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Lv X, Luo J, Huang W, Guo H, Bai X, Yan P, Jiang Z, Zhang Y, Jing R, Chen Q, Li M. Identifying diagnostic indicators for type 2 diabetes mellitus from physical examination using interpretable machine learning approach. Front Endocrinol (Lausanne) 2024; 15:1376220. [PMID: 38562414 PMCID: PMC10982324 DOI: 10.3389/fendo.2024.1376220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Identification of patients at risk for type 2 diabetes mellitus (T2DM) can not only prevent complications and reduce suffering but also ease the health care burden. While routine physical examination can provide useful information for diagnosis, manual exploration of routine physical examination records is not feasible due to the high prevalence of T2DM. Objectives We aim to build interpretable machine learning models for T2DM diagnosis and uncover important diagnostic indicators from physical examination, including age- and sex-related indicators. Methods In this study, we present three weighted diversity density (WDD)-based algorithms for T2DM screening that use physical examination indicators, the algorithms are highly transparent and interpretable, two of which are missing value tolerant algorithms. Patients Regarding the dataset, we collected 43 physical examination indicator data from 11,071 cases of T2DM patients and 126,622 healthy controls at the Affiliated Hospital of Southwest Medical University. After data processing, we used a data matrix containing 16004 EHRs and 43 clinical indicators for modelling. Results The indicators were ranked according to their model weights, and the top 25% of indicators were found to be directly or indirectly related to T2DM. We further investigated the clinical characteristics of different age and sex groups, and found that the algorithms can detect relevant indicators specific to these groups. The algorithms performed well in T2DM screening, with the highest area under the receiver operating characteristic curve (AUC) reaching 0.9185. Conclusion This work utilized the interpretable WDD-based algorithms to construct T2DM diagnostic models based on physical examination indicators. By modeling data grouped by age and sex, we identified several predictive markers related to age and sex, uncovering characteristic differences among various groups of T2DM patients.
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Affiliation(s)
- Xiang Lv
- College of Chemistry, Sichuan University, Chengdu, China
| | - Jiesi Luo
- Basic Medical College, Southwest Medical University, Luzhou, China
| | - Wei Huang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratoryof Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hui Guo
- College of Chemistry, Sichuan University, Chengdu, China
| | - Xue Bai
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratoryof Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Pijun Yan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratoryof Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zongzhe Jiang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratoryof Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yonglin Zhang
- Department of Pharmacy, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Runyu Jing
- School of Cyber Science and Engineering, Sichuan University, Chengdu, China
| | - Qi Chen
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratoryof Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Menglong Li
- College of Chemistry, Sichuan University, Chengdu, China
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Ye W, Li L, Zeng J. Association of Cardiac Valve Calcification and 1-year Mortality after Lower-extremity Amputation in Diabetic Patients: A Retrospective Study. Curr Neurovasc Res 2024; 20:599-607. [PMID: 38083889 DOI: 10.2174/0115672026277348231130112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/18/2023] [Accepted: 10/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Cardiac valve calcification predisposes patients to a higher risk of adverse cardiovascular events. This study aimed to investigate the association between cardiac valve calcification and 1-year mortality in diabetic patients after lower-extremity amputation. METHODS This was a retrospective study conducted on the clinical data of diabetic patients who underwent lower-extremity amputation admitted to the Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China for diabetic foot ulcers needed lower extremity amputation surgery between July 2017 and March 2021. Detailed preoperative medical assessments were performed and recorded. Cardiac valve calcification was assessed using echocardiography at baseline. Oneyear follow-up assessments were conducted and included clinical visits, hospital record assessments, and telephone reviews to obtain the survival status of patients. RESULTS Ninety-three diabetic patients participated in the study. The 1-year follow-up mortality rate after amputation was 24.7%. Compared to the survival group, the prevalence of cardiac valve calcification and the Revised Cardiac Risk Index (RCRI) were higher in the mortality group. In the Cox regression analysis, cardiac valvular calcification (HR=3.427, 95% CI=1.125- 10.443, p =0.030) was found to be an independent predictor of all-cause mortality after amputation. In addition, the patients with both aortic valve calcification and mitral annular calcification had a higher all-cause mortality rate (50%). Receiver operator characteristic curve analysis showed a stronger predictive ability when using a combination of calcified valve number and RCRI (AUC=0.786 95%, CI=0.676-0.896, p =0.000). CONCLUSION In diabetic patients after lower-extremity amputation, cardiac valve calcification was associated with all-cause mortality during 1-year follow-up. Combination of calcified valve number and RCRI score showed a stronger predictive value for mortality.
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Affiliation(s)
- Weibin Ye
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Li Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Jianfeng Zeng
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
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Harb A, Elbatreek MH, Elshahat A, El-Akabawy N, Barakat W, Elkomy NM. Repurposing alagebrium for diabetic foot ulcer healing: Impact on AGEs/NFκB/NOX1 signaling. Eur J Pharmacol 2023; 959:176083. [PMID: 37769985 DOI: 10.1016/j.ejphar.2023.176083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is a common diabetic complication associated with disability and reduced quality of life. Available therapeutics are not sufficient to combat the spread of DFU. Here we aim to investigate the impact of alagebrium, an advanced glycation end product (AGE)-crosslink breaker, on the healing of DFU. METHODS Diabetes was induced in Wistar rats by STZ, and after four weeks, wound was induced on the foot. Alagebrium (10 mg/kg) was administered orally for 14 days, and wound size was measured every 3 days. Behavioral tests i.e., hot plate and footprint tests, were performed to assess sensory function and gait. Blood was collected to assess HbA1c, serum AGEs, MDA and NOX1. Tissue was collected to assess histological changes and expression of NF-κB, iNOS, TNF-α, VEGF and EGF. In a subsequent set of experiments with similar design, alagebrium was applied topically as a film-forming gel. RESULTS Systemic alagebrium treatment accelerated the healing of diabetic wound, improved sensory functions and gait, and ameliorated histological changes. It also reduced serum levels of AGEs, MDA and NOX1, and the tissue expression of NF-κB, iNOS, TNF-α, and increased VEGF and EGF in diabetic rats. Topical alagebrium led to similar beneficial effects i.e., accelerated diabetic wound healing, improved wound histological changes, reduced expression of NF-κB and iNOS and increased VEGF. CONCLUSIONS Our findings suggest repurposing of alagebrium for the management of DFU to accelerate the healing process and improve the clinical outcomes in diabetic patients.
