead to progression of disease and irreversible deformities. There is a paucity of data on Stage 0 ACN from India. The aim of this study was to assess clinical and radiological characteristics and treatment outcomes in Indian Type 2 Diabetes patients with Stage 0 ACN. MATERIALS AND METHODS: A comparative, case-control study was carried out amongst patients attending the Integrated Diabetes Foot Clinic at a tertiary care South Indian hospital. During the 3-year study period, a total of 1811 patients with Type 2 Diabetes Mellitus were screened. Of these, n = 10 patients with stage 0 ACN Charcot's arthropathy were identified based on clinical features and MRI imaging of the foot for confirmation of diagnosis. These were compared with an age and duration of diabetes-matched group of n = 50 patients without ACN as controls. RESULTS: Our study identified 10 patients (0.5%) with Stage 0 Acute charcot neuroarthropathy (ACN) in the study population. Those with ACN had higher BMI, poorer glycaemic control and greater degree of peripheral neuropathy (p < 0.05). Clinically relative lack of pain and infrared thermometric temperature difference >2 °C in the affected foot were the most significant findings, while MRI foot was useful in early detection of active and severe stage 0 disease. Total contact cast was the preferred initial offloading modality, with delay in initiating complete immobilization leading to worse outcomes. CONCLUSIONS: This is the first study to highlight the characteristic features of Stage 0 ACN in Indian Type 2 Diabetes patients. Thorough clinical evaluation, infrared thermometry and radiological findigs on MRI foot leads to early disease detection. Complete offloading, preferably with total contact casts can prevent disease progression and chronic deformities.


Assuntos
Artropatia Neurogênica/patologia , Biomarcadores/análise , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/etiologia , Doença Aguda , Artropatia Neurogênica/complicações , Artropatia Neurogênica/metabolismo , Glicemia/análise , Estudos de Casos e Controles , Pé Diabético/epidemiologia , Progressão da Doença , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Índia/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico
12.
Diabetes Metab Syndr ; 13(2): 1287-1292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336479

RESUMO

CONTEXT: Diabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group. SUBJECTS AND METHODS: This cross-sectional study included 180 type 2 diabetic patients (aged 30-70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects. RESULTS: The prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD). CONCLUSION: Chronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD).


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Nefropatias Diabéticas/etiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Adulto , Idoso , Doença Crônica , Estudos Transversais , Pé Diabético/epidemiologia , Pé Diabético/patologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/patologia , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/patologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/patologia , Egito/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco
13.
Diabetes Metab Syndr ; 13(2): 1535-1541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336518

RESUMO

AIM: This study has been conducted with the aim of determining the relationship between health literacy, knowledge and self-care behaviors to take care of the diabetic foot in low-income individuals, based on the extended parallel process model (EPPM). METHODS: This cross-sectional study was conducted on 400 patients with type II diabetes referred to the Diabetes Clinic, using a random sampling method and using standard questionnaires. In this study, the constructs of knowledge, EPPM (perceived sensitivity, perceived severity, response efficacy, self-efficacy), and health literacy were significantly related to self-care behaviors (p < 0.05). RESULTS: Based on the linear regression results, the constructs of knowledge, health literacy, and constructs of EPPM were able to account for 43% of the variance to perform diabetic foot self-care behaviors. The maximum impact was related to the constructs of health literacy and self-efficacy (p < 0.001). CONCLUSION: Based on these results, levels of knowledge and health literacy of patients were very poor overall, and the self-care behaviors were not appropriate. On the other hand, considering the great impact of health literacy in performing self-care behaviors, it is suggested that educational courses be held in this regard and proper strategies are employed to enhance the health literacy of diabetic patients.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/psicologia , Pé Diabético/terapia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Alfabetização em Saúde , Modelos Estatísticos , Autocuidado , Estudos Transversais , Pé Diabético/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários
14.
Diabetes Metab Syndr ; 13(2): 905-912, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336544

RESUMO

BACKGROUND: Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION: In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.


Assuntos
Amputação/estatística & dados numéricos , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Complicações do Diabetes/etiologia , Pé Diabético/etiologia , Guiana/epidemiologia , Humanos , Incidência , Fatores de Risco
15.
Diabetes Metab Syndr ; 13(2): 913-923, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336545

RESUMO

BACKGROUND: Therapeutic footwear is built on a model of patient's foot, for people with diabetes suffering with neuropathy. Can the footwear helps to improve plantar pressure in neuropathic foot? This study focussed on available data on therapeutic footwear as an intervention for improving and offloading plantar pressure in neuropathic diabetic foot. METHODS: Relevant scientific literature in PubMed, Medline and Google Scholar published between 2000 and 2017 were searched. The keywords searched were therapeutic footwear, plantar pressure, neuropathic foot, rocker sole, ulcer healing and offloading of plantar pressure. Articles on randomized controlled trials, observational, cohort, feasibility and factorial studies were reviewed. RESULTS: One hundred and twenty five (125) articles were identified. The article comprised of 6 randomized controlled trials, 2 observational, 1 cohort, 1 feasibility and 1 factorial study met the inclusion criteria and were critiqued with a total enrolment of 1380 study subjects. CONCLUSIONS: The review of the collated literature demonstrated that, therapeutic footwear can improve the healing of neuropathic diabetic foot ulcer by redistributing plantar pressure. However, the efficacy of therapeutic footwear requires the inclusion of technical features that should not be compromised from the design to the production of the footwear.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/fisiopatologia , Pé Diabético/prevenção & controle , Neuropatias Diabéticas/prevenção & controle , Órtoses do Pé/estatística & dados numéricos , Sapatos , Complicações do Diabetes/etiologia , Pé Diabético/etiologia , Neuropatias Diabéticas/etiologia , Humanos , Cicatrização
16.
Diabetes Metab Syndr ; 13(3): 2075-2079, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235139

