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Platini H, Adammayanti KA, Maulana S, Putri PMK, Layuk WG, Lele JAJMN, Haroen H, Pratiwi SH, Musthofa F, Mago A. The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2024; 20:21-37. [PMID: 38288358 PMCID: PMC10823873 DOI: 10.2147/tcrm.s433033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
Introduction Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction. Objective This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients. Methods Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method. Results Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22-1.57, p < 0.0001), shortened the healing time (Mean difference [MD] -16.97 days (95% CI: -32.64 to -1.29; p < 0.00001), shortened the length of hospital stay (MD= -20.11, 95% CI: -38.02, -2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02). Conclusion APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.
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Affiliation(s)
- Hesti Platini
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Keyzha Amartya Adammayanti
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Sidik Maulana
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Putu Moradha Kharisma Putri
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Welly Grivin Layuk
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | | | - Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Sri Hartati Pratiwi
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Faizal Musthofa
- Nursing Internship Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- West Sapphire Medical-Surgical Ward, Santosa Bandung Central, Bandung, West Java, Indonesia
| | - Arpit Mago
- Department of Clinical Medicine, Jawaharlal Nehru Medical College, Belagavi, India
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Ma Z, Ding Y, Ding X, Mou H, Mo R, Tan Q. PDK4 rescues high-glucose-induced senescent fibroblasts and promotes diabetic wound healing through enhancing glycolysis and regulating YAP and JNK pathway. Cell Death Discov 2023; 9:424. [PMID: 38001078 PMCID: PMC10674012 DOI: 10.1038/s41420-023-01725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
During the process of wound healing, fibroblasts migrate to the wound site and perform essential functions in promoting cell proliferation, as well as synthesizing and secreting the extracellular matrix (ECM). However, in diabetic wounds, senescent fibroblasts exhibit impaired proliferative capacity and fail to synthesize essential ECM components. Pyruvate dehydrogenase kinase 4 (PDK4), a key enzyme regulating energy metabolism, has been implicated in modulating cellular senescence and fibroblast function. However, its specific role in diabetic wounds remains poorly understood. In this study, we conducted a series of in vivo and in vitro experiments using STZ-induced diabetic mice and human dermal fibroblasts. We evaluated cellular senescence markers, including SA-β-gal, P53, P16, P21, and PAI-1, as well as senescence-associated secretory phenotype (SASP) factors. Finally, we observed that PDK4 increased in normal wound healing, but its expression was insufficient in diabetic wounds. Significantly, the overexpression of PDK4 demonstrated the potential to accelerate diabetic wound healing and improve the senescence phenotype both in vivo and in vitro. Furthermore, our study elucidated the underlying mechanism by which PDK4 improved the senescent phenotype through the enhancement of glycolysis and regulation of YAP and JNK pathway. The effect was dependent on metabolic reprogramming and subsequent reduction of reactive oxygen species (ROS), which was mediated by PDK4. Overall, our findings highlight the potential of PDK4 as a promising therapeutic target for addressing diabetic wounds.
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Affiliation(s)
- Zhouji Ma
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, NO. 321, Zhongshan Road, Nanjing, Jiangsu, China.
| | - Youjun Ding
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, NO. 321, Zhongshan Road, 210008, Nanjing, Jiangsu, China
- Department of Emergency Surgery, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Fourth People's Hospital), Zhenjiang, China
| | - Xiaofeng Ding
- Department of Dermatologic Surgery, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haining Mou
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, NO. 321, Zhongshan Road, Nanjing, Jiangsu, China
| | - Ran Mo
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, NO. 321, Zhongshan Road, Nanjing, Jiangsu, China
| | - Qian Tan
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, NO. 321, Zhongshan Road, Nanjing, Jiangsu, China.
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, NO. 321, Zhongshan Road, Nanjing, Jiangsu, China.
- Department of Burns and Plastic Surgery, Anqing Shihua Hospital, Nanjing Drum Tower Hospital Group, 246002, Anqing, China.
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Hessain D, Andersen A, Fredslund EK. Inequalities in healthcare utilisation among adults with type 2 diabetes. Diabetes Res Clin Pract 2023; 205:110982. [PMID: 37890705 DOI: 10.1016/j.diabres.2023.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately. RESULTS The majority (59.7 %) had attended the ophthalmologist at least once in the preceding year, whereas 46.5 % and 34.2 % had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p < 0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p < 0.001). CONCLUSIONS This study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.