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Affiliation(s)
- Afnan Harb
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Mahmoud H Elbatreek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.
| | - Ahmed Elshahat
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Nadia El-Akabawy
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Waleed Barakat
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Nesreen Mim Elkomy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
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Alshammari L, O'Halloran P, McSorley O, Doherty J, Noble H. The effectiveness of foot care educational interventions for people living with diabetes mellitus: An umbrella review. J Tissue Viability 2023:S0965-206X(23)00066-9. [PMID: 37369610 DOI: 10.1016/j.jtv.2023.06.001] [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: 04/10/2023] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Diabetes Mellitus is a public health problem becoming more prevalent. Diabetic foot is a debilitating condition caused by diabetes mellitus. Diabetic foot, which includes foot ulceration, infection, and destruction of tissues may necessitate amputation. AIM The aim of this review is to derive evidence from existing systematic reviews and meta-analysis on the effectiveness of foot care educational interventions, directly aimed at people living with diabetes. METHODS A systematic search was implemented using biomedical citation databases including Embase, CINAHL, MEDLINE, and PsycINFO. Major repositories of systematic reviews such as the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, and the PROSPERO register were also searched. The search also included a grey literature search and manual searches of reference lists contained within review studies and other relevant published reviews. The umbrella review searched for articles published from January 2016 to 2021 to ensure sources were current and reflected the most recent interventions. RESULTS This umbrella review is the first to collect and summarise the evidence from existing systematic reviews and meta-analyses of foot care educational interventions directly aimed at people living with diabetes. It reports findings from nine systematic reviews on the evaluation of foot care educational interventions. The number of studies included in each review ranged from 6 to 81. A total of 314 primary studies were included. After examining the overlap between studies reported in multiple reviews, 82 were included in the final review. Without providing effective and consistent preventive and prophylactic foot care, creating, and testing interventions, integrating the concept into practice will remain challenging. CONCLUSION Currently, most educational foot care intervention programmes concentrate on a single intervention. However, there is insufficient evidence that a single educational intervention effectively reduces the occurrence of ulcers and amputations or improves patients' knowledge and behaviour. Two studies used complex interventions, and they reduced the incidence amputation and foot ulceration incidence for people living with diabetes.
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Affiliation(s)
- Layla Alshammari
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK; College of Nursing, University of Hail, Hail, 2440, Saudi Arabia.
| | - Peter O'Halloran
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Oonagh McSorley
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Julie Doherty
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Helen Noble
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
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Sympathetic System in Wound Healing: Multistage Control in Normal and Diabetic Skin. Int J Mol Sci 2023; 24:ijms24032045. [PMID: 36768369 PMCID: PMC9916402 DOI: 10.3390/ijms24032045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
In this review, we discuss sympathetic regulation in normal and diabetic wound healing. Experimental denervation studies have confirmed that sympathetic nerve endings in skin have an important and complex role in wound healing. Vasoconstrictor neurons secrete norepinephrine (NE) and neuropeptide Y (NPY). Both mediators decrease blood flow and interact with inflammatory cells and keratinocytes. NE acts in an ambiguous way depending on receptor type. Beta2-adrenoceptors could be activated near sympathetic endings; they suppress inflammation and re-epithelialization. Alpha1- and alpha2-adrenoceptors induce inflammation and activate keratinocytes. Sudomotor neurons secrete acetylcholine (ACh) and vasoactive intestinal peptide (VIP). Both induce vasodilatation, angiogenesis, inflammation, keratinocytes proliferation and migration. In healthy skin, all effects are important for successful healing. In treatment of diabetic ulcers, mediator balance could be shifted in different ways. Beta2-adrenoceptors blockade and nicotinic ACh receptors activation are the most promising directions in treatment of diabetic ulcers with neuropathy, but they require further research.
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Imamura Y, Suzuki K, Saijo H, Tanaka K. Longitudinal physiological remoulding of lower limb skin as a cause of diabetic foot ulcer: a histopathological examination. J Wound Care 2022; 31:S29-S35. [PMID: 36004943 DOI: 10.12968/jowc.2022.31.sup8.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is recognised as a severe complication in patients with type 2 diabetes. With the increasing incidence of diabetes, it represents a major medical challenge. Several models have been proposed to explain its aetiology; however, they have never been assessed by longitudinal histopathological examination, which this study aims to address. METHOD Multiplex-immunofluorescence analysis was carried out with lengthwise serial skin specimens obtained from the medial thigh, lower leg, ankle, dorsum of foot and acrotarsium close to the DFU region of a patient with type 2 diabetes receiving above the knee amputation. RESULTS Proximal-to-distal gradual loss of peripheral nerve was demonstrated, accompanied by compromised capillaries in the superficial papillary plexus and distended CD31-positive capillaries in the dorsum of foot. Neural fibres and capillaries were also significantly compromised in the sweat gland acinus in the ankle and dorsum of foot. Injuries in the superficial papillary plexus, sweat gland acinus, and sweat gland-associated adipose tissues were accompanied by significant infiltration of macrophages. These results indicated that longitudinal impairment of local blood circulation could be the cause of peripheral neuropathy, which initiated ulcer formation. Resultant chronic inflammation, involving sweat gland-associated adipose tissue, gave rise to impairment of wound healing, and thus DFU formation. CONCLUSION Longitudinal histopathological examination demonstrated that impairment of local microvascular circulation (rather than the systemic complication caused by type 2 diabetes) was considered the primary cause of peripheral neuropathy, which initiated ulceration. Together with chronic inflammation in the superficial papillary plexus and sweat gland-associated adipose tissue, it resulted in the development of a DFU. Although this is a study of just one individual's limb, our study provided a unique observation, contributing mechanistic insights into developing novel intervening strategies to prevent and treat DFUs.
