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ABSTRACT: Diabetic complications in the lower extremities, especially those secondary to diabetic macroangiopathy, have increasingly become a clinical emergency, given the high prevalence and progression of the disease. Until recently, the only approach to treating advanced stage disease was medical therapy and major amputation; however, the advent of revascularization procedures has radically improved the prognosis of patients with critical lower limb ischemia. In this setting, iloprost holds a dual position: as first-choice therapy in patients ineligible for revascularization and as complementary therapy in candidates for surgical or endovascular revascularization.
Minerva cardioangiologica 02/2011; 59(1):101-8.
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ABSTRACT: This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn(R) Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.
The International Journal of Lower Extremity Wounds 03/2010; 9(1):10-5. · 1.20 Impact Factor
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ABSTRACT: Neuropathic leg ulcers (NLUs) affect more than 10% of diabetic patients with peripheral neuropathy and represent the most common cause of ulceration of the leg in these patients. Though their pathogenesis is well known, related to the chronic neuropathic edema, the management of NLUs, mainly based on elastocompression, is still controversial, with lower healing rates than nondiabetic venous leg ulcers. The authors tested if a novel gel formulation, containing amino acids and hyaluronic acid (Vulnamin)gel; Errekappa, Milan, Italy), will improve the outcomes of NLUs when used together with elastocompression. Thirty patients affected by NLU were randomized into 2 groups, both treated with 4-layer elastocompressive bandaging: patients in group A were topically treated with the application of Vulnamin) gel, whereas patients in group B received only the inert gel vehicle. The healing rate at 3 months was evaluated as the primary endpoint, whereas the secondary endpoints were healing time, reduction in ulcer area and ulceration score in 4 weeks, number of infective complications, and overall satisfaction of patients. Healing rate was significantly (P < .05) higher in patients in group A when compared with those in group B; healing time, patients' satisfaction, and reduction in ulcer area and ulceration score in 4 weeks were also higher in patients in group A. However, no significant differences were found in the prevalence of infections and other adverse events. The use of Vulnamin) gel with elastocompression is safe and effective in the management of NLUs of diabetic patients.
The International Journal of Lower Extremity Wounds 09/2009; 8(3):134-40. · 1.20 Impact Factor
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ABSTRACT: We retrospectively evaluated the safety and effectiveness of colistin alone or in combination with other antimicrobials in eight diabetic patients with severe diabetic foot infections due to multidrug resistant (MDR) Pseudomonas aeruginosa, complicated in 4 cases by osteomyelitis. All patients received colistin after other ineffective antimicrobial treatment, when MDR P. aeruginosa strains were isolated by cultural examination and together with a multidisciplinary care approach including revascularization, surgical debridement and adequate offloading. The mean duration of therapy was 72 +/- 52.9 days. Six out of 8 patients (75%) successfully benefited from colistin therapy, while 2 patients failed and/or experienced side effects that led to discontinuation of therapy. Serious adverse events (i.e. acute renal failure and pulmonary edema) were observed in 1 patient. Our data allow us to conclude that colistin, alone or in combination with other antimicrobials, is safe and effective when administered as part of a multidisciplinary approach, to promote healing of diabetic foot infection due to MDR P. aeruginosa.
Journal of chemotherapy (Florence, Italy) 01/2007; 18(6):648-51. · 1.08 Impact Factor
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ABSTRACT: The evaluation of the safety and effectiveness of colistin in association with rifampin and imipenem in 1 diabetic patient with severe diabetic foot infection (DFI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa, complicated by osteomyelitis, is presented in this "Case Report". The patient received colistin after other ineffective antimicrobial treatment when an MDR P aeruginosa strain was isolated by cultural examination, together with a multidisciplinary care approach including surgical debridement and adequate offloading. The efficacy of combination colistin plus rifampin plus imipenem was observed with a checkerboard method and bactericidal activity of the serum. The patient received colistin combination therapy for 6 weeks with cure of the infection and without renal toxicity. These data suggest that colistin, in combination with rifampin and imipenem, is safe and effective, in promoting healing in DFI due to MDR P aeruginosa and suggest the need for controlled clinical studies.