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Affiliation(s)
- Dunia Hessain
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Eskild Klausen Fredslund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
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Wysocka-Mincewicz M, Szczerbik E, Mazur M, Grabik M, Kalinowska M, Syczewska M. Foot Plantar Pressure Abnormalities in Near Adulthood Patients with Type 1 Diabetes. Biomedicines 2023; 11:2901. [PMID: 38001902 PMCID: PMC10668972 DOI: 10.3390/biomedicines11112901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
Increased ulcer risk diminishes the quality of life in diabetes. This study assessed abnormalities in foot plantar pressure distribution in adolescents with T1D to detect early signs of ulcer risk. A total of 102 T1D patients, without diabetic neuropathy, were included (mean age 17.8 years, mean diabetes duration 7.4 year). Pedography was captured using Novel emed. Data from the study group were compared with reference data. The study revealed a statistically significant reduced foot contact area in both feet in the entire foot and under the head of the fifth metatarsal bone and the second toe. In both feet, the peak pressure was increased under the entire foot, hindfoot, midfoot, first metatarsal head, big toe, and second toe. There was no statistically significant difference in peak pressure. The mean plantar pressure rating was statistically significantly increased in both feet across the entire sole, in the hindfoot, midfoot, and first metatarsal head. T1D patients of age near adulthood without neuropathy have increased values in mean pressure and reduced contact area, pointing to the need of monitoring and preventive measures. These results point to the need of further research and analysis which should include various risk factor such as foot anatomy, body posture, or certain metabolic factors.
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Affiliation(s)
- Marta Wysocka-Mincewicz
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.); (M.G.)
| | - Ewa Szczerbik
- Kinesiology Lab, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (E.S.); (M.K.); (M.S.)
| | - Maria Mazur
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.); (M.G.)
| | - Magdalena Grabik
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.); (M.G.)
| | - Małgorzata Kalinowska
- Kinesiology Lab, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (E.S.); (M.K.); (M.S.)
| | - Małgorzata Syczewska
- Kinesiology Lab, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (E.S.); (M.K.); (M.S.)
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Jia Q, Ming Y, Bai J, Miao F, Qin W. A 15-year follow-up report of an elderly diabetic foot with multiple recurrences leading to toe amputation and thoughts on the model of care for diabetic foot ulcer. Glob Health Med 2023; 5:184-187. [PMID: 37397947 PMCID: PMC10311673 DOI: 10.35772/ghm.2023.01040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Elderly diabetic patients are a high prevalence of diabetic foot ulcers, and their high recurrence, disability, and mortality rates impose a heavy economic burden on families and society. This paper reports a case of an elderly patient with a diabetic foot ulcer who was admitted in April 2007 and discharged after recovery from comprehensive diabetic foot treatment. Due to intermittent foot care and lack of home care, the patient's foot ulcers recurred after repeated healing during home rehabilitation, eventually resulting in the amputation of the right bunion. After the patient was discharged from the hospital with an amputated toe, the whole-process seamless management model of "hospital - community - family" was implemented. The hospital provides specialized foot support and guidance, and the community is responsible for daily disease management and referrals. The family is responsible for the implementation of home rehabilitation programs, and family caregivers need to identify and provide feedback on foot abnormalities promptly. As of May 2022, the patient had not experienced ulcer recurrence. This paper reports the whole process of "ulcer development → ulcer healing → ulcer recurrence healing → toe amputation → continuous care management" experienced by the patient in 15 years, aiming to reflect on the significance of the whole-process seamless foot care management model of "hospital-community-family" for diabetic foot ulcer rehabilitation through the case.
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Affiliation(s)
- Qing Jia
- Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yue Ming
- Department of Endocrine Ward, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiaojiao Bai
- Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Fei Miao
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wen Qin
- Department of Geriatrics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Eldukali WA, Boshaalla MA. Diabetic Foot Infection Characteristics and Antibiotics Susceptibility Patterns in a Regional Hospital in Libya. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1755437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Introduction Diabetes is a major global health problem, among the top causes of death worldwide. Diabetic foot infection (DFI) is associated with an increased risk of amputation by 155 times and a mortality rate of 57% at 5 years. This study aims to characterize DFI epidemiology in a local hospital and analyze local microbiological patterns and antibiotic susceptibility testing.
Patients and Methods This is a retrospective review of Al Jala hospital Benghazi/Libya medical records. Eligible patients were included, if they had DFI with confirmed tissue/pus samples collections was submitted to the hospital laboratory for microbiology and Antibiotics susceptibility analysis.