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Affiliation(s)
- Yoshinobu Imamura
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Keiji Suzuki
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Hiroto Saijo
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Heidari M, Zolaktaf V, Ghasemi G, Nejadian SL. Integrated Exercise and Glycemic and Peripheral Sensation Control in Diabetic Neuropathy: A Single-Blind, Randomized Controlled Trial. Int J Prev Med 2021; 12:169. [PMID: 35070202 PMCID: PMC8724797 DOI: 10.4103/ijpvm.ijpvm_306_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neuropathy control and management is an objective in therapeutic exercises prescribed for patients with Type 2 diabetic peripheral neuropathy. We examined the effects of 12-week integrated exercise (IE) on glycemic control and peripheral sensation criteria in patients with diabetic neuropathy. METHODS This study was carried out in 2019-2020 in Janan diabetic society of Najaf Abad in Iran. Based on MNSI scores, we assigned 40 patients into two equal paired random groups (control vs. IE). Pre and posttests were administered before and after three months of intervention. RESULTS Repeated measures ANOVA showed no significant interaction effect between the FBS of the groups (P = 0.26) but significant interaction effects were observed between the levels of 2 hrs pp G, 4 pm G, HbA1c, Diapason, Monofilament, and Thermofeel in favor of the IE group (P < 0.05). CONCLUSIONS At the beginning of IE, we used massage and foam roller to release pain and improve blood circulation as well as sensation in the neuropathic areas. This may have helped the patients perform the aerobic and resistance exercises more easily. Therefore, better glycemic control and peripheral sensation were achieved. Verification of the long-term effects of this training strategy requires further study. Verification of the long-term effects of this training strategy requires further study.
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Affiliation(s)
- Masoome Heidari
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Vahid Zolaktaf
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Gholamali Ghasemi
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Shahram Lenjan Nejadian
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
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Maras O, Dulgeroglu D, Cakci A. Ankle Proprioception in Patients with Type 2 Diabetes Mellitus. J Am Podiatr Med Assoc 2021; 111:470034. [PMID: 34478528 DOI: 10.7547/18-178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. METHODS Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. RESULTS Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores. CONCLUSIONS Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.
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Xu L, Zeng H, Zhao J, Zhao J, Yin J, Chen H, Chai Y, Bao Y, Liu F, Jia W. Index of Plantar Pressure Alters with Prolonged Diabetes Duration. Diabetes Ther 2019; 10:2139-2152. [PMID: 31595458 PMCID: PMC6848324 DOI: 10.1007/s13300-019-00697-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcers develop with deviations in the distribution of plantar pressure. It is difficult to interpret any alteration in plantar pressure under different conditions of type 2 diabetes mellitus (T2DM). The aim of this study was to gain a better insight into the variations in plantar pressure with increased duration of diabetes. METHODS Plantar pressure was examined in 1196 participants with or without T2DM. Subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) were assigned to control groups, and those with T2DM were divided into five groups according to diabetes duration (< 2 years, 2-5 years, 5-10 years, 10-15 years, and > 15 years). The clinical characteristics, plantar peak pressure, and pressure-time integral (PTI) were compared among the seven study groups, and factors associated with peak pressure and the PTI were analyzed. RESULTS At the hallux, peak pressure exhibited an upward trend in patients with T2DM within 5 years of diabetes duration, followed by a distinct downward slope with further progression of the disease (trend analysis, p < 0.05). An uneven distribution of peak pressure was found at other locations, but this unevenness was ultimately lower than that in the two control groups (p < 0.05). No obvious trend was noted for PTI among patients with different diabetes duration; however, those with diabetes for > 10 years manifested a significantly sharper increase in the PTI at the metatarsus (11.63 Ns/cm2, p < 0.05) and heel (14.12 Ns/cm2, p < 0.05) than at the hallux (8.76 Ns/cm2). A fluctuation in the PTI was also detected at the hallux and midfoot of diabetes patients, which was broadly flat when compared with that of the two control groups. The stepwise multiple regression analysis revealed that the variation in plantar pressure was independently associated with age, body mass index, and vibration perception threshold (VPT) (p < 0.05). CONCLUSIONS There would appear to be an association between longer diabetes duration and decreased peak pressure for the hallux, suggesting that individuals with diabetes for > 10 years will have an increased PTI for the metatarsus and heel. The reduced pressure on the hallux is believed to be transferred to the metatarsus. Age, BMI, and VPT are distinct risk factors of abnormal plantar pressure.
