Prevention and treatment of microvascular and neuropathic complications of diabetes

Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.

Impact of a diabetes electronic management system on patient care in a community clinic

The purpose of this study is to evaluate the effectiveness of using a diabetes registry program as part of a comprehensive quality improvement program. Diabetes care management objectives were compared between 82 patients of physicians who participated in the quality improvement program and 63 patients of nonparticipating physicians. Overall completion of management objectives increased 26.1% in the intervention group versus 2.6% in the control group. The intervention was associated with a dramatic improvement in compliance with care management guidelines and is strongly recommended in other community clinic settings.

Single-stage surgical treatment of noninfected diabetic foot ulcers

A retrospective study was undertaken to evaluate a single-stage approach in the treatment of noninfected, chronic, well-perfused diabetic foot wounds. This single-stage approach consisted of total excision of the ulcer with broad exposure, correction of the underlying osseous deformity, and immediate primary closure using a local random flap. Four hundred cases of pedal ulcers were analyzed by chart review. Of those, 67 cases underwent a single-stage surgical treatment and were analyzed for length of hospital stay, postoperative complications, time to heal, recurrence of the ulcer, and postprocedure ambulatory status. The age of the ulcers before surgery was 12 +/- 12 months (mean +/- SD), with a range of 1 to 60. The median perioperative hospital stay was 5 +/- 7.6 days. All patients were followed until the wounds were healed or to amputation. The median total time to heal was 30.8 +/- 40 days. Ninety-seven percent of the wounds healed. The recurrence rate of ulceration was 10.4 percent (seven of 67), over a time span of up to 6 years. All but one patient returned to previous levels of ambulation, and many patients had improved levels of ambulation. The single-stage approach eliminated the need for additional surgical procedures, with their associated costs and risks. In addition, healing times were significantly reduced, resulting in decreased hospital stays and subsequent costs and providing the patient with an expedient return to footwear so that bipedal function could be restored. Most importantly, by addressing the underlying bony pathologic findings, the recurrence rates were also drastically reduced.