diabetestalk.net

Diabetic Foot Pathophysiology Ppt

Diabetic Foot

Diabetic Foot

A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus.[1] Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while. People with diabetes are also at risk of developing a diabetic foot ulcer. Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%.[2] In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy). Around half of patients with a diabetic foot ulcer have co-existing PAD.[3] Where wounds take a long time to heal, infection may set in and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.[4] Prevention[edit] Prevention of diabetic foot may include optimising metabolic control (regulating glucose levels); identification and screening of people at high risk for diabetic foot ulceration; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor.[5] There is however only limited evidence that patient education has a long-term Continue reading >>

Diabetic Foot Ulcer-diagnosis And Management

Diabetic Foot Ulcer-diagnosis And Management

Diabetes mellitus; Vasculopathy; Amputations; Multifactorial aetiopathogenesis; Neuropathy; Ischemia; Infection Diabetes mellitus (DM) is a serious and complex disease affecting almost all the vital organs in the body. About 347 million people in the world are diagnosed with DM [ 1 ] and majority of them are due to DM type 2 [ 2 ]. In recent years, studies have substantiated the relationship of sugar sweetened beverages and cardiovascular diseases, type 2 DM and long term weight gain [ 3 ]. The incidence of DM is on the rise and it has been predicted that it will increase by a double by the year 2030 [ 4 ]. DM is known to have many complications and one of the most distressing is Diabetic Foot Ulcer (DFU) which affects 15% of people with diabetes [ 5 ]. The incidence and importance of this complication is highlighted by the fact that papers on diabetic foot in Pub-Med have increased from 0.7% in the 1980-88 to 2.6% in 1998-2004 [ 6 ]. DFU is prone to infections, chronicity and recurrence which eventually affect the mental health of patients [ 7 ]. A benign looking ulcer in a patient with diabetes often ends up in amputation. A study in the United States reported that 38% of all the amputations were associated with DM [ 8 ]. This can lead to severe morbidity and mortality. Therefore DFU puts enormous financial burden on the patient and the health care services, even though it is preventable [ 9 ]. The successful DFU management strategies involve intensive prevention, early assessment and aggressive treatment by a multi-disciplinary team of experts. The aim of this review is to discuss the current diagnostic and management options for diabetic foot ulcer. DFU is characterized by a classical triad of neuropathy, ischemia, and infection [ 5 ]. Due to the impaired metabolic Continue reading >>

Diabetic Ulcers

Diabetic Ulcers

LYRICA is contraindicated in patients with known hypersensitivity to pregabalin or any of its other components. Angioedema and hypersensitivity reactions have occurred in patients receiving pregabalin therapy. There have been postmarketing reports of hypersensitivity in patients shortly after initiation of treatment with LYRICA. Adverse reactions included skin redness, blisters, hives, rash, dyspnea, and wheezing. Discontinue LYRICA immediately in patients with these symptoms. There have been postmarketing reports of angioedema in patients during initial and chronic treatment with LYRICA. Specific symptoms included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There were reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Discontinue LYRICA immediately in patients with these symptoms. Antiepileptic drugs (AEDs) including LYRICA increase the risk of suicidal thoughts or behavior in patients taking AEDs for any indication. Monitor patients treated with any AED for any indication for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses showed clinical trial patients taking an AED had approximately twice the risk of suicidal thoughts or behavior than placebo-treated patients. The estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one patient for every 530 patients treated with an AED. The most common adverse reactions across all LYRICA clinical trials are dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, constipation, euphoric mood, balance Continue reading >>

Diabetic Foot: Surgical Approach In Emergency

Diabetic Foot: Surgical Approach In Emergency

Copyright © 2013 C. Setacci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Critical limb lschemia (CLI) and particularly diabetic foot (DF) are still considered “Cinderella” in our departments. Anyway, the presence of arterial obstructive disease increases the risk of amputation by itself; when it is associated with foot infection, the risk of amputation is greatly increased. Methods. From January 2007 to December 2011, 375 patients with DF infection and CLI have been admitted to our Unit; from 2007 to 2009, 192 patients (Group A) underwent surgical debridement of the lesion followed by a delayed revascularization; from 2010 to 2011, 183 patients (Group B) were treated following a new 4-step protocol: (1) early diagnosis with a 24 h on call DF team; (2) urgent treatment of severe foot infection with an aggressive surgical debridement; (3) early revascularization within 24 hours; (4) definitive treatment: wound healing, reconstructive surgery, and orthesis. We reported rates of mortality, major amputation, and foot healing at 6 months of followup. Results. The majority of patients in both groups were male; no statistical differences in medical history and clinical condition were reported at the baseline. The main difference between the two groups was the mean time from debridement to revascularization (3 days in Group A and 24 hours in Group B). After 6 months of follow-up, mortality was 11% in Group A versus 4.4% in Group B. Major amputation rate was 39.6% and 24.6% in Groups A and B, respectively. Wound healing was achieved in 17.8% in Group A and 20.8% in Group B. Conclusions. Continue reading >>