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Affiliation(s)
- Lei Xu
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hui Zeng
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Zhao
- Department of Vascular Surgery, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jungong Zhao
- Department of Interventional Radiology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Yin
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Chen
- Department of Orthopedics, Shanghai Clinical Medical Center of Orthopedics, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopedics, Shanghai Clinical Medical Center of Orthopedics, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Bao
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Liu
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Weiping Jia
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology and Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Multi-disciplinary Collaboration Diabetic Foot Group Shanghai Diabetes Institute, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Xu L, Zeng H, Zhao J, Zhao J, Yin J, Chen H, Chai Y, Bao Y, Liu F, Jia W. WITHDRAWN: Index of plantar pressure alters with prolonged diabetes duration. Diabetes Metab Syndr 2019. [DOI: 10.1016/j.dsx.2019.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang H, Zhang H, Cao F, Lu J, Tang J, Li H, Zhang Y, Feng B, Tang Z. Protection of insulin‑like growth factor 1 on experimental peripheral neuropathy in diabetic mice. Mol Med Rep 2018; 18:4577-4586. [PMID: 30221656 DOI: 10.3892/mmr.2018.9435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 07/19/2018] [Indexed: 11/05/2022] Open
Abstract
The present study investigated whether insulin‑like growth factor‑1 (IGF‑1) exerts a protective effect against neuropathy in diabetic mice and its potential underlying mechanisms. Mice were divided into four groups: Db/m (control), db/db (diabetes), IGF‑1‑treated db/db and IGF‑1‑picropodophyllin (PPP)‑treated db/db. Behavioral studies were conducted using the hot plate and von Frey methods at 6 weeks of age prior to treatment. The motor nerve conduction velocity (NCV) of the sciatic nerve was measured using a neurophysiological method at 8 weeks of age. The alterations in the expression levels of IGF‑1 receptor (IGF‑1R), c‑Jun N‑terminal kinase (JNK), extracellular signal‑regulated kinase (ERK), p38 and effect of IGF‑1 on the sciatic nerve morphology were observed by western blotting and electron microscopy. Compared with the control group, the diabetes group developed hypoalgesia after 12 weeks, and neurological lesions improved following an intraperitoneal injection of recombinant (r)IGF‑1. The sciatic NCV in the diabetes group was significantly lower compared with the control group. The sciatic NCV improved following rIGF‑1 intervention; however, was impaired following administration of the IGF‑1 receptor antagonist, PPP. The myelin sheath in the sciatic nerve of the diabetes group was significantly more impaired compared with the control group. The myelin sheath in the sciatic nerves of the rIGF‑1‑treated group was significantly improved compared with the diabetes group; whereas, they were significantly impaired following administration of the IGF‑1R inhibitor. In addition, the expression of IGF‑1R, phosphorylated (p)‑JNK and p‑ERK of sciatic nerves in the db/db mice was significantly increased following treatment with IGF‑1. The expression levels of these proteins were significantly lower in the IGF‑1‑PPP group compared with the IGF‑1 group; however, no significant difference was observed in the expression levels of p‑p38 following treatment with IGF‑1. The results of the present study demonstrated that IGF‑1 may improve neuropathy in diabetic mice. This IGF‑1‑induced neurotrophic effect may be associated with the increased phosphorylation levels of JNK and ERK, not p38; however, it was attenuated by administration of an IGF‑1R antagonist.
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Affiliation(s)
- Hua Wang
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Hao Zhang
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Fuming Cao
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Jiaping Lu
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Jin Tang
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Huizhi Li
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Yiyun Zhang
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Zhaosheng Tang
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
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Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
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Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Malekpour Alamdari N, Gholizade B, Pashaii P. A survey of lower limb amputation rate in patients with diabetes at Shahid Modarres Hospital, Tehran, Iran, during 5 years. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2017. [DOI: 10.15171/jarcm.2017.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Hinojosa CA, Boyer-Duck E, Anaya-Ayala JE, Nunez-Salgado A, Laparra-Escareno H, Torres-Machorro A, Lizola R. Impact of the bacteriology of diabetic foot ulcers in limb loss. Wound Repair Regen 2016; 24:923-927. [DOI: 10.1111/wrr.12462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Carlos A. Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Estefania Boyer-Duck
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Javier E. Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Ana Nunez-Salgado
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Hugo Laparra-Escareno
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Adriana Torres-Machorro
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
| | - Rene Lizola
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy; Instituto Nacional de Ciencias Médicas y nutrición “Salvador Zubirán,”; Mexico City Mexico
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Low KTA, Peh WCG. Magnetic resonance imaging of diabetic foot complications. Singapore Med J 2016; 56:23-33; quiz 34. [PMID: 25640096 DOI: 10.11622/smedj.2015006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot.
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Affiliation(s)
- Keynes T A Low
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, 90 Yishun Central, Singapore 768828.
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Prevention of lower-limb lesions and reduction of morbidity in diabetic patients. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:482-7. [PMID: 26229849 PMCID: PMC4487491 DOI: 10.1016/j.rboe.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022]
Abstract
Objective Methods Results Conclusions
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do Amaral Júnior AH, do Amaral LAH, Bastos MG, do Nascimento LC, Alves MJM, de Andrade MAP. Prevenção de lesões de membros inferiores e redução da morbidade em pacientes diabéticos. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Elsharawy MA, Hassan K, Alawad N, Kredees A, Almulhim A. Screening of diabetic foot in surgical inpatients: a hospital-based study in saudi arabia. Int J Angiol 2013; 21:213-6. [PMID: 24293979 DOI: 10.1055/s-0032-1330230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Previous reports found that identification of diabetic patients at high risk of foot ulcers, and managing the risk factors early, lower extremity amputations could be prevented. The aim of this study is to determine the value of screening diabetics in estimating the risk of foot ulceration among surgical inpatients. This is a prospective study on all diabetic patients admitted to the surgical department, King Fahd Hospital of the University, Saudi Arabia, during the year 2011. Patients were screened for the presence of diabetic foot. They were classified according to the international working group on the diabetic foot into four grades [0 (lowest risk patients), 1, 2, 3 (highest risk patients)]. During the study period, 391 patients had diabetes mellitus (DM), of these 73 (19%) had active ulcer and were excluded from the study and the rest were screened. Grade 0 was in 174 (54.5%) patients, the rest were grades 1, 2, and 3. There was significant difference between low-risk groups (grades 0, 1) and high-risk groups (grades 2, 3) as regards age, smoking and duration of DM. This study indicates that prevalence of diabetic patients with risk of foot ulceration in surgical inpatients was high. Routine screening of diabetic foot is recommended specially in old patients.