Results Out of 126 patients, 77 (61.1%) were men, and 49 (38.9%) were women. The mean age was 55.4 years. Incision drainage with debridement was the most common surgical procedure (77.1%). 38.88% of growth was polymicrobial. Gram-negative rods were isolated in 70.9%, and gram-positive cocci in 27.4%. The most commonly isolated bacteria were Pseudomonas aeruginosa (15.9%) and Proteus sps. (14.2%), Staphylococcus aureus (11.3%), and Escherichia coli (10.2%). Methicillin-resistant Staphylococcus aureus (MRSA) constitutes 30% of isolated S. aureus. The most common effective antibiotic for P. aeruginosa was imipenem (90%), for S. aureus was linezolid (100%), and for MRSA was linezolid, vancomycin (100%), and ciprofloxacin 88.8%. Sixty-four percent of total bacterial isolates were MDROs (gram-positive isolates 65.3%, gram-negative isolates 63.6%).
Conclusions The emergence of antibiotic-resistant bacteria is a global health concern. This study attempts to evaluate the local microbiology and antimicrobial susceptibility to tailor the treatment choice for better patient outcomes.
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Affiliation(s)
- Wail A. Eldukali
- Internal Medicine Department, Gastroenterology and Hepatology Unit, Benghazi Medical Center, Benghazi, Libya
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Shin DY, Park JU, Choi MH, Kim S, Kim HE, Jeong SH. Polydeoxyribonucleotide-delivering therapeutic hydrogel for diabetic wound healing. Sci Rep 2020; 10:16811. [PMID: 33033366 PMCID: PMC7546631 DOI: 10.1038/s41598-020-74004-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with diabetes experience delayed wound healing because of the uncontrolled glucose level in their bloodstream, which leads to impaired function of white blood cells, poor circulation, decreased production and repair of new blood vessels. Treatment using polydeoxyribonucleotide (PDRN), which is a DNA extracted from the sperm cells of salmon, has been introduced to accelerate the healing process of diabetic wounds. To accelerate the wound-healing process, sustained delivery of PDRN is critical. In this study, taking advantage of the non-invasive gelation property of alginate, PDRN was loaded inside the hydrogel (Alg-PDRN). The release behavior of PDRN was altered by controlling the crosslinking density of the Alg hydrogel. The amount of PDRN was the greatest inside the hydrogel with the highest crosslinking density because of the decreased diffusion. However, there was an optimal degree of crosslinking for the effective release of PDRN. In vitro studies using human dermal fibroblasts and diabetes mellitus fibroblasts and an in ovo chorioallantoic membrane assay confirmed that the Alg-PDRN hydrogel effectively induced cell proliferation and expression of angiogenic growth factors and promoted new blood vessel formation. Its effectiveness for accelerated diabetic wound healing was also confirmed in an in-vivo animal experiment using a diabetic mouse model.
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Affiliation(s)
- Da Yong Shin
- Department of Materials Science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Min-Ha Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Sukwha Kim
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hyoun-Ee Kim
- Department of Materials Science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
- Advanced Institutes of Convergence Technology, Seoul National University, Gwanggyo, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16229, Republic of Korea
| | - Seol-Ha Jeong
- Department of Materials Science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea.
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Ndour MA, Diedhiou D, Sow D, Diallo IM, Diallo A, Barrage AL, Diallo IK, Diembou M, Seck LB, Dieng PA, Mbaye MN, Sarr A. Evaluation of Podological Risk at Type 2 Diabetics Tracked at the Mark Sankale Diabetes Center in Dakar. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/jdm.2020.102004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jadali F, Nemati H, Jadali P, Jadali P. Comparison of Diabetic Foot Care with Other Diabetic Preventive Care Services. J Am Podiatr Med Assoc 2018; 108:362-369. [PMID: 29320218 DOI: 10.7547/17-081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetes is a major chronic disease with high morbidity and mortality. Diabetic preventive care services are essential in the management and outcome of the disease. More than other preventive diabetic care services, preventive care of diabetic retinopathy has been emphasized and recommended by practitioners and insurance companies. We investigated the status of preventive care in the diabetic population. METHODS Information was collected from 420 outpatients aged 30 to 80 years. The patients were divided into two groups: those with well-controlled blood sugar levels (hemoglobin A1c [HbA1c] level ≤7%) and those with uncontrolled blood sugar levels (HbA1c level >7%). RESULTS Data analysis indicated that for both groups, 93% of the participants were seen for diabetic eye care at least once and 78% were getting an annual eye examination regularly. In the controlled and uncontrolled blood sugar groups, 26% and 32% of patients, respectively, had ever seen a nephrologist and 38% and 49%, respectively, had ever seen a cardiologist. In the controlled and uncontrolled blood sugar groups, 32% and 38% of patients, respectively, had visited a podiatric physician. For statistical analysis and comparison of results between the two groups, we applied the χ2 test and calculated 95% confidence intervals. There were some significant differences regarding the complications of diabetes mellitus and preventive care. CONCLUSIONS There is a need for greater engagement by podiatric physicians and health-care providers to promote regular visits for the diabetic population to podiatric medical clinics.
