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Aug 21, 2023

Multidisciplinary approaches for the prevention and management of diabetic x disease – Guidelines

Diabetic foot disease is the most common cause of hospitalization for diabetes. Patients with diabetic foot have a higher risk of amputation and death, and thus it is important to standardize their diagnosis and treatment.

Epidemiological studies have shown that diabetic foot ulcers (DFUs) have a prevalence of 5–10% and an incidence of 6.3%. Diabetic foot disease is the most common cause of hospitalization for diabetes. Patients with diabetic foot have a higher risk of amputation and death, and thus it is important to standardize their diagnosis and treatment. The prognosis of DFUs is poor: this disease is debilitating to quality of life, often leading to nontraumatic lower extremity amputation and even mortality. The most common etiologies of DFU include neuropathic (approximately 55%), arterial (10%) and neuroischemic causes (approximately 35%). ). The healing rate of DFUs after 12 weeks of treatment is 24–82% [2], and the recurrence rate is as high as 60%.

The ‘Guidelines on a multidisciplinary approach for the prevention and management of diabetic foot disease (2020 edition)’ was compiled by professional from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology.

Diabetic foot is frequently a challenging condition in clinical practice, with issues including infection, neuropathy and vascular lesions, but the underlying soft tissue and bone healing abnormalities should also be taken into consideration, especially in people with a long duration of foot disease and glycated hemoglobin A1c (HbA1c) >7%. Therefore, the assessment should be comprehensive and thorough, with special focus on infections, lower extremity peripheral vascular disease, preoperative risk stratification and treatment risk assessment.

A comprehensive medical evaluation should be performed on all patients diagnosed with diabetes, especially for important organs such as the heart, brain and kidney and their levels of risk, and an assessment of lower limb disease should be made.

Diabetic foot infection (DFI) is a clinical diagnosis based on local signs (erythema, swelling, warmth, pain). Systemic inflammatory symptoms may be present in severe infection

In all patients suspected of having DFIs, plain film radiography of the foot is recommended to determine bone abnormalities (deformities, damage), soft tissue gases and foreign bodies (strong; moderate). When DFO is diagnosed, advanced medical imaging, such as MRI (strong; low), is recommended

All patients with diabetes (regardless of the presence or absence of ulceration) should undergo peripheral arterial assessment at least annually, including an updating of the medical history and pedal pulse palpation. Patients aged >50 years who had a previous history of DFUs, cardio-cerebral atherosclerosis, previous vascular intervention, bypass surgery or abnormal lower extremity blood vessel conditions should have peripheral assessment performed at least once every 1–3 months.

The ABI is currently the first choice for evaluating PAD; together with the toe-brachial index (TBI), Doppler ultrasound of the dorsal or posterior tibial artery and transcutaneous oxygen pressure can improve the diagnostic accuracy of lower limb ischemia. When noninvasive examinations indicate the presence of ischemia, further investigation may be needed to aid in the planning of a lower limb revascularization approach.

The assessment of DPN should include a light touch sensation test with a 10-gram monofilament and other neurological tests, such as vibration perception, sharp/blunt sensation, hot/cold temperature sensation and ankle reflex.

Establish a multidisciplinary limb protection team comprising endocrinologists, foot and ankle (podiatric) surgeons, vascular surgeons and infectious disease physicians; if necessary, promptly request referral to a specialist diabetic foot treatment center to help reduce amputation and mortality rates in patients with diabetic foot disease.

Good glycemic control (avoiding hypoglycemia) enables the healing of DFUs and reduces the risk of foot ulcer infection and amputation in patients (strong; moderate).

Authors: Aiping Wang,Guozhong Lv, Xingbo Cheng, Xianghua Ma,Wei Wang, Jianchao GuiJi HuMeng LuGuoping ChuJin’an ChenHao ZhangYiqiu JiangYuedong ChenWengbo YangLin JiangHoufa GengRendong ZhengYihui Li, Wei FengBoey JohnsonWenjuan WangDalong Zhu, and Yin Hu

Newspaper Burns Trauma. 2020; 8: tkaa017.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336185/