The International Journal of Lower Extremity Wounds 10/2006; 5(3):213-6. · 1.20 Impact Factor
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A Piaggesi,
L Rizzo,
F Golia,
D Costi,
F Baccetti,
S Ciaccio,
S De Gregorio,
E Vignali,
D Trippi,
V Zampa,
C Marcocci,
S Del Prato
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ABSTRACT: To test the effectiveness of a combined approach to an early diagnosis of neuro-osteoarthropathy (NOA) of the diabetic foot, we studied a group of outpatients with active NOA, presenting for the first time to our Diabetic Foot Clinic in 1998, by means of an integrated approach designed to assess bone turnover.
Fifteen consecutive diabetic patients (five Type 1 and ten Type 2 diabetic individuals, age 61.9+/-12.2 years, diabetes duration 18.7+/-8.9 years, HbA(1c) 8.4+/-1.5%) with active NOA (Group 1) were compared to nine diabetic patients with chronic stable NOA (Group 2), 14 neuropathic diabetic patients without NOA (Group 3), 13 non-neuropathic diabetic patients (Group 4) and 15 healthy controls (Group 5). Determination of serum carboxy-terminal collagen telopeptide (ICTP), bone alkaline phosphatase isoenzyme (B-ALP), osteocalcin (BGP) concentrations, as well as urinary excretion of deoxypyridinoline (DPD) were obtained in all individuals for assessment of bone reabsorption and new bone formation. Moreover in all individuals quantitative ultrasound (QUS) of the calcaneal bone was performed and mass density of lumbar spine and femur bone was determined by dual-energy X-ray absorptiometry (DEXA).
QUS was significantly lower in the active NOA patients as compared with other groups (P<0.01), while ICTP was higher in both NOA groups (P<0.01). Urinary DPD was higher in the neuropathic non-NOA group (P<0.01) than the other groups, and osteocalcin was higher in healthy controls compared to diabetic patients without NOA. QUS and ICTP were inversely correlated (r=0.44, P=0.000). QUS in the active NOA group was significantly (P<0.01) lower in the affected compared to the unaffected foot.
Our results indicate a possible role for an integrated approach to the diagnosis and monitoring of NOA involving the diabetic foot. DPD may identify patients at-risk for NOA, ICTP could be tested as a marker for NOA in asymptomatic cases. Finally, QUS of the calcaneal bone may be useful in discriminating active versus quiescent phases.
Diabetes Research and Clinical Practice 10/2002; 58(1):1-9. · 2.75 Impact Factor
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ABSTRACT: To test the safety and effectiveness of carboxyl-methyl-cellulose dressing (Aquacel; ConvaTec, UK) in the management of deep diabetic foot ulcers, a group of consecutive out-patients attending the foot clinic of the Department of Metabolic Diseases was studied.
Patients were selected according to the following inclusion criteria: a foot ulcer deeper than 1 cm for > 3 weeks, good peripheral blood supply (palpable peripheral pulses or ABPI > 0.9). Exclusion criteria were as follows: active infection, as evident from clinical signs (purulent discharge, redness, swelling, tenderness) and confirmed by culture exams, plasma creatinine > 2 mg/dl, recent episodes of ketoacidosis, malignancies, and any therapy or pathology which might interfere with the healing process. Twenty patients were enrolled in the study and having obtained their informed consent, their lesions were surgically debrided with the complete elimination of all necrotic tissue and debris up to the bleeding healthy tissue; then ulcers were staged and measured, and patients were randomly assigned to two different treatment groups. Patients in group A were dressed with saline-moistened gauze, while patients in group B were dressed with Aquacel according to the manufacturer's instructions. All patients in both groups received special post-operative shoes (Podiabetes; Zeno Buratto, Treviso, Italy) and crutches until complete re-epithelialization. Ulcers were all left to heal by secondary intent. After 8 weeks patients were blindly evaluated for: the rate of reduction of lesional volume (RLV), rate of granulation tissue (GT), number of infective complications (IC). Intralesional (ILTC) and perilesional (PLTC) temperatures were also recorded with a thermocouple surface digital thermometer, and the difference between the two values (Delta TC) was calculated. Healing time (HT, days), was then compared between the two groups. Data were compared by analysis of variance (ANOVA), linear regression, Kaplan-Meier survival analysis and Fisher's exact test.