RESUMO

Uncontrolled high blood sugar levels leads to diabetic neuropathy, which is usually develops slowly. Damaged nerves stop sending messages or may send message slowly at the wrong times. The propsed model is an insole for individuals with peripheral neuropathy conditions, where the peak plantar pressure value is measured at specified locations of the foot by means of a pressure sensor, which can be accessed via  a mobile applications; Simultaneously, a stimulation is given at acupressure points of the foot to relieve pain at definite intervals of time, based on the signals from the controller. A controller is being used to perform these operations which will be transmitted to the mobile application via Bluetooth terminal.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/reabilitação , Neuropatias Diabéticas/reabilitação , Órtoses do Pé/normas , Dor/prevenção & controle , Doenças do Sistema Nervoso Periférico/reabilitação , Sapatos/normas , Adulto , Idoso , Pé Diabético/etiologia , Neuropatias Diabéticas/etiologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Prognóstico , Dispositivos Eletrônicos Vestíveis
17.
Life Sci ; 233: 116525, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31158376

RESUMO

BACKGROUND: Impaired wound healing in diabetes foot ulcers (DFUs) brings a great burden to diabetic patients. Pro-angiogenesis through elevating nitric oxide (NO) is beneficial to the wound healing process. Ginsenoside Rg1, the main active in Notoginseng, is reported to regulate the angiogenesis in endothelial cells through modulating miR-23a. However, the effect of Rg1 in diabetes remains elusive. METHODS: High fat diet combined with streptozotocin-induced diabetic rats were treated with Rg1. Then incision area and tissue NO level were measured to evaluate the wound closure efficacy of Rg1. Then high glucose cultured HUVECs were employed to mimic diabetic environment in vitro. Overexpression and knockdown plasmids of miR-23a or IRF-1 were constructed and transfected in HUVECs. qPCR and western blot were used to determine the mRNA and protein level, respectively. Dual-luciferase reporter assay was utilized to determine the interaction of IRF-1/miR-23a. RESULTS: Rg1 accelerated the wound closure speed in diabetic rats and increased NO level through elevating iNOS expression. Knockdown of iNOS reversed Rg1-induced VEGF expression, cell proliferation, anti-apoptotic efficacy and cell migration ability in high glucose cultured HUVECs. Further investigation revealed that Rg1 mediated iNOS through miR-23a. miR-23a inhibited the expression of IRF-1, a protein which could directly bind to the iNOS mRNA 3'UTR. CONCLUSION: Rg1 promoted angiogenesis in diabetic wound healing process through NO signaling via miR-23a, providing a novel candidate for DFUs treatment.


Assuntos
Diabetes Mellitus Experimental/complicações , Pé Diabético/tratamento farmacológico , Ginsenosídeos/farmacologia , Fator Regulador 1 de Interferon/metabolismo , MicroRNAs/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Cicatrização/efeitos dos fármacos , Animais , Apoptose , Movimento Celular , Proliferação de Células , Fármacos do Sistema Nervoso Central/farmacologia , Pé Diabético/etiologia , Pé Diabético/metabolismo , Pé Diabético/patologia , Regulação da Expressão Gênica , Células Endoteliais da Veia Umbilical Humana , Humanos , Fator Regulador 1 de Interferon/genética , Masculino , Óxido Nítrico Sintase Tipo II/genética , Ratos , Ratos Sprague-Dawley
18.
Clin Podiatr Med Surg ; 36(3): 371-379, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079604

RESUMO

The etiology of ulcerations in diabetes mellitus is associated with the presence of peripheral sensory neuropathy and repetitive trauma due to normal walking activities to areas on the foot that are subject to moderate or high pressures and shear. The combination of loss of protective sensation, deformity, and repetitive trauma is the perfect storm for ulcer development. Once an ulcer is developed, the most important part of the healing process is offloading the ulcer site. Offloading is the mainstay of healing neuropathic ulcers.


Assuntos
Pé Diabético/prevenção & controle , Órtoses do Pé , Sapatos , Pé Diabético/etiologia , Neuropatias Diabéticas/complicações , Desenho de Equipamento , Humanos
19.
J Foot Ankle Res ; 12: 21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30976327

RESUMO

Background: Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications. Methods: A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using t-tests, Mann-Whitney U tests and chi-square tests with Fischer's exact tests. P-values < 0.05 were considered statistically significant. Results: Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support. Conclusions: Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.


Assuntos
Atitude Frente a Saúde , Pé Diabético/prevenção & controle , Sapatos , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/reabilitação , Pé Diabético/etiologia , Pé Diabético/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Recidiva , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Suécia
20.
BMC Endocr Disord ; 19(1): 27, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30823912

RESUMO

BACKGROUND: Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana. METHODS: This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA. RESULTS: The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84-5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21-2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22-12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06-1.22, p < 0.001), male gender (HR: 3.50, CI:2.88-5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58-10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51-7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05-1.25, p = 0.03), hypertension (HR:1.14, CI:1.12-3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21-8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39-9.53, p < 0.001). CONCLUSION: The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Extremidade Inferior/fisiopatologia , Pé Diabético/etiologia , Feminino , Seguimentos , Gana/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
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