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Affiliation(s)
- Mohamed A Elsharawy
- Department of Surgery, University of Dammam, Al-Khobar, Kingdom of Saudi Arabia
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Cheng C, Singh V, Krishnan A, Kan M, Martinez JA, Zochodne DW. Loss of innervation and axon plasticity accompanies impaired diabetic wound healing. PLoS One 2013; 8:e75877. [PMID: 24098736 PMCID: PMC3786937 DOI: 10.1371/journal.pone.0075877] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/19/2013] [Indexed: 12/26/2022] Open
Abstract
Loss of cutaneous innervation from sensory neuropathy is included among mechanisms for impaired healing of diabetic skin wounds. The relationships between cutaneous axons and their local microenvironment during wound healing are challenged in diabetes. Here, we show that secondary wound closure of the hairy dorsal skin of mice is delayed by diabetes and is associated with not only a pre-existing loss of cutaneous axons but substantial retraction of axons around the wound. At 7d following a 3mm punch wound, a critical period of healing and reinnervation, both intact skin nearby the wound and skin directly at the wound margins had over 30-50% fewer axons and a larger deficit of ingrowing axons in diabetics. These findings contrasted with a pre-existing 10-15% deficit in axons. Moreover, new diabetic ingrowing axons had less evidence of plasticity. Unexpectedly, hair follicles adjacent to the wounds had a 70% reduction in their innervation associated with depleted expression of hair follicular stem cell markers. These impairments were associated with the local upregulation of two established axon regenerative ‘roadblocks’: PTEN and RHOA, potential but thus far unexplored mediators of these changes. The overall findings identify striking and unexpected superimposed cutaneous axon loss or retraction beyond that expected of diabetic neuropathy alone, associated with experimental diabetic skin wounding, a finding that prompts new considerations in diabetic wounds.
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Affiliation(s)
- Chu Cheng
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vandana Singh
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anand Krishnan
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michelle Kan
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jose A. Martinez
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Douglas W. Zochodne
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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Coenzyme Q10 prevents peripheral neuropathy and attenuates neuron loss in the db-/db- mouse, a type 2 diabetes model. Proc Natl Acad Sci U S A 2012; 110:690-5. [PMID: 23267110 DOI: 10.1073/pnas.1220794110] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common complication in both type 1 and type 2 diabetes. Here we studied some phenotypic features of a well-established animal model of type 2 diabetes, the leptin receptor-deficient db(-)/db(-) mouse, and also the effect of long-term (6 mo) treatment with coenzyme Q10 (CoQ10), an endogenous antioxidant. Diabetic mice at 8 mo of age exhibited loss of sensation, hypoalgesia (an increase in mechanical threshold), and decreases in mechanical hyperalgesia, cold allodynia, and sciatic nerve conduction velocity. All these changes were virtually completely absent after the 6-mo, daily CoQ10 treatment in db(-)/db(-) mice when started at 7 wk of age. There was a 33% neuronal loss in the lumbar 5 dorsal root ganglia (DRGs) of the db(-)/db(-) mouse versus controls at 8 mo of age, which was significantly attenuated by CoQ10. There was no difference in neuron number in 5/6-wk-old mice between diabetic and control mice. We observed a strong down-regulation of phospholipase C (PLC) β3 in the DRGs of diabetic mice at 8 mo of age, a key molecule in pain signaling, and this effect was also blocked by the 6-mo CoQ10 treatment. Many of the phenotypic, neurochemical regulations encountered in lumbar DRGs in standard models of peripheral nerve injury were not observed in diabetic mice at 8 mo of age. These results suggest that reactive oxygen species and reduced PLCβ3 expression may contribute to the sensory deficits in the late-stage diabetic db(-)/db(-) mouse, and that early long-term administration of the antioxidant CoQ10 may represent a promising therapeutic strategy for type 2 diabetes neuropathy.