HT was significantly shorter in Group B than in Group A (P < 0.001). RLV was significantly (P < 0.01) higher in Group B patients compared with Group A, as well as GT (P < 0.05). IC were in 1/10 Group B and in 3/10 Group A (P = 0.582). In addition, both ILTC and Delta TC were higher in Group B compared with Group A ones (P < 0.01).
Carboxyl-methyl-cellulose dressings were shown to be safe, effective and well tolerated in the management of non-ischaemic, non-infected deep diabetic foot ulcers.
Diabetic Medicine 04/2001; 18(4):320-4. · 2.90 Impact Factor
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ABSTRACT: Diabetic impotence is generally due to peripheral neuropathy, but a central pathway impairment has also been suggested. We evaluated somatosensory transmission in a group of impotent diabetic men to assess the role of central nervous system (CNS) involvement.
Somatosensory evoked potentials (SEPs) of pudendal (pdn) and posterior tibial (ptn) nerves were recorded in 74 patients. Type and duration of diabetes, severity of sexual dysfunction, medium term metabolic control, occurrence of microangiopathic chronic complications and autonomic neuropathy were evaluated.
Our data show an impairment of central conduction times in pdn (25.7%) and ptn (39.2%) greater than peripheral nervous impairment (pdn 12.2%, ptn 8.1%), in impotent diabetic patients without any further major complication. Central nervous conduction delay resulted to be correlated with poor glycemic control. Significant evident autonomic dysfunction was found only in a minority of cases.
Our data might suggest that altered conduction along CNS and somatic peripheral neuropathy might develop independently. We confirm the hypothesis of a "central diabetic neuropathy" and suggest that central sensory pathways involvement, not related to peripheral impairment, could play a role in the pathogenesis of erectile dysfunction in diabetic patients.
Acta Neurologica Scandinavica 07/1999; 99(6):381-6. · 2.47 Impact Factor
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ABSTRACT: To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studied. All patients who came to the clinic for the first time from January to December 1995 inclusive with an uncomplicated neuropathic ulcer were randomized into two groups. Group A received conservative treatment, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone segments underlying the lesion and surgical closure. Healing rate, healing time, prevalence of infection, relapse during a 6-month period following intervention and subjective discomfort were assessed. Twenty-four ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 +/- 13.46 yr, duration of diabetes 18.2 +/- 8.41 yr, HbA1c 9.5 +/- 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53 +/- 9.87yr, duration of diabetes 16.84 +/- 10.61 yr; HbA1c 8.9 +/- 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 +/- 86.60 days vs 46.73 +/- 38.94 days; p < 0.001). Infective complications occurred significantly more often in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower discomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatment of neuropathic foot ulcers in diabetic patients proved to be an effective approach compared to conventional treatment in terms of healing time, complications, and relapses, and can be safely performed in an outpatient setting.
