Diabetes Management 3: The Pathogenesis And Management Of Diabetic Foot Ulcers

Diabetes management 3: the pathogenesis and management of diabetic foot ulcers

Diabetes management 3: the pathogenesis and management of diabetic foot ulcers
The final part in this three-part series on diabetes looks at causes, management and complications of diabetic foot ulcers.This article comes with a handout for a journal club discussion
Two frequent features of diabetes are peripheral vascular disease leadingto ischaemic lower limb extremities, and sensory neuropathy, which renders the patient prone to foot injury and vulnerable to the development of diabetic footulcers. This final article in our three-part series on diabetes describes the clinical features of the diabetic foot and discusses the importance of early assessment and effective management.
Citation:Nigam Y, Knight J (2017) Diabetes management 3: the pathogenesis and management of diabetic foot ulcers. Nursing Times [online]; 113: 5, 51-54.
Authors:Yamni Nigam is associate professor in biomedical science; John Knight is senior lecturer in biomedical science; both at the College of Human Health and Science, Swansea University.
This article has been double-blind peer reviewed
Scroll down to read the article or download a print-friendly PDF here
Download the Nursing Times Journal Club handout here to distribute with the article before your journal club meeting
In this series, read part 1 here and part 2 here
Diabetes is a costly disease that takes a heavy toll both on patients and families, as well as on healthcare resources. It is estimated to affect around 3.2million people in the UK and to take up a tenth of the NHS budget (Hex et al, 2012). Disease of the foot is one of th Continue reading

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Understanding diabetes testing: Where are we, and where are we going?

Diabetes is a prevalent and pressing health concern, affecting 29.1 million people in the United States alone—8.1 million of whom are as-of-yet undiagnosed.1 While people with diabetes make up more than nine percent of the entire U.S. population, the Centers for Disease Control and Prevention (CDC) estimates that 86 million more people have some level of prediabetes,2 meaning they have blood glucose or hemoglobin A1c levels that are elevated but not to the point that they demonstate frank type 2 diabetes. Prediabetes is an increased likelihood of developing diabetes.
Worldwide, in 2015, there were 415 million people with diabetes. That number is expected to jump to 642 million people by the year 2040. North America, the Caribbean, and Europe will experience incremental growth in diabetes cases during that time, but other regions of the world will see numbers of patients with diabetes more than double (Table 1). A total of $673 billion—12 percent of global health expenditure—is allocated to diabetes.3
Type 1 and type 2
Not everyone with prediabetes will develop diabetes; however, an estimated 15 to 30 percent will develop non-insulin-dependent type 2 diabetes within five years.4 Non-insulin-dependent diabetes was formulated as a category after the discovery, in 1959, that some people with diabetes still produce insulin.5 Insulin-dependent diabetes, originally called “juvenile” diabetes, is categorized as type 1 and manifests with symptoms that are sudden and dramatic.
This distinction between type 1 and type 2 should not be seen as minimizing the health risks assoc Continue reading

Low Fat Diets and Exercise for Type2 Diabetes T2D 41

Home / Diabetes , Health and Nutrition /Low Fat Diets and Exercise for Type2 Diabetes T2D 41
Low Fat Diets and Exercise for Type2 Diabetes T2D 41
Several years back, the monumental task of recommending an optimal diet for type 2 diabetics was assigned to Dr. Richard Kahn, then the chief medical and scientific officer of the American Diabetes Association (ADA). Like any good scientist, he began by reviewing the available published data.
When you look at the literature, whoa is it weak. It is so weak , he said. But that was not an answer that the ADA could give. People demanded dietary advice. So, without any evidence to guide him one way or the other, Dr. Kahn went with the generic advice to eat a low fat, high carbohydrate diet. This was the same general diet advice given to public at large.
The United States Department of Agricultures food pyramid would guide food choices. The foods that formed the base of the pyramid, the ones to be eaten preferentially were grains and other refined carbohydrates. These are the exact foods that caused the greatest increase in blood glucose. This was also the precise diet that failed to halt obesity and type 2 diabetes epidemics in generations of Americans.
Lets juxtapose these two incontrovertible facts together.
Type 2 diabetes is characterized by high blood glucose.
Refined carbohydrates raise blood glucose the most.
Type 2 diabetics should eat the very foods that raise blood glucose the most? Illogical is the only word that comes to mind. This happened, not just in the United States, but around the world. The British Diabe Continue reading

Test may miss diabetes in some African-Americans

More than 200 scientists from around the world teamed up to study the genetics of hemoglobin A1c (HbA1c), or "glycated hemoglobin", a measurement used by clinicians to diagnose and monitor diabetes. The authors report that they have identified 60 genetic variants that influence HbA1c measurements, as well as the ability of this test to diagnose diabetes. The gene variants, including one that could lead to African Americans being underdiagnosed with T2D, are described in PLOS Medicine in a paper by James Meigs of Harvard Medical School, USA, and Inês Barroso of the Wellcome Trust Sanger Institute, UK, and colleagues.
Levels of HbA1c in a given person depend on both blood glucose levels and characteristics of that person's red blood cells. In the new work, researchers analyzed genetic variants associated with each of these factors, together with HbA1c levels in 160,000 people without diabetes from European, African, and Asian ancestry who had participated in 82 separate studies worldwide. 33,000 people were followed over time to determine whether they were later diagnosed with diabetes.
The team identified 60 genetic variants--42 new and 18 previously known--that impact a person's HbA1c levels. People who had more variants that affect HbA1c levels through effects on blood glucose levels were more likely, over time, to develop diabetes (odds ratio 1.05 per HbA1c-raising allele, P=3x10-29). However, people who had more variants that affected HbA1c through effects on red blood cells did not have an increased diabetes risk. The impact of genetic variants on HbA1c levels was larg Continue reading

Managed Care Updates: Medicare and CGM, Omada Health Hires, Council for Diabetes Prevention Officers

CMS Takes Step Toward Medicare Coverage of CGM for Seniors With Diabetes
CMS has updated its definition of durable medical equipment to include continuous glucose monitors (CGMs) that are approved for dosing, a step that advocacy groups hailed as the first toward getting the devices covered by Medicare.1
The policy change was announced January 12, 2017, by JDRF, formerly known as the Juvenile Diabetes Research Foundation, which has led the drive for CGM coverage in Medicare. In a statement, JDRF said the new definition created a “pathway toward the extension of coverage for the devices that will bring the nation’s largest insurer in line with the vast majority of the country’s private payers.”2
“JDRF is encouraged by this decision, which will bring us one step closer to Medicare coverage for continuous glucose monitors,” said Aaron Kowalski, PhD, chief mission officer. The group thanked leaders in Congress who had pressed for this change, including Senators Susan M. Collins (R-ME) and Jeanne Shaheen (D-NH).2 Collins previously authored a commentary in support of CGM coverage in Evidence-Based Diabetes Management™, stating that Medicare’s blanket denial of CGM reimbursement was at odds with the positions of the FDA and the National Institutes of Health.3
CGMs, which give patients real-time data on their blood glucose levels—and where they are headed—has been shown to help patients reduce glycated hemoglobin and greatly limit glucose variability, the highs and lows in blood glucose levels that have harmful health effects. Because the original FDA approval Continue reading