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Study on the foot shape characteristics of the elderly in China. Foot (Edinb) 2017; 33:68-75. [PMID: 29126046 DOI: 10.1016/j.foot.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND With aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities. OBJECTIVES The authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China. METHODS A convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples. RESULTS Hallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95±4.86mm; elderly male, 48.55±4.94mm) than that of the general adult population (adult female, 40.18±3.43mm; adult male, 43.22±3.20mm) (p<0.01). CONCLUSION The foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus.
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Raharinavalona SA, Ramalanjaona HR, Andrianera N, Patrick Rakotomalala AD, Ramahandridona G. [Podiatric risk screening in patients with type 2 diabetes in Antananarivo]. Pan Afr Med J 2017; 27:213. [PMID: 28979615 PMCID: PMC5622827 DOI: 10.11604/pamj.2017.27.213.11311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/16/2017] [Indexed: 11/20/2022] Open
Abstract
Diabetic foot disease heavily weighs upon diabetics, being a significant cause of morbidity and severe disability. Their prevention is indispensable. Our study aimed to reduce the rate of amputations in diabetics. We conducted a retrospective, descriptive, cross-sectional, multicenter study of podiatric risk screening in patients with type 2 diabetes in the Endocrinology Department at the University Hospital of Befelatanana and at the Amadia Clinic, Faravohitra, over a period of 6 months. The average age of our patients was 54.43 years. Male sex predominated (60%). The patients suffered from diabetes which had evolved, on average, over a period of 7.35 years. The most common patient's history was smoking and chronic ulcerations of the foot. More than half of patients had an imbalance of diabetes, microalbuminuria and retinopathy. 56.50% of patients were aware of their risk but less than 46% of patients gave specific examples of appropriate behaviour. Only 13.33% of patients had undergone foot examination before this study. Their podiatric risk was very high. Predictive factors for ulceration included smoking, a history of chronic ulcer of the lower limbs, an imbalance of diabetes and foot deformity. Effective prevention strategies for amputations should include the screening and the identification of population at risk of ulceration.
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Affiliation(s)
| | | | - Nalisoa Andrianera
- Service d'Endocrinologie, Hôpital Joseph Raseta de Befelatanana, Antananarivo, Madagascar
| | | | - George Ramahandridona
- Clinique et Centre d'Education de Diabète de l'AMADIA Madagascar Diabetes Association - Faravohitra Antananarivo, Madagascar
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Hartmann B, Fottner C, Herrmann K, Limbourg T, Weber MM, Beckh K. Interdisciplinary treatment of diabetic foot wounds in the elderly: Low risk of amputations and mortality and good chance of being mobile with good quality of life. Diab Vasc Dis Res 2017; 14:55-58. [PMID: 27941057 DOI: 10.1177/1479164116666477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS A major proportion of patients with diabetic foot syndrome are older than 65 years. Little is known about outcomes of these elderly patients. METHODS We analysed 245 treatment cases in an observational single-centre study for comorbidities and outcomes over a 6-month period. RESULTS In all, 122 patients had peripheral arterial disease which was significantly increasing with age (n = 245, df = 1, χ2 = 23.06, p ⩽ 0.0001). Increasing age correlated positively with decreasing rate of revascularisations (n = 122, df = 1, χ2 = 4.23, p = 0.039). In total, 23 (9.3%) patients died in the observation period. In-hospital mortality was 2.8%, percentage of major amputations 2.8%. In the invasively treated subgroup, 13 out of 67 patients died within the observation period. Death after revascularisation was independent of age (n = 67, df = 1, χ2 = 2.05, p = 0.153). Mobility decreased in the whole study group with increasing age. The risk of decrease with age was not influenced by revascularisation status. CONCLUSION With careful interdisciplinary evaluation, elderly patients with diabetic foot syndrome can be treated with favourable outcome. Mobility before and after treatment deserves more attention as a predictor of treatment success and outcome parameter.