Diabetic Foot Pathophysiology

Diabetic Foot Pathophysiology

Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus . Due to arterial abnormalities and diabetic neuropathy and delayed wound healing, infection or gangrene of the foot is relatively common. The key components of diabetic foot are neuropathy , angiopathy and trauma . [1] The most important cause of diabetic foot is neuropathy . This presence, to some extent, is more than half of the patients with diabetes older than 60 years old. Peripheral neuropathy usually is profound at the point where it leads to the formation of a foot ulcer. What causes neuropathy and why it occurs is not fully known. It is most likely caused by a combination of factors such as; high blood glucose, reactive oxygen species , vasculopathy, reduced oxygenation of the nerves, inflammation , autoimmunity in diabetes, genetic factors, mechanical injury, smoking and alcohol abuse . Generalized symmetric distal polyneuropathy is the most common and widely recognized form of diabetic neuropathy leading to diabetic foot ulcer. It may be either sensory or motor, and involves small fibers, large fibers or both. The clinical manifestations are divided into the three types of sensory, motor and autonomic neuropathy. Motor neuropathy causes wasting of small muscles of the feet with hammer toes and weakness of hands and feet. Abnormal thresholds for warm thermal perception Autonomic neuropathy is the increased or decreased blood flow to the foot (hot foot) with an increased risk of charcot neuroarthropathy , decreased sweating, dry skin, impaired vasomotion and blood flow. These lead to cold feet which ultimately result into the loss of skin integrity, providing a vulnerable site for infection [2] . Micro and macrovascular complications are the leading cause of diabetic compli Continue reading >>

Diabetic Foot Infections: An Update On Treatment

Diabetic Foot Infections: An Update On Treatment

US Pharm. 2013;38(4):23-26. ABSTRACT: Foot infections are a common and serious complication of diabetes. While gram-positive cocci—particularly staphylococci and streptococci—are the most common causes of mild-to-moderate infections, mixed gram-positive cocci and gram-negative bacilli with or without anaerobic organisms tend to cause chronic infections. Mild infections should be treated on an outpatient basis with oral antibiotics directed against staphylococci and streptococci, and severe infections should be treated initially with broad-spectrum parenteral antibiotics on an inpatient basis, followed by oral antibiotics when possible. Pharmacists play an important role in educating health care professionals and patients about the proper treatment and prevention of diabetic foot infections. Foot infection, a common and serious complication of diabetes, increases the risk of hospitalization, amputation, and death. According to the CDC, 25.8 million Americans have diabetes, and these patients have up to a 3% annual risk and a 25% lifetime risk of developing a foot ulcer.1,2 In 2007, hospitalization for ulcer, inflammation, and/or infection as a primary diagnosis was 5.7 per 1,000 diabetic patients.1 Diabetic ulceration is the primary cause of 85% of all lower-extremity amputations.2,3 Mortality following amputation ranges from 13% to 67% after 1 year, 35% to 65% after 3 years, and 31% to 39% after 5 years.4,5 Given this increase in morbidity and mortality, the treatment and prevention of diabetic foot infections (DFI) are key. It is estimated that 40% of amputations could be prevented with appropriate wound care.2 The Infectious Diseases Society of America (IDSA) updated its guidelines for the treatment of DFIs in 2012.6 This review is intended to educate pharmacists Continue reading >>