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Jordan BF, Magat J, Colliez F, Ozel E, Fruytier AC, Marchand V, Mignion L, Bouzin C, Cani PD, Vandeputte C, Feron O, Delzenne N, Himmelreich U, Denolin V, Duprez T, Gallez B. Mapping of oxygen by imaging lipids relaxation enhancement: A potential sensitive endogenous MRI contrast to map variations in tissue oxygenation. Magn Reson Med 2012; 70:732-44. [DOI: 10.1002/mrm.24511] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 01/02/2023]
Affiliation(s)
- Bénédicte F. Jordan
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Julie Magat
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Florence Colliez
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Elif Ozel
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Anne-Catherine Fruytier
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Valérie Marchand
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Lionel Mignion
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Caroline Bouzin
- Angiogenesis and Cancer Research Laboratory; Pole of Pharmacology and Therapeutics; Institute of Experimental and Clinical Research; Université Catholique de Louvain; Brussels Belgium
| | - Patrice D. Cani
- Metabolism and Nutrition Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Caroline Vandeputte
- Biomedical MRI/Molecular Small Animal Imaging Center; Katholieke Universiteit Leuven; Leuven Belgium
| | - Olivier Feron
- Angiogenesis and Cancer Research Laboratory; Pole of Pharmacology and Therapeutics; Institute of Experimental and Clinical Research; Université Catholique de Louvain; Brussels Belgium
| | - Nathalie Delzenne
- Metabolism and Nutrition Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
| | - Uwe Himmelreich
- Biomedical MRI/Molecular Small Animal Imaging Center; Katholieke Universiteit Leuven; Leuven Belgium
| | | | - Thierry Duprez
- Radiology and Medical Imaging; St. Luc hospital; Institute of Neuroscience (IoNS); Université Catholique de Louvain; Brussels Belgium
| | - Bernard Gallez
- Biomedical Magnetic Resonance Research Group; Louvain Drug Research Institute; Université Catholique de Louvain; Brussels Belgium
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Xavier ATDF, Foss MC, Marques Junior W, Santos CBD, Onofre PTBN, Pace AE. Cultural adaptation and validation of the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument (NeuroQol) for Brazilian Portuguese - Phase 1. Rev Lat Am Enfermagem 2011; 19:1352-61. [DOI: 10.1590/s0104-11692011000600011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
This methodological study aimed to adapt the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument - NeuroQol to Brazilian Portuguese and to analyze its psychometric properties. Participants were 50 people with peripheral diabetic neuropathy and foot ulcers. The floor and ceiling effects, the convergent and discriminant validity and the reliability were analyzed. The Cronbach’s alpha coefficient was used to test the reliability and the Pearson’s correlation coefficient to estimate the convergent validity, the Student’s t test was used to evaluate the discriminant validity in the comparison of the NeuroQol scores between participants with and without ulcers. Floor and ceiling effects were found in some domains of the NeuroQol. The reliability was satisfactory. The correlations between the domains of the NeuroQol and the SF-36 were negative, significant and of moderate to strong magnitude. The findings show that the Brazilian version of the NeuroQol is reliable and valid and may be employed as a useful tool for improving nursing care for people with DM.
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Affiliation(s)
| | | | | | | | | | - Ana Emilia Pace
- Universidade de São Paulo; WHO Collaborating Centre for Nursing Research Development, Brazil
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Abstract
Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. The pathophysiologies of diabetic foot ulceration with polyneuropathy and angiopathy as well as wound-healing impairment in patients with diabetes mellitus are important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the--compared with European data--noticeably higher rates of major amputations in Germany.
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Fang RC, Galiano RD. A review of becaplermin gel in the treatment of diabetic neuropathic foot ulcers. Biologics 2011; 2:1-12. [PMID: 19707423 PMCID: PMC2727777 DOI: 10.2147/btt.s1338] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diabetic neuropathic foot ulcers represent a serious health care burden to patients and to society. While the management of chronic diabetic foot ulcers has improved in recent years, it remains a frustrating problem for a variety of clinicians. This review examines the scientific underpinnings supporting the use of becaplermin (Regranex((R)); Ortho-McNeil Pharmaceutical, Raritan, NJ), or recombinant human platelet-derived growth factor (rhPDGF-BB), in diabetic forefoot wounds. An emphasis is placed upon proper medical and surgical care of diabetic foot wounds, as multiple studies have demonstrated that the success of this growth factor in accelerating healing is ultimately dependent on proper ulcer care. A focus on the cost-effectiveness of this form of therapy in the treatment of diabetic foot ulcers is also outlined.
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Affiliation(s)
- Robert C Fang
- Division of Plastic and Reconstructive Surgery and Wound Healing Research Laboratory, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Jordan DN, Jordan JL. Foot self-care practices among Filipino American women with type 2 diabetes mellitus. Diabetes Ther 2011; 2:1-8. [PMID: 22127764 PMCID: PMC3124639 DOI: 10.1007/s13300-010-0016-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION To determine the foot self-care practices performed by Filipino American (FA) women with type 2 diabetes mellitus (DM). METHOD The Summary of Diabetes Self Care Activities - Revised and Expanded measure was administered to 118 FA adult female immigrants with type 2 DM. RESULTS Younger FA women (<65 years), participants with higher education, those who immigrated to the United States (US) at younger ages, and participants diagnosed with type 2 DM at younger ages reported they washed their feet every day during the past week. Moreover, FA women who immigrated to the US at younger ages and participants who were diagnosed with the disease at younger ages reported that they dried their feet (in between toes) daily during the previous week. Further, FA women who were diagnosed with type 2 DM at younger ages were more likely to report that they checked their feet every day during the past week, when compared with participants who were diagnosed with the disease at older ages. Finally, most FA women did not inspect the inside of their shoes. CONCLUSION Foot self-care practices were less frequently performed by older FA women with type 2 DM (≥65 years), making them more prone to the development of foot problems such as ulcers, infections, and disfigurations. Optimum foot self-care practices must be encouraged in older FA women to prevent such foot problems, and subsequent amputations.
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Affiliation(s)
- Deovina Nasis Jordan
- Department of Nursing, 5 West, Ronald Reagan UCLA Medical Center 5354, 757 Westwood Plaza, Los Angeles, CA 90095-7404 USA
| | - James Lowell Jordan
- Department of Nursing, 5 West, Ronald Reagan UCLA Medical Center 5354, 757 Westwood Plaza, Los Angeles, CA 90095-7404 USA
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Behjati M. Worm therapy as a treatment for diabetic foot ulcer: lessons learned from the banks of the Nile. INT J LOW EXTR WOUND 2010; 9:185-6. [PMID: 21134957 DOI: 10.1177/1534734610389596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jaksa PJ, Mahoney JL. Quality of life in patients with diabetic foot ulcers: validation of the Cardiff Wound Impact Schedule in a Canadian population. Int Wound J 2010; 7:502-7. [PMID: 20860554 DOI: 10.1111/j.1742-481x.2010.00733.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was to evaluate and validate the Cardiff Wound Impact Schedule (CWIS), a disease-specific quality-of-life measure, in a diabetic foot ulcer (DFU) population. Patients with DFUs have restrictions as part of their treatment and rehabilitation, which can affect health-related quality of life (HRQoL). Because of the high number of comorbidities experienced in diabetes, a disease-specific quality-of-life measure is needed to best assess the affect of a foot ulcer on HRQoL. Patients with DFUs completed the CWIS and a World Health Organization generic quality-of-life questionnaire. Validity was assessed by comparing domains of the questionnaires. Patients were categorised using the University of Texas wound classification system. Mean CWIS scores were compared between categories to assess the questionnaire's ability to differentiate wound severity. Patients with open ulcers scored significantly lower on the CWIS than those with healed ulcers. Correlations between questionnaire domains were as follows: Social Life with Social Functioning (r = 0·641, P < 0·001); Well-Being with General Health (r = 0·533, P < 0·01); Physical Symptoms and Daily Living with Physical Functioning (r = 0·631, P < 0·01) and Health-Related Quality of Life with Vitality (r = 0·425, P < 0·01). However, there was no significant difference in mean CWIS scores between categories of wound severity. We have demonstrated the ability of the CWIS in assessing HRQoL in a DFU population and its ability to differentiate between healed and non healed states.