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Affiliation(s)
- Bettina Hartmann
- Department of Gastroenterology and Diabetology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Christian Fottner
- I. Medical Clinic, Department of Endocrinology and Metabolism, University of Mainz, Mainz, Germany
| | - Karin Herrmann
- Department of Gastroenterology and Diabetology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Tobias Limbourg
- Stiftung IHF, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Matthias M Weber
- I. Medical Clinic, Department of Endocrinology and Metabolism, University of Mainz, Mainz, Germany
| | - Karlheinz Beckh
- Department of Gastroenterology and Diabetology, Klinikum Worms, Worms, Germany
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Al-Mayahi M, Cian A, Kressmann B, de Kalbermatten B, Rohner P, Egloff M, Jafaar J, Malacarne S, Miozzari HH, Uçkay I. Associations of diabetes mellitus with orthopaedic infections. Infect Dis (Lond) 2015; 48:70-3. [DOI: 10.3109/23744235.2015.1082620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Chiwanga FS, Njelekela MA. Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania - a cross-sectional study. J Foot Ankle Res 2015; 8:20. [PMID: 26064190 PMCID: PMC4462176 DOI: 10.1186/s13047-015-0080-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/01/2015] [Indexed: 01/05/2023] Open
Abstract
Background At the time of diagnosis, more than 10 % of people with type 2 diabetes mellitus have one or two risk factors for a foot ulceration and a lifetime risk of 15 %. Diabetic foot ulcers can be prevented through well-coordinated foot care services. The objective of this study was to determine knowledge of foot care and reported practice of foot self-care among diabetic patients with the aim of identifying and addressing barriers to preventing amputations among diabetic patients. Methods Patients were randomly selected from all public diabetic clinics in Dar es Salaam. A questionnaire containing knowledge and foot care practice questions was administered to all study participants. A detailed foot examination was performed on all patients, with the results categorized according to the International Diabetes Federation foot risk categories. Statistics were performed using SPSS version 14. Results Of 404 patients included in this study, 15 % had foot ulcers, 44 % had peripheral neuropathy, and 15 % had peripheral vascular disease. In multivariate analysis, peripheral neuropathy and insulin treatment were significantly associated with presence of foot ulcer. The mean knowledge score was 11.2 ± 6.4 out of a total possible score of 23. Low mean scores were associated with lack of formal education (8.3 ± 6.1), diabetes duration of < 5 years (10.2 ± 6.7) and not receiving advice on foot care (8.0 ± 6.1). Among the 404 patients, 48 % had received advice on foot care, and 27.5 % had their feet examined by a doctor at least once since their initial diagnosis. Foot self-care was significantly higher in patients who had received advice on foot care and in those whose feet had been examined by a doctor at least once. Conclusions The prevalence of diabetic foot is high among patients attending public clinics in Dar es Salaam. There is an urgent need to establish coordinated foot care services within the diabetic clinic to identify feet at risk, institute early management, and provide continuous foot care education to patients and health care providers.
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Affiliation(s)
- Faraja S Chiwanga
- Muhimbili National Hospital, Kalenga Street, Upanga, P.O Box 65000, Dar es Salaam, Tanzania
| | - Marina A Njelekela
- Muhimbili National Hospital, Kalenga Street, Upanga, P.O Box 65000, Dar es Salaam, Tanzania ; Muhimbili University of Health and Allied Sciences, Mindu Street, Upanga, P.O Box 65001, Dar es Salaam, Tanzania
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15
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Matricciani L, Jones S. Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: an integrative review. DIABETES EDUCATOR 2014; 41:106-17. [PMID: 25480398 DOI: 10.1177/0145721714560441] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Appropriate and timely foot self-care practices may prevent diabetes-related foot complications. However, self-care practices are often neglected, particularly by older adults. The purpose of this study was to conduct an integrative, systematic literature review of the psychosocial barriers and enablers of foot self-care practices among older adults diagnosed with diabetes. METHODS An integrative, systematic literature review and a deductive thematic analysis was conducted to determine psychosocial barriers and enablers of foot self-care practices among older adults. RESULTS A total of 130 different studies were retrieved from the search strategy. From these, 9 studies were identified and included for review. Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications. CONCLUSION Foot self-care practices appear underutilized as primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications. Health care professionals such as diabetes educators, podiatrists, and general practitioners may play an important role in the prevention of foot complications among older adults by recognizing, referring, and providing early education to older adults.
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Affiliation(s)
- Lisa Matricciani
- Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, Australia (Ms Matricciani, Dr Jones)
| | - Sara Jones
- Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, Australia (Ms Matricciani, Dr Jones)
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Uçkay I, Gariani K, Pataky Z, Lipsky BA. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab 2014; 16:305-16. [PMID: 23911085 DOI: 10.1111/dom.12190] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/05/2013] [Accepted: 07/11/2013] [Indexed: 01/18/2023]
Abstract
Foot infections are frequent and potentially devastating complications of diabetes. Unchecked, infection can progress contiguously to involve the deeper soft tissues and ultimately the bone. Foot ulcers in people with diabetes are most often the consequence of one or more of the following: peripheral sensory neuropathy, motor neuropathy and gait disorders, peripheral arterial insufficiency or immunological impairments. Infection develops in over half of foot ulcers and is the factor that most often leads to lower extremity amputation. These amputations are associated with substantial morbidity, reduced quality of life and major financial costs. Most infections can be successfully treated with optimal wound care, antibiotic therapy and surgical procedures. Employing evidence-based guidelines, multidisciplinary teams and institution-specific clinical pathways provides the best approach to guide clinicians through this multifaceted problem. All clinicians regularly seeing people with diabetes should have an understanding of how to prevent, diagnose and treat foot infections, which requires familiarity with the pathophysiology of the problem and the literature supporting currently recommended care.