Diabetic Neuropathy: Pathophysiology And Prevention Of Foot Ulcers

Diabetic Neuropathy: Pathophysiology And Prevention Of Foot Ulcers

Diabetic neuropathy, which affects 60% to 70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes, often leading to foot ulcers and potentially to lower limb amputations, both of which are preventable. The physiologic, structural, and functional changes associated with diabetic neuropathy and foot ulcers are discussed. Advanced practice nurses are in a unique position to implement strategies for the prevention of serious and debilitating complications from diabetic neuropathy, including foot assessment, education, and specialist referrals. Research evidence is given to support the use of the Semmes-Weinstein monofilaments to evaluate decreased plantar sensation, a common precursor to ulceration. Ongoing patient and family education can emphasize the importance of preventive self-care measures. Referrals for specialist care and therapeutic footwear can be made by advanced practice nurses. If begun early, these interventions can prevent foot ulcers from diabetic neuropathy, thereby improving the quality of life and reducing healthcare costs for this chronic disease. GEORGE A. ZANGARO is a clinical nurse specialist and a Lieutenant in the United States Navy, currently stationed at Roosevelt Roads, Puerto Rico. He holds a master of science degree in Medical Surgical Nursing from the University of Maryland, School of Nursing, Baltimore, Maryland. This article was written during Lt. Zangaro's master's program. MARGARET M. HULL is an assistant professor at the University of Maryland, School of Nursing, Department of Adult Health, where she teaches nursing research in the undergraduate program and medical surgical and oncology nursing in the advanced practice graduate programs. She received her doctorate from the University of Continue reading >>

Diabetic Foot Ulcer

Diabetic Foot Ulcer

Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. Wound healing is an innate mechanism of action that works reliably most of the time. A key feature of wound healing is stepwise repair of lost extracellular matrix (ECM) that forms the largest component of the dermal skin layer.[1] But in some cases, certain disorders or physiological insult disturbs the wound healing process. Diabetes mellitus is one such metabolic disorder that impedes the normal steps of the wound healing process. Many studies show a prolonged inflammatory phase in diabetic wounds, which causes a delay in the formation of mature granulation tissue and a parallel reduction in wound tensile strength.[2] Treatment of diabetic foot ulcers should include: blood sugar control, removal of dead tissue from the wound, wound dressings, and removing pressure from the wound through techniques such as total contact casting.[3] Surgery in some cases may improve outcomes.[3] Hyperbaric oxygen therapy may also help but is expensive.[3] It occurs in 15% of people with diabetes,[4] and precedes 84% of all diabetes-related lower-leg amputations.[5] Classification[edit] Diabetic foot ulcer is a complication of diabetes. Diabetic foot ulcers are classified as either neuropathic, neuroischaemic or ischaemic.[6] Risk factors[edit] Risk factors implicated in the development of diabetic foot ulcers are infection, older age,[7] diabetic neuropathy, peripheral vascular disease, cigarette smoking, poor glycemic control, previous foot ulcerations or amputations,[5] and ischemia of small and large blood vessels.[8][9] Prior history of foot disease, foot deformities that produce abnormally high forces of pressure, renal failure, oedema, impaired ability to look Continue reading >>

Management Of Diabetic Foot Ulcers

Management Of Diabetic Foot Ulcers

INTRODUCTION The lifetime risk of a foot ulcer in patients with diabetes (type 1 or 2) may be as high as 25 percent [1-3]. Diabetic foot ulcers are a major cause of morbidity and mortality, accounting for approximately two-thirds of all nontraumatic amputations performed in the United States [4,5]. Infected or ischemic diabetic foot ulcers account for approximately 25 percent of all hospital stays for patients with diabetes [6]. These observations illustrate the importance of prompt and appropriate treatment of foot ulcers in patients with diabetes. The management of diabetic foot ulcers, including local wound care, use of mechanical offloading, treatment of infection, and indications for revascularization are reviewed here. The evaluation of the diabetic foot and specific management of the threatened limb are reviewed separately. (See "Evaluation of the diabetic foot" and "Treatment of chronic lower extremity critical limb ischemia".) ETIOLOGY Risk factors that can lead to foot wounds in patients with diabetes include loss of protective sensation due to neuropathy, prior ulcers or amputations, foot deformity leading to excess pressure, external trauma, infection, and the effects of chronic ischemia, typically due to peripheral artery disease [1]. Patients with diabetes also have an increased risk for nonhealing related to mechanical and cytogenic factors, as well as a high prevalence of peripheral artery disease. (See "Evaluation of the diabetic foot", section on 'Risk factors'.) ULCER CLASSIFICATION The first step in managing diabetic foot ulcers is assessing, grading, and classifying the ulcer. Classification is based upon clinical evaluation of the extent and depth of the ulcer and the presence of infection or ischemia, which determine the nature and intensity of tr Continue reading >>