Diabetic Medicine 06/1998; 15(5):412-7. · 2.90 Impact Factor
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ABSTRACT: Primary care of the diabetic patient with foot ulcer can be provided by medically or surgically trained practitioners. We have prospectively followed 90 sequential patients with newly developed foot ulcers from two major centers. One in the USA where the primary doctor was a podiatrist and one in Europe with a diabetologist. Thirty-four patients from Boston and 56 from Pisa (mean age, 55.6; range, 26-75 years; vs. 66.5; range, 35-94; P < 0.001), matched for sex, weight, type, duration of diabetes, renal impairment and retinopathy took part. Boston patients had more severe neuropathy, assessed with clinical examination utilizing a neuropathy disability score (NDS) (16 +/- 6 vs. 6 +/- 3 (mean +/- S.D.) P < 0.001) and vibration perception threshold (46 +/- 8 vs. 35 +/- 12 V: P < 0.001) while no difference existed in the number of patients with clinical infection, a history of lower extremity by-pass operation (6 (18%) vs. 3 (5%); P = NS) and in the size and the severity of the ulcer, according to the Wagner classification. Initial treatment was similar in both centers with emphasis on outpatient ulcer debridement, pressure relieving foot-wear and topical wound care. Hospitalization was needed in five (15%) Boston and 12 (21%) Pisa patients (P = NS) while surgery was performed on five (15%) Boston and 16 (29%) Pisa patients (P = NS). The in-hospital stay was similar in both centers (1.4 +/- 4.4 vs. 2.1 +/- 5.9 days; P = NS). The most common operations in both centers were incision, drainage and bone debridement. Ulcers healed in all patients but the amount of healing time was shorter in Boston patients (6.7 +/- 4.2 vs. 10.5 +/- 6.5 weeks; P < 0.02). We conclude that despite the differences in the two systems similar success rates were achieved in the two centers while a more surgically oriented strategy may have resulted in a slightly shorter healing time.
Diabetes Research and Clinical Practice 02/1997; 35(1):21-6. · 2.75 Impact Factor
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ABSTRACT: In order to test whether or not an in-service requalification course on diabetes care for health professionals (HP) of nondiabetological departments can enhance their level of knowledge about diabetes and the quality of care for diabetic inpatients admitted for reasons other than diabetes, we carried out a requalification course involving 171 HP (161 nurses and 10 midwives) from nondiabetological departments of our hospital. Areas of intervention were: general knowledge of diabetes (GKD), bedside monitoring of blood glucose (BMG), insulin preparation and administration (IPA), diagnosis and treatment of hypoglycemic crises (DTH), and hospitalization-related problems (HRP). HP, divided into groups of about 20 each, completed a basal evaluation by means of a 25-item multiple choice questionnaire, and then attended six separate educative sessions, each of focusing on one topic, consisting of a theory lesson and an interactive exercise of equivalent length. At the end of the course, HP were re-evaluated with the same questionnaire, and their skills in BMG, IPA and DTH were tested by means of specific operational checklists, which divided each complex operation into a sequence of single operations, and then compared them with those of a control group of untrained colleagues (CG). The global knowledge of diabetes after the courses significantly improved, as gathered from the percentages of correct answers in each questionnaire (61.82% +/- 23.64% vs 31.18% +/- 20.00%; P < 0.001); separate analysis of different areas evidenced improvements in GKD (72.28% +/- 12.47% vs 31.46% +/- 20.56%; P < 0.01), BMG (68.77% +/- 15.75% vs 37.50% +/- 27.75%; P < 0.01), IPA (72.02% +/- 11.72% vs 33.45% +/- 21.22%; P < 0.05), and DTH (90.76% +/- 6.86% vs 49.82% +/- 26.68%; P < 0.05), but not in HRP. Professional skills profiles of HP, evaluated by measuring the number of errors done performing each task, were significantly (P < 0.001) better than those of CG, for BMG (1.09 +/- 0.73 vs 4.91 +/- 2.01), IPA (2.36 +/- 1.64 vs 5.64 +/- 2.25), and DHT (1.27 +/- 0.94 vs 3.82 +/- 1.12). Linear regression showed a significant (P < 0.001) correlation of skills and knowledge after the course for BMG (r2 = .49), IPA (r2 = .53), and DTH (r2 = .61). Positive although nonspecific indicators of outcomes of the course were the increase (of about 100%) of requests to our metabolic unit for diabetological consultations from other departments as well as the mentioning of diabetes in the diagnosis of discharge, and the 20% increase in the consumption of sticks for BMG. The course produced a significant improvement of knowledge and skills on specific diabetological items among participants.