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Affiliation(s)
- I Uçkay
- Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Terranova C, Bruttocao A. The clinical management of diabetic foot in the elderly and medico-legal implications. MEDICINE, SCIENCE, AND THE LAW 2013; 53:187-193. [PMID: 23921214 DOI: 10.1177/0025802412473595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.
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Affiliation(s)
- Claudio Terranova
- Legal Medicine Unit, Department of Molecular Medicine, Padova University Hospital, Italy
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18
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Tirosh A, Stern Z, Mazar M, Calderon-Margalit R. The influence of age on the management of patients with diabetes in the Israeli population. Popul Health Manag 2013; 16:276-82. [PMID: 23537157 DOI: 10.1089/pop.2012.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors' aim was to study the association between age and the quality of community health care of diabetes mellitus (DM). This was a cross-sectional study of patients with DM in the setting of a large health maintenance organization (HMO) in Israel. The population included DM patients aged 40-84 years who were identified at emergency rooms or through the HMO's computerized database. A set of quality care indicators were determined. Logistic regressions were used to estimate the odds ratios (OR) for diabetes care indicators, controlling for age and other potential confounders. Older patients were more likely to be in the target range of glycemic control and to be vaccinated against influenza. Patients older than age 70 years received fewer recommendations for physical activity (OR 0.41, P<0.01) and self-foot examination (OR 0.57, P=0.024). The authors found decreased performance of recommendations for physical activity and self-foot examination, and a higher performance of annual blood tests and immunizations among elderly patients with diabetes.
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Affiliation(s)
- Amit Tirosh
- Endocrine Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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De León Rodriguez D, Allet L, Golay A, Philippe J, Assal JP, Hauert CA, Pataky Z. Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy. Diabetes Metab Res Rev 2013; 29:139-44. [PMID: 23081857 DOI: 10.1002/dmrr.2366] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 08/24/2012] [Accepted: 10/03/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy. METHODS Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40-80% of baseline PPP in 70% of the totality of steps and during three consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR(®)) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2). RESULTS The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p < 0.0001) and T2 (167 ± 11, p = 0.001), as compared with T0 (242 ± 12 kPa) without any increase of the PPP elsewhere. At the contralateral foot (not concerned by off-loading), the PPP was slightly higher under the lateral midfoot at T1 (68 ± 8 kPa, p = 0.01) and T2 (65 ± 8 kPa, p = 0.01), as compared with T0 (58 ± 6 kPa). CONCLUSIONS The foot off-loading by biofeedback leads to a safe and regular plantar pressure distribution without inducing any new 'at-risk' area under both feet.
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Affiliation(s)
- D De León Rodriguez
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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20
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Jan YK, Lung CW, Cuaderes E, Rong D, Boyce K. Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy. Physiol Meas 2012; 34:53-66. [PMID: 23248175 DOI: 10.1088/0967-3334/34/1/53] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetic foot ulcers are one of the most serious complications associated with diabetes mellitus. Current research studies have demonstrated that biomechanical alterations of the diabetic foot contribute to the development of foot ulcers. However, the changes of soft tissue biomechanical properties associated with diabetes and its influences on the development of diabetic foot ulcers have not been investigated. The purpose of this study was to investigate the effect of diabetes on the biomechanical properties of plantar soft tissues and the relationship between biomechanical properties and plantar pressure distributions. We used the ultrasound indentation tests to measure force-deformation relationships of plantar soft tissues and calculate the effective Young's modulus and quasi-linear viscoelastic parameters to quantify biomechanical properties of plantar soft tissues. We also measured plantar pressures to calculate peak plantar pressure and plantar pressure gradient. Our results showed that diabetics had a significantly greater effective Young's modulus and initial modulus of quasi-linear viscoelasticity compared to non-diabetics. The plantar pressure gradient and biomechanical properties were significantly correlated. Our findings indicate that diabetes is linked to an increase in viscoelasticity of plantar soft tissues that may contribute to a higher peak plantar pressure and plantar pressure gradient in the diabetic foot.