Diabetic Foot Problems: Prediabetic Foot Problems: Prevvention Andention And Managementmanagement

Diabetic Foot Problems: Prediabetic Foot Problems: Prevvention Andention And Managementmanagement

© NICE 2017. All rights reserved. Subject to Notice of rights (rights). YYour responsibilityour responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Diabetic foot problems: prevention and management (NG19) © NICE 2017. All rights reserved. Subject to Notice of rights (conditions#notice-of-rights). Page 2 of 49 ContentsContents Overview ............................................................................................... Continue reading >>

An Overview Of Diabetic Foot Disease Dahiru Il, Amaefule Ke, Okpe Io, Ibrahim A, Muazu Sb - Niger J Basic Clin Sci

An Overview Of Diabetic Foot Disease Dahiru Il, Amaefule Ke, Okpe Io, Ibrahim A, Muazu Sb - Niger J Basic Clin Sci

The incidence of diabetes globally is reaching an epidemic proportion and with it carries the risk of complications and diabetic foot disease inclusive. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischaemia and abnormal foot structure and biomechanics. Early recognition of the aetiology of these lesions is important for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection and revascularisation of ischaemic limbs are the mainstays of treatment. Even with proper management, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents and negative pressure wound therapy. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google scholar and hand searching of bibliographies of published articles using the keywords: Diabetes, diabetic foot, neuropathy, peripheral arterial disease and ulceration. The enormity of the challenges associated with the management of this important complication of diabetes, coupled with the various progresses being made in this area, and the need to streamline the principles of management, especially in our environment prompted us to review this subject matter. Keywords:Diabetes, diabetic foot, neuropathy, peripheral arterial disease, ulceration Dahiru IL, Amaefule KE, Okpe IO, Ibrahim A, Muazu SB. An overview of diabetic foot disease. Niger J Basic Clin Sci 20 Continue reading >>

Diabetes Complications

Diabetes Complications

Mechanisms Hyperglycemia Tissue damage *Repeated acute changes in cellular metabolism **Cumulative long term changes in stable macromolecules Genetic susceptibility Independent accelerating factors * Sorbitol accumulation ï‚ NADH/NAD ratio  Myoinositol early glycation ** Forming advanced glycation end products Independent accelerating factors: - HT - Hyperlipidemia - Smoking Macro-vascular Complications The major cardiovascular risk factors in the non-diabetic population (smoking, hypertension and hyperlipidemia) also operate in diabetes, but the risks are enhanced in the presence of diabetes. Overall life expectancy in diabetic patients is 7 to 10 years shorter than non-diabetic people. Macro-vascular Disease Once clinical macro-vascular disease develops in diabetic patients they have a poorer prognosis for survival than normoglycemic patients with macrovascular disease The protective effect females have for the development of vascular disease are lost in diabetic females CAD Morbidity and Mortality in Type 2 DM Framingham Data: 20 year follow-up:Age 45-74: 2-3 fold increase in clinically evident atherosclerotic disease in diabetics women diabetics=male diabetics in terms of CAD mortality Multiple Risk Factor Intervention Trial (MRFIT) 5000 men with type 2 DM Followed for 12 years Men with type 2 DM had absolute risk of CAD-related death 3 times higher than non-diabetic cohort To further focus on the epidemiology of coronary disease in type 2 diabetes, it is important to understand that diabetics have a significantly increased risk when compared to their non-diabetic cohorts. Framingham data with 20 year follow-up on patients aged 45 to 74 revealed that diabetics had a 2-3 fold increase in clinically evident atherosclerotic disease. Furthermore, women diabeti Continue reading >>

