Diabetic foot syndrome from the perspective of internist educated in podiatry

Česká verzia

Authors: Alexandra Jirkovská
Authors place of work: Centrum diabetologie IKEM, Praha
Published in the journal: Vnitř Lék 2016; 62(Suppl 4): 42-47
Category: Reviews

Summary

Podiatry is the science dealing with the diagnostics and treatment of the foot and ankle and associated tissues and structures by all appropriate methods and also with the local manifestation of the overall processes in this area. Diabetic foot disease is defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of people with diabetes according to the latest edition of the International Consensus. Successful treatment and prevention of diabetic foot syndrome depends on a holistic approach, in which it is seen as part of the multiple organ involvement. Teamwork of series of experts is therefore necessary. Internist with diabetes and podiatric education plays a key role in this team in particular, when control diabetes and in the prevention and treatment of co-morbidities, in the diagnosis of malnutrition and in the nutritional therapy and in the early diagnosis and effective treatment of infections. Last but not least, internist in collaboration with other professionals works when treatment of lower limb ischemia, suitable offloading of the ulcer and topical therapy and in the prevention of ulcers. Recurrent ulcerations are the major problem in podiatry and it can occur in up to 40% of patients in the first year after healing. Follow-up of patients with diabetic foot syndrome by experienced internist can help reduce the serious consequences, including amputation and cardiovascular mortality.

Key words:
diabetic foot – internal medicine – podiatry

Zdroje

1. Bakker K, Apelqvist J, Lipsy B et al. [International Working Group on the Diabetic Foot (IWGDF)]. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev 2016; 32(Suppl 1): S2-S6. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.2694>.

2. Jirkovská A. Možnosti plnění mezinárodních doporučení terapie syndromu diabetické nohy v České republice. Vnitř Lék 2011; 57(11): 908–912.

3. Jirkovská A. Stěžejní otázky terapie syndromu diabetické nohy. Vnitř Lék 2002; 48(6): 542–548.

4. Dubský M, Jirkovská A, Bém R et al. Terapie kritické končetinové ischemie u pacientů se syndromem diabetické nohy pomocí autologních kmenových buněk. Vnitř Lék 2011; 57(5): 451–455.

5. Stratton I, Adler I, Neil H et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258): 405–412.

6. Niu Y, Xie T, Ge K et al. Effects of extracellular matrix glycosylation on proliferation and apoptosis of human dermal fibroblasts via the receptor for advanced glycosylated end products. Am J Dermatopathol 2008; 30(4): 344–351. Dostupné z DOI: <http://dx.doi.org/10.1097/DAD.0b013e31816a8c5b>.

7. Uccioli L, Izzo V, Meloni M et al. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings. J Wound Care 2015; 24(4 Suppl): S35-S42. Dostupné z DOI: <http://dx.doi.org/10.12968/jowc.2015.24.Sup4b.35>.

8. Dubský M, Jirkovská A, Bem R et al. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. Int Wound J 2013; 10(5): 555–561. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1742–481X.2012.01022.x>.

9. Pscherer S, Dippel F, Lauterbach S et al. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Prim Care Diabetes 2012; 6(3): 241–246. Dostupné z DOI: <http://dx.doi.org/10.1016/j.pcd.2012.02.004>.

10. Hasan R, Firwana B, Elraiyah T et al. A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome. J Vasc Surg 2016; 63(2 Suppl): 22S-28S. e1-e2. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jvs.2015.10.005>.

11. Brownrigg J, Ray K Medical therapy and metabolic control to optimize cardiovascular risk and reduce overall mortality. In: Hinchliffe R, Schaper N, Thompson M et al. The diabetic foot. JP Medical Publishers: London 2014: 33–38. ISBN 978–1907816628.

12. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg 2006; 117(7 Suppl): S42- S58.

13. Wild T, Rahbarnia A, Kellner M et al. Basics in nutrition and wound healing. Nutrition 2010; 26(9): 862–866. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2010.05.008>.

14. Wohl P. Nutriční péče. In: Jirkovská A et al. Syndrom diabetické nohy. Maxdorf: Praha 2006: 302–322.

15. Razzaghi R, Pourbagheri H, Momen-Heravi M et al. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications 2016. pii: S1056–8727(16)30220–3. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jdiacomp.2016.06.017>.

16. Gau BR, Chen HY, Hung SY et al. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers. J Diabetes Complications 2016; 30(1): 138–142. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jdiacomp.2015.09.011>.

17. Bouillanne O, Morineau G, Dupont C et al. Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82(4): 777–783.

18. DeLegge M, Drake I. Nutritional assessment. Gastroenterol Clin North Am 2007; 36(1): 1–22.

19. Caputo G, Cavanagh P, Ulbrecht J et al. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994; 331(13): 854–860.

20. Mason J, Keeffet C, Hutchinson A et al. A systematic review of foot ulcer in patients with type 2 diabetes mellitus. II: treatment. Diabet Med 1999; 16(11): 889–909.

21. Grayson M, Gibbons G, Balogh K et al. Probing to bone in infected pedal ulcers. JAMA 1995; 273(9): 721–723.

22. Lipsky B, Aragón-Sanchez J, Giggle M et al. IWGDG Guidance on the diagnosis and management of foot infections in persons with diabetes. In: Bakker K, Apelqvist J, Lipsky B et al [International Working Group on the Diabetic Foot (IWGDF)]. Prevention and management of Foot Problems in Diabetes. Guidance Documents and Recommendations. 2015. Dostupné z WWW: http://www.iwgdf.org.

23. Peters EJ, Lipsky BA, Berendt AR et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes Metab Res Rev 2012; 28(Suppl 1): S142-S162. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.2247>.

24. Fejfarová V, Jirkovská A, Petkov V et al. Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot. J Diabetes Complications 2004; 18(2): 108–112.

25. Edmonds ME, Blundell MP, Morris ME et al. Improved survival of the diabetic foot: the role of special footclinic. QJMed 1986; 60(232): 763–771.

26. Young MJ, McCardle JE, Randall LE et al. Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 2008; 31(11): 2143–2147. Dostupné z DOI: <http://dx.doi.org/10.2337/dc08–1242>.