[Pathophysiology and treatment for diabetic neuropathy]

The Role of Footcare Nurses in Foot Lesions Treatment

Footcare awareness and practice are limited in Japan, which is attributable to unavailability of specialized podiatry services, in contrast to the Western healthcare system. Japan does not have national educational courses in podiatry and footcare, and daily foot care is not routinely practiced owing to the cultural background. Moreover, medical insurance covers only diabetic footcare, which contributes to the limited popularity of footcare in Japan. Footcare in Japan is provided by qualified nurses (foot care nurses) who are certified by various organizations and societies. Footcare nurses render the following services: (a) Provision of professional footcare after evaluation and patient education for foot self-care. (b) Multidisciplinary coordination between the footcare team. Owing to lack of podiatry services in Japan, a multidisciplinary therapeutic approach to foot lesions is necessary. The footcare nurse coordinates communication of patient information across team members and interdepartmental referrals for effective multidisciplinary therapy. (c) Patient education to improve awareness of footcare. Footcare is not currently widely established as a component of medical and nursing care and patient welfare, and greater awareness regarding its role is necessary. The importance of footcare to maintain healthy walking needs to be emphasized among individuals with foot lesions. In view of the high life expectancy and rapid population aging in Japan, maintaining a healthy gait is essential to improve healthy life expectancy, and foot care nurses can play an active role in the future.

Association Between Estimated Glomerular Filtration Rate and Microvascular Complications in Type II Diabetes Mellitus Patients: A 1-Year Cross-Sectional Study

BACKGROUND

Previous studies have indicated that reduced estimated glomerular filtration rate (eGFR) is not only the predictor of renal function impairment in patients with diabetic nephropathy, but also in patients with diabetic neuropathy, diabetic retinopathy, and other diabetic-related complications. Therefore, evaluation of eGFR is critical in diabetic patients. However, there is a paucity of data regarding the association of various stages of kidney disease with microvascular complications.

OBJECTIVE

The objective of the study was to evaluate the association between eGFR and microvascular complications in type II diabetes mellitus (DM) patients.

METHODS

The present 1-year cross-sectional study involved a total of 50 type II DM patients with duration of >5 years. Descriptive data, detailed history regarding the duration of DM, and clinical investigations were performed according to a predesigned and pretested proforma. Specific investigations such as urine microalbumin excretion test and serum creatinine test were also performed. Serum creatinine test was done to calculate the eGFR by modification of diet in renal disease (MDRD) formula. All the type II DM patients were divided into various stages of kidney disease by calculating the eGFR by MDRD. Chi-square test was used to find the association of eGFR with microvascular complications. P < 0.05 was considered statistically significant.

RESULTS

The mean age of the study patients was 57.76 ± 10.35 years with a male predominance. Most of the patients were identified with diabetic nephropathy (33) and diabetic neuropathy (32). Many (21) patients were in stage I kidney disease. Reduced eGFR was associated significantly with diabetic neuropathy (P = 0.007) and diabetic nephropathy (P = 0.0092); whereas, no significant association was observed with diabetic retinopathy (P = 0.285). Furthermore, reduced eGFR led to reduction in glycated hemoglobin levels, and increased the risk of hypertension (P = 0.0401) in patients with type II DM.

CONCLUSION

Overall, eGFR can be considered as a rational noninvasive mode of assessing the renal status in patients with type II DM. Reduction in eGFR is significantly associated with microvascular complications, such as diabetic neuropathy and diabetic nephropathy.