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Affiliation(s)
- Peter J Jaksa
- Division of Plastic Surgery/Wound Care, Faculty of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8.
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Donovan A, Schweitzer ME. Use of MR imaging in diagnosing diabetes-related pedal osteomyelitis. Radiographics 2010; 30:723-36. [PMID: 20462990 DOI: 10.1148/rg.303095111] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The clinical diagnosis of diabetes-related osteomyelitis relies on the identification and characterization of an associated foot ulcer, a method that is often unreliable. Magnetic resonance (MR) imaging is the modality of choice for imaging evaluation of pedal osteomyelitis. Because MR imaging allows the extent of osseous and soft-tissue infection to be mapped preoperatively, its use may limit the extent of resection. At MR imaging, the simplest method to determine whether osteomyelitis is present is to follow the path of an ulcer or sinus tract to the bone and evaluate the signal intensity of the bone marrow. Combined findings of low signal intensity in marrow on T1-weighted images, high signal intensity in marrow on T2-weighted images, and marrow enhancement after the administration of contrast material are indicative of osteomyelitis. Secondary signs of osteomyelitis include periosteal reaction, a subtending skin ulcer, sinus tract, cellulitis, abscess, and a foreign body. The location of a marrow abnormality is a key distinguishing feature of osteomyelitis: Whereas neuroarthropathy most commonly affects the tarsometatarsal and metatarsophalangeal joints, osteomyelitis occurs distal to the tarsometatarsal joint, in the calcaneus and malleoli. In the midfoot, secondary signs of infection help differentiate between neuroarthropathy and a superimposed infection.
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Affiliation(s)
- Andrea Donovan
- Department of Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room AG 278, Toronto, Ontario, Canada M4N 3M5.
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Nather A, Chionh SB, Tay PLM, Aziz Z, Teng JWH, Rajeswari K, Erasmus A, Nambiar A. Foot Screening for Diabetics. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n6p472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: This study aims to evaluate the results of foot screening performed in a study population of 2137 diabetics (3926 feet) screened from 2006 to 2008 by the National University Hospital (NUH) multi-disciplinary team for diabetic foot problems. Materials and Methods: A standardised protocol was designed. Foot screening consisted of detailed history taking and clinical examination including assessment for sensory neuropathy by Semmes Weinstein monofilament (SWMF) and neurothesiometer and assessment of vasculopathy by ankle-brachial index (ABI) and total body irradiation (TBI). The foot screening was performed by a trained staff nurse. All patients were classified according to King’s College Classification. Results: Majority of the patients were in the fifth (27.9%) and sixth (30.0%) decades of life. Two thousand sixty-four had type II diabetes, and only 73 had type I diabetes. Neuropathy was found in 1307 (33.3%) feet based on 5.07 SWMF. Vasculopathy was recorded in 510 (13.0%) and 546 (13.9%) feet based on ABI <0.8 and TBI <0.7. According to King’s Classification, 1069 (50.0%) were Stage 1: Normal and 615 (28.8%) were Stage 2: At-Risk. Conclusion: Foot screening should be performed as early as possible to detect “At-Risk” feet and prevent the development of diabetic foot complications, thereby further reducing the risk of major amputations.
Key words: “At-Risk” feet, Diabetic foot screening, King’s Classification
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Affiliation(s)
- Aziz Nather
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Patricia LM Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zameer Aziz
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Janelle WH Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Adriaan Erasmus
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ajay Nambiar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Jayaprakash P, Bhansali S, Bhansali A, Dutta P, Anantharaman R. Magnitude of foot problems in diabetes in the developing world: a study of 1044 patients. Diabet Med 2009; 26:939-42. [PMID: 19719717 DOI: 10.1111/j.1464-5491.2009.02781.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To gain insight into the prevalence of peripheral neuropathy, foot care practices, foot at risk and foot ulcers in patients with diabetes mellitus at a tertiary care centre. METHODS A prospective case study involving 1044 patients with diabetes mellitus attending the diabetes clinic of a tertiary care centre in north India from January 2007 to May 2008. All subjects underwent a detailed clinical assessment including vibration perception threshold (VPT) and ankle brachial pressure index (ABI), along with metabolic parameters, and were categorized into ulcer, foot at risk and patients with no risk factors. Foot care practices were assessed with a questionnaire. Peripheral neuropathy was defined as VPT score > or = 25 V. Peripheral vascular disease (PVD) was defined as ABI < 0.9. One hundred and forty-nine patients with foot at risk were followed up for 9.0 +/- 2.3 months (range 5-13 months). RESULTS The prevalence of peripheral neuropathy was 34.9% and of PVD 12.6%. Two thirds of the patients were at risk for foot ulceration; 9% had an ulcer and 20.2% of them required amputation. Correct foot care practices were followed by 214 (20.5%) subjects of the whole study population and by only 135 (19.3%) of the patients with foot at risk. Improvement in glycaemic control in the patients on follow-up was associated with improvement or stabilization of VPT score. Five (3.4%) patients developed new ulcers on follow-up. CONCLUSION The high prevalence of neuropathy and PVD, coexisting with poor adherence to foot care practices predisposes to foot problems in people with diabetes in our study population.