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Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Graillot D, Quipourt V, Bouillet B, Petit JM, Manckoundia P. [Type 2 diabetes in the elderly, which specific features?]. Rev Med Interne 2012; 33:575-9. [PMID: 22766159 DOI: 10.1016/j.revmed.2012.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 04/24/2012] [Accepted: 06/02/2012] [Indexed: 11/18/2022]
Abstract
Type 2 diabetes, whose prevalence has increased among elderly aged over 75 years, has a number of specific features which differ from that in young people: heterogeneous population, association with other cardiovascular risk factors and several comorbidities, different therapeutic constraints and risks, and lower life expectancy. By using a standardized geriatric assessment it is possible to determine therapeutic and glycemic goals for each patient. In the elderly, main complications of diabetes are hypoglycemia and foot lesions. In order to avoid malnutrition, lifestyle and dietary rules should not be too strict. Recommendations for the prescription of oral antidiabetic agents are the same for both elderly and young subjects, but with increased monitoring in the elderly because of the high risk of complications including iatrogenic hypoglycemia. Insulin therapy should be preferred.
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Affiliation(s)
- D Graillot
- Service de Médecine Interne Gériatrie, Hôpital de Jour, Centre de Champmaillot, CHU de Dijon, 2, rue Jules-Violle, BP 87 909, 21079 Dijon cedex, France
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22
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Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez Mañas L. European Diabetes Working Party for Older People 2011 Clinical Guidelines for Type 2 Diabetes Mellitus. Executive Summary. DIABETES & METABOLISM 2011; 37 Suppl 3:S27-38. [DOI: 10.1016/s1262-3636(11)70962-4] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Trends in the quality of care for elderly people with type 2 diabetes: The need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys). DIABETES & METABOLISM 2011; 37:152-61. [PMID: 21435929 DOI: 10.1016/j.diabet.2011.02.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 02/12/2011] [Indexed: 11/22/2022]
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Zequera ML, Garavito L, Sandham W, Alvarado JA, Rodríguez Á, Wilches CA, Villa AC, Quintero SV, Bernal JC. Assessment of the effect of time in the repeatability of the stabilometric parameters in diabetic and non-diabetic subjects during bipedal standing using the LorAn pressure distribution measurement system. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:8531-8534. [PMID: 22256329 DOI: 10.1109/iembs.2011.6092105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study was designed to assess the effect of time on the repeatability of the LorAn pressure distribution measurement system, and evaluate the variability of plantar pressure and postural balance, during barefoot standing in diabetic and non-diabetic subjects, for future diabetic foot clinical evaluation. Fourteen subjects were evaluated (8 females, 6 males, 8 non-diabetics and 6 diabetics, age range 30-70 years) and had no musculoskeletal symptoms. Four variables were measured with the platform in the barefoot standing position. Ten measurements were taken using two different techniques for feet and posture positioning, during three sessions, once a week. The MANOVA test confirmed that the platform measurements are reproducible for variables body baricenter (x) and foot baricenter (x) through time, being the coefficients of variation, with a 99% confidence interval, lower than 1.6% for body baricenter (x), and lower than 2.06% for foot baricenter (x), for all studied conditions. For the remaining variables, the results were not stabilized through time, which makes necessary to standardize the measurement protocol that guarantees the repeatability in all variables.
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Affiliation(s)
- Martha L Zequera
- Electronics Department, Pontificia Universidad Javeriana, Bogotá, Colombia.
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25
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Suhonen R, Leino-Kilpi H. Older orthopaedic patients’ perceptions of individualised care: a comparative survey. Int J Older People Nurs 2010; 7:105-16. [DOI: 10.1111/j.1748-3743.2010.00243.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Allet L, Armand S, de Bie RA, Golay A, Monnin D, Aminian K, Staal JB, de Bruin ED. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia 2010; 53:458-66. [PMID: 19921145 PMCID: PMC2815802 DOI: 10.1007/s00125-009-1592-4] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 10/06/2009] [Indexed: 11/04/2022]
Abstract
AIMS/HYPOTHESIS Gait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients. METHODS This was a randomised controlled trial (n=71) with an intervention (n=35) and control group (n=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up. RESULTS The trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p<0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down. CONCLUSIONS/INTERPRETATION Specific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients' physical activity levels and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT00637546 FUNDING This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/
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Affiliation(s)
- L Allet
- Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, the Netherlands.