Acta Diabetologica 12/1996; 33(4):277-83. · 2.78 Impact Factor
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ABSTRACT: The present study was designed to evaluate whether autonomic diabetic neuropathy is a marker of severe cardiovascular disease. We recruited three groups of 12 patients each with the same age, sex and body weight distribution: Group DAN + (diabetics with neuropathy), Group DAN- (diabetics without neuropathy) and Group C (healthy control group). The patients underwent two-dimensional color Doppler echocardiography and maximal electrocardiographic exercise test by cycloergometer (multistage program with 25 W increments 3 min steps). Cardiovascular autonomic function was evaluated by Ewing's tests (heart rate and blood pressure measurement during lying to standing, deep breathing, handgrip isometric stress test and Valsalva manoeuvre). Heart rate and blood pressure proved to be significantly higher in the Group DAN+, than in the other groups, either at baseline or during stress test. Only 33% of DAN+ patients proved to reach 100 W during stress test, compared to 82% of DAN- and 87% of control subjects. No DAN+ patients reached 125 W, compared with 45% of DAN- and 58% of Group C patients. Echocardiographic examination showed normal left ventricular systolic function in all groups, without any significant difference in ventricular dimensions, and impaired left ventricular diastolic function in DAN+ patients, compared to Group C subjects (peak E 66.75 +/- 8.36 vs 73.49 +/- 12.53 cm/s; peak A 72.1 +/- 13.42 vs 59.75 +/- 13.26 cm/s; E/A 0.84 +/- 0.21 vs 1.38 +/- 0.15 and isovolumetric relaxation time 101 +/- 21 vs 70 +/- 17 ms). Our data suggest that diabetic autonomic neuropathy is a marker of reduced exercise tolerance and of diastolic left ventricular dysfunction.
Cardiologia (Rome, Italy) 11/1995; 40(10):769-73.
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ABSTRACT: We tested the level of knowledge on diabetes and professional skills in a group of 60 non-diabetological health care professionals at the Policlinic of Pisa regarding the recognition and treatment of hypoglycaemia, the storage, mixing and administration of insulin, blood glucose stick monitoring, and the prevention and treatment of diabetic foot. The evaluation was carried out using a multiple-choice questionnaire and observation of the subjects, performance by means of pre-defined observation schedules, during the preparation and administration of a blend of rapid-intermediate insulin, the use of blood glucose sticks and the management of a simulated hypoglycaemic crisis. As regards hypoglycaemia, 90% of subjects did not give a correct definition, 88.3% were unaware of the existence of asymptomatic hypoglycaemia, and 96.6% did not give a complete answer as to the treatment of hypoglycaemia. For insulin, 51.7% did not know the standards for correct storage of insulin, 88.3% did not know the difference between "clear" and "opaque" insulins, and 91.7% ignored the required interval between administration of regular insulin and meals. For foot care, 45% admitted that the problems with diabetics' feet were frequently not controlled, and between 21.7% and 63.3% did not known the hygiene rules for feet. Assessment of the performance of the subjects using schedules revealed incorrect use of sticks and administration of insulin (80.2% mixed and 92.4% injected the insulin incorrectly). There is clearly a need for education of non-diabetological health professionals regarding the disease. This is supported by the health professionals themselves, 94.5% of whom wished to participate in a course on diabetes.