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Affiliation(s)
- P Jayaprakash
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Vacuum cushioned removable cast walkers reduce foot loading in patients with diabetes mellitus. Gait Posture 2009; 30:11-5. [PMID: 19321342 DOI: 10.1016/j.gaitpost.2009.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 02/07/2009] [Accepted: 02/15/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diabetes mellitus is one of the most common diseases worldwide and the number of patients is expected to increase dramatically in future. Plantar ulceration is partly caused by high plantar pressures and a major complication in diabetic patients. PURPOSE The aim of this study was to investigate the pressure-relieving effects of two vacuum orthoses in patients with diabetes mellitus. METHODS Twenty patients with diabetes mellitus were included. They presented with plantar callosities but no ulceration. Exclusion criteria included the use of walking aids and other systemic diseases. Plantar pressure distribution was measured with sensor insoles (Pedar-X, Novel GmbH) during walking in two vacuum orthoses, a post-operative shoe and an off-the-shelf shoe as reference condition. Statistical analysis was conducted using Friedman and Wilcoxon signed-rank tests. RESULTS Significant differences in plantar pressure distribution were found between the four walking conditions. The contact area increased in the midfoot with the vacuum orthoses. Maximum force and peak pressures showed a significant decrease under the rearfoot and forefoot and increased in the midfoot area during walking with both vacuum orthoses. The high-cut vacuum orthosis revealed equal pressure relief under the forefoot and significantly lower rearfoot pressures compared to the post-operative shoe. CONCLUSIONS The vacuum orthoses demonstrated a comparable pressure-relieving efficacy under the forefoot to post-operative shoes. Using vacuum orthosis significantly benefited re-distribution of plantar pressure and the roll-over process. Clinical significance of the pressure-relieving efficacy could not be confirmed in this investigation and has to be addressed in further studies.
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Abstract
Diabetic pedal osteomyelitis is primarily a manifestation of vascular insufficiency with resultant tissue ischemia, neuropathy, and infection. Nearly all cases of pedal osteomyelitis arise from a contiguous ulcer and soft tissue infection. MR imaging is the modality of choice to assess for the presence of osteomyelitis and associated soft tissue complications, to guide patient management, and to aid in limited limb resection.
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Abstract
Since diabetes mellitus is growing at epidemic proportions worldwide, the prevalence of diabetes-related complications is bound to increase. Diabetic foot disorders, a major source of disability and morbidity, are a significant burden for the community and a true public health problem. Many epidemiological data have been published on the diabetic foot but they are difficult to interpret because of variability in the methodology and in the definitions used in these studies. Moreover, there is a lack of consistency in population characteristics (ethnicity, social level, accessibility to care) and how results are expressed. In westernized countries, two of 100 diabetic patients are estimated to suffer from a foot ulcer every year. Amputation rates vary considerably: incidence ranges from 1 per thousand in the Madrid area and in Japan to up to 20 per thousand in some Indian tribes in North America. In metropolitan France, the incidence of lower-limb amputation is approximately 2 per thousand but with marked regional differences, and in French overseas territories, the incidence rate is much higher. Nevertheless, the risk for ulceration and amputation is much higher in diabetics compared to the nondiabetic population: the lifetime risk of a diabetic individual developing an ulcer is as high as 25% and it is estimated that every 30s an amputation is performed for a diabetic somewhere in the world. As reviewed in this paper, peripheral neuropathy, arterial disease, and foot deformities are the main factors accounting for this increased risk. Age and sex as well as social and cultural status are contributing factors. Knowing these factors is essential to classify every diabetic using a risk grading system and to take preventive measures accordingly.
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Affiliation(s)
- J-L Richard
- Service des Maladies de la Nutrition et Diabétologie, Centre Médical, Le Grau du Roi, CHU de Nîmes place Prof Robert Debré, Nîmes, France.
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Systemic Insulin-like Growth Factor-1 Reverses Hypoalgesia and Improves Mobility in a Mouse Model of Diabetic Peripheral Neuropathy. Mol Ther 2008; 16:1400-8. [DOI: 10.1038/mt.2008.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Kordestani S, Shahrezaee M, Tahmasebi M, Hajimahmodi H, Ghasemali DH, Abyaneh M. A randomised controlled trial on the effectiveness of an advanced wound dressing used in Iran. J Wound Care 2008; 17:323-7. [DOI: 10.12968/jowc.2008.17.7.30525] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Kordestani
- Department of Biomedical Engineering, Amir Kabir University of Technology, Tehran, Iran and Managing Director, ChitoTech, Tehran, Iran
| | - M. Shahrezaee
- Department of Orthopaedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M.N. Tahmasebi
- Department of Orthopaedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - H. Hajimahmodi
- Department of Orthopaedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - D. Haji Ghasemali
- Department of Orthopaedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. ACTA ACUST UNITED AC 2005. [PMID: 16291066 DOI: 10.1016/j.mpmed.2010.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When assessing the economic effects of diabetic foot disease, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years. Costing should therefore include not only the immediate ulcer episode, but also social services, home care, and subsequent ulcer episodes. A broader view of total resource use should include some estimate of quality of life and the final outcome. An integrated care approach with regular screening and education of patients at risk requires low expenditure and has the potential to reduce the cost of health care.
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