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Pataky Z, de León Rodriguez D, Allet L, Golay A, Assal M, Assal JP, Hauert CA. Biofeedback for foot offloading in diabetic patients with peripheral neuropathy. Diabet Med 2010; 27:61-4. [PMID: 20121890 DOI: 10.1111/j.1464-5491.2009.02875.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The reduction of high plantar pressure in diabetic patients with peripheral neuropathy is mandatory for prevention of foot ulcers and amputations. We used a new biofeedback-based method to reduce the plantar pressure at an at-risk area of foot in diabetic patients with peripheral neuropathy. METHODS Thirteen diabetic patients (age 60.8 +/- 12.3 years, body mass index 29.0 +/- 5.0 kg/m(2)) with peripheral neuropathy of the lower limbs were studied. Patients with memory impairment were excluded. The portable in-shoe foot pressure measurement system (PEDAR) was used for foot offloading training by biofeedback. The learning procedure consisted in sequences of walking (10 steps), each followed by a subjective estimation of performance and objective feedback. The goal was to achieve three consecutive walking cycles of 10 steps, with a minimum of seven steps inside the range of 40-80% of the baseline peak plantar pressure. The peak plantar pressure was assessed during the learning period and at retention tests. RESULTS A significant difference in peak plantar pressure was recorded between the beginning and the end of the learning period (when the target for plantar pressure was achieved) (262 +/- 70 vs. 191 +/- 53 kPa; P = 0.002). The statistically significant difference between the beginning of learning and all retention tests persisted, even at the 10-day follow-up. CONCLUSIONS Terminal augmented feedback training may positively affect motor learning in diabetic patients with peripheral neuropathy and could possibly lead to suitable foot offloading. Additional research is needed to confirm the maintenance of offloading in the long term.
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Affiliation(s)
- Z Pataky
- Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, Department of Community Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Hokkam EN. Assessment of risk factors in diabetic foot ulceration and their impact on the outcome of the disease. Prim Care Diabetes 2009; 3:219-224. [PMID: 19783493 DOI: 10.1016/j.pcd.2009.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 08/07/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
Abstract
AIMS The current study aims to identify risk factors for diabetic foot ulcer and their impact on the outcome of the disease. METHODS Three hundred diabetic patients were enrolled in the study. One hundred eighty subjects with diabetic foot ulcer and 120 diabetic controls without foot lesions. All expected risk factors were studied in all patients and after a follow up period, patients with diabetic foot ulcer were classified into group A (patients with healed ulcers) and group B (patients with persistent ulcer or ended by amputation). The risk factors were reanalyzed in both groups to find out their impact on the outcome of the disease. RESULTS The following variables were significant factors for foot ulceration: Male gender (P=0.009), previous foot ulcer (P=0.003), peripheral vascular disease (P=0.004), and peripheral neuropathy (P=0.006). Also lack of frequent foot self-examination was independently related to foot ulcer risk. The outcome was related to longer diabetes duration (P=0.004), poor glycaemic control (P=0.006) and anaemia (P=0.003) and presence of infection (P<0.001). CONCLUSIONS Peripheral vascular disease and peripheral neuropathy together with lack of foot self-examination, poor glycaemic control and anaemia are main significant risk factors for diabetic foot ulceration.
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Affiliation(s)
- Emad Naeem Hokkam
- Department of surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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Bourdel Marchasson I, Doucet J, Bauduceau B, Berrut G, Blickle JF, Brocker P, Constans T, Fagot Campagna A, Kaloustian E, Lassmann Vague V, Lecomte P, Simon D, Tessier D, Verny C, Vischer UM. Key priorities in managing glucose control in older people with diabetes. J Nutr Health Aging 2009; 13:685-91. [PMID: 19657551 DOI: 10.1007/s12603-009-0198-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Older people with diabetes represent a major and increasing proportion of our elderly population and their care requires better organisation. Targets for risk factor control and pathways of care must be adjusted to the subject's general health status. It is thus advisable to screen for frailty. We have carried out a detailed literature review of the studies published on diabetes in older people since 1990. Studies were considered if they included groups or subgroups of diabetic patients > 65 years old. This review discusses the elaboration of general targets for care, the approach to risk factor control, the screening and the specific prevention or management of complications, the integration of geriatric concepts in diabetes care and the specificity of education with respect to frailty status.
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Affiliation(s)
- I Bourdel Marchasson
- Pôle de gérontologie Clinique, Hôpital Xavier Arnozan, 33604 Pessac cédex, France.
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A call to incorporate the prevention and treatment of geriatric disorders in the management of diabetes in the elderly. DIABETES & METABOLISM 2009; 35:168-77. [DOI: 10.1016/j.diabet.2009.02.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
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Doucet J, Druesne L, Capet C, Gréboval E, Landrin I, Moirot P, Micaud G. Risk factors and management of diabetes in elderly French patients. DIABETES & METABOLISM 2008; 34:574-80. [DOI: 10.1016/j.diabet.2008.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 05/09/2008] [Accepted: 05/17/2008] [Indexed: 11/26/2022]
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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