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Pie Diabético: de la Fisiopatología a la clínica

Diabetes Internacional 03/2009; 1(3):15-22.

ABSTRACT La diabetes mellitus constituye una epidemia que afecta cada día un mayor número de personas y en consecuen-cia, la cantidad de pacientes que desarrollan complica-ciones derivadas de esta condición es mayor. Dentro de estas complicaciones, una de las más temidas es el pie diabético, el cual se define como la ulceración, infección y destrucción de los tejidos del pie, presentándose en un 17% de los Diabéticos. Clásicamente se consideran tres factores principales que conducen al pie diabético: 1) La neuropatía, causada por las alteraciones en el me-tabolismo de las células nerviosas como consecuencia de un nivel elevado de glucosa, que conlleva a una se-rie respuestas metabólicas anómalas; 2) La macroangio-patía, resultante de la aterosclerosis de las arterias del miembro inferior, lo cual conlleva a isquemia; y 3) La microangiopatía y la disfunción endotelial característica del diabético que afecta la vasa vasorum y la vasa nervo-rum. También los cambios biomecánicos conducen a al-teraciones osteomusculares y osteoarticulares, siendo la más atroz la osteoartropatía autonómica diabética o pie de Charcot. Estos factores conducen a la úlcera del pie diabético -la cual puede ser agravada por infección de la misma y como consecuencia del mal cuidado-y que aún practicando las medidas generales y terapéuticas con-vencionales, puede evolucionar a la gangrena del miem-bro. Recientemente nuevas líneas de tratamiento que van desde la antibióticoterapia, pasando por el tratamiento quirúrgico como revascularizaciòn, la amputación han sido implementadas, y actualmente se experimenta con factores de crecimiento y células madres, entre otras, con la finalidad de mejorar la calidad de vida del diabético y su entorno familiar.

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