Diabetic Foot Ulcers

Diabetic Foot Ulcers

Ulceration in diabetic foot due to lack of protective sensation Epidemiology incidence approximately 12% of diabetics have foot ulcers most common medical complication causing diabetics to get medical treatment foot ulcers are responsible for ~85% of lower extremity amputations risk factors factors associated with decreased healing potential uncontrolled hyperglycemia inability to offload the affected area poor circulation infection poor nutrition factors associated with increased healing potential serum albumin > 3.0 g/dL total lymphocyte count > 1,500/mm3 Pathophysiology neuropathy has largest effect on diabetic foot pathology sensory dysfunction leads to lack of protective sensation and is primary risk factor for ulcer development autonomic dysfunction leads to drying of skin due to lack of normal glandular function net effect is increased mechanical and axial stress on skin that is more prone to injury due to drying angiopathy lesser effect than neuropathy >60% of diabetic ulcers have decreased blood flow due to peripheral vascular disease Associated conditions infection / osteomyelitis high rates of associated osteomyelitis if bone is able to be probed, or is exposed at the base of the ulcer organisms usually polymicrobial gram-positive most common pathogens are aerobic gram positive cocci (s. aureus) gram-negative increased gram-negative organisms are found in chronic wounds and wounds recently treated with antibiotics anaerobes obligate anaerobic pathogens with ischemia or gangrene deep cultures and bacterial biopsies help guide management Prognosis diabetic foot ulceration is considered the most likely predictor of eventual lower extremity amputation in patients with diabetes mellitus Classification Wagner Classification and Treatment Description Treatment Grade Continue reading >>

Ppt Management Of The Diabetic Foot Powerpoint Presentation | Free To View - Id: 15df2c-zwnlo

Ppt Management Of The Diabetic Foot Powerpoint Presentation | Free To View - Id: 15df2c-zwnlo

After you enable Flash, refresh this webpage and the presentation should play. PPT MANAGEMENT OF THE DIABETIC FOOT PowerPoint presentation | free to view - id: 15df2c-ZWNlO The Adobe Flash plugin is needed to view this content ... www.w3.org/1999/02/22-rdf-syntax-ns#' xmlns:iX='... xmlns:xapMM='... PowerPoint PPT presentation The Diabetic Foot may be defined as a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in 50 of all lower limb amputations are diabetes 70 of lower limb amputations are preceded by a 3-10 of those with diabetes have a foot ulcer 15 of those with diabetes will, during their lifetime develop an ulcer ( at any one time 20 80 of foot ulcers are precipitated by external Diabetic patients are 15x at risk of BKA than Up to 50 of patients who receive a BKA undergo a contralateral amputation within 1-3 years 3 year mortalilty after amputation is 20-50 In no trauma related lower limb amputations foot ulcers precede 84 of amputations and 50 of such amputations will be in patients with Diabetic nephropathy is the leading cause of ESRD All stages of diabetic nephropathy are associated The rate of lower limb amputation in patients is Rate of lower limb amputation among diabetic patients with ESRD is 10x that of the general 2/3 of patients with diabetes ESRD who have lower limb amputations die within 2 years Financial - to NHS 251.5 m( annual cost of How to manage the non ulcerated/ulcerated foot Chronic sensorimotor neuropathy the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after Studies indicate neuropathy present in 90 of Acute or subacute inflammation of all or part of the foot in people with diabetes complicated by distal symmetrical neuropathy, accompanying fra Continue reading >>

The Diabetic Foot

The Diabetic Foot

CONTENT Definition Epidemiology Social & Economic factors Pathophysiology of foot ulceration Diabetic Neuropathy Peripheral Vascular Disease & Diabetes Biomechanics of Foot Wear The Diabetic Foot Ulcer Outcome & Management Neuro-osteoarthropathy Amputation in Diabetic Patient Prevention of Foot Problem Diabetic Foot Definition: Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb (based on WHO definition) Epidemiology 40% - 60% of all non traumatic lower limb amputation 85% of diabetic related foot amputation are preceded by foot ulcer 4 out of 5 ulcer in diabetics are precipitated by trauma 4% -10% is the prevalence of foot ulcer in diabetics Epidemiology In Sudan: Prevalence of DM ? 6 – 12 % DSF inpatient KTH : 30% - 40% risk of major amputation 8% - 20% mortality Social & Economic Factors Diabetic foot complications are expensive : (cost of healing 7000-10000 USD) (healing with amp. 43000-63000USD) In Khartoum : (4 weeks dressing cost 110000SD) Intervention of foot care is cost effective in most societies Scarce information regarding long term prognosis Diabetic Neuropathy Sensorimotor & peripheral sympathatic neuropathy are major risk factors for ulcer History & careful foot examination are mandatory to diagnose neuropathy Up to 50%of type2 diabetic patient have significant neuropathy & at risk of foot ulcer Periphral vascular disease& diabetic PVD PVD is the most important factors related to outcome of diabetic foot ulcer PVD is diagnosed by simple clinical examination non invasive vascular test determines probability of healing Symptoms of ischemia may be masked by neuropathy Microangiopathy shouldn't be accepted as primary cause of ulcer Conservat Continue reading >>

More in diabetes