Acta Diabetologica 02/1993; 30(1):25-8. · 2.78 Impact Factor
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ABSTRACT: Reports the cases of 2 insulin-dependent diabetic patients, a 30-yr-old woman and a 25-yr-old man, with a long history of frequent episodes characterized by sweatiness, anxiety, tremor, tachycardia, and confusion that they interpreted as hypoglycemia and that induced them to take large amounts of sugar with a consequent deterioration of metabolic control. A diagnosis of panic attack disorder was made using Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) criteria. Following therapy with antidepressants and psychotherapy, the Ss showed improved metabolic control and a progressive decrease in the frequency and severity of episodes. Greater attention to the mental status of diabetics and more collaboration between diabetologists and psychiatrists are suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
New Trends in Experimental & Clinical Psychiatry. 01/1970;
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ABSTRACT: In a group of 46 consecutive outpatients attending the diabetic clinic of our Metabolic Department, 30 insulin-dependent and 16 non-insulin-dependent diabetic patients in stable metabolic control, and in 38 age-matched controls, we measured vibration perception threshold with biothesiometer and autonomic function, by means of the five classical cardiovascular tests: R-R interval variations during deep breathing, Valsalva ratio, lying-to-standing, postural hypotension, and sustained handgrip. None of the patients complained of symptoms related to diabetic autonomic neuropathy (DAN) or sensory polyneuropathy. Vibration perception threshold positively correlated with Valsalva ratio (p < 0.05) and deep breathing (p < 0.01), and all of them correlated with age (p < 0.001), but not with duration of diabetes and metabolic control. Patients scored significantly lower than controls in vibration perception threshold and all of the autonomic function tests. According to the outcomes of cardiovascular tests ["Autonomic Score" (AS)] patients were divided into two different groups: presence (DAN+ = AS > or = 3) or absence (DAN- = AS < 3) of autonomic neuropathy. The DAN- group (n = 28, 60.9%) showed no significant differences from the DAN+ group (n = 18, 39.1%) in age, duration of diabetes, glycated hemoglobin, or body mass index. DAN+ patients had vibration perception threshold measured at the first toe tip and at external malleolus significantly higher than DAN- patients (p < 0.01 and p < 0.001, respectively) and controls (p < 0.005), as well as all the other cardiovascular tests except sustained handgrip. No difference in any of these items was observed between DAN- patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Diabetes and its Complications 6(3):157-62. · 2.03 Impact Factor
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ABSTRACT: The utilization of a computer-assisted information system may be both useful and efficacious in the care and follow-up of diabetic patients. The model developed by us operates under GCOS-6 on a Microsystem 6/10 Honeywell computer (20 MB hard-disk storage, 512 kb central memory) and allows the creation of clinical data files for individual patients, statistical analysis of the data, and a print-out of clinical records. The package, which may be employed on a multi-user system, is supplied with an easy to understand user's manual. It represents an effective tool for the precise management of the care of diabetic patients and also provides several opportunities for research.
Life support systems: the journal of the European Society for Artificial Organs 4(3):263-7.
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ABSTRACT: To investigate whether pain and paresthesias could identify two different subclasses of small-fibre diabetic neuropathy, and to evaluate their relation to the metabolic control, we tested nerve conduction velocity (NCV) of median nerve (sensitive-SM, and motor-MM) and deep peroneal nerve (DP) in 48 diabetics (24 IDDM, 24 NIDDM) reporting pain (group A) or paresthesias (group B) that might be due to diabetic polyneuropathy. Glycated haemoglobin (HbA1c) was also assessed. No difference between group A and group B was found either in NCV, in all nerves tested, or in HbA1c. No relation was observed between NCV of nerves tested and HbA1c, duration of diabetes, age and type of diabetes in both groups.
Functional neurology 4(2):141-6. · 1.52 Impact Factor
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ABSTRACT: The effects of individual teaching imparted during routine diabetologic counselling on the knowledge concerning diabetes and metabolic control, were assessed in 42 outpatients (28 IDDM; 14 NIDDM), attending the diabetic clinic (study group, SG). We evaluated the outcome of a multiple-choice questionnaire and fasting blood glucose (FBG), 24-h urine glucose (UG), mean regulation index (MRI) and glycated hemoglobin (HbA1), before and 60 days after providing information about diet (D), physical exercise (E) and hypoglycemic drugs (HD) or insulin therapy (IT). Results were compared with those obtained in a group of 57 age- and sex-matched patients (36 IDDM; 21 NIDDM) who did not receive individual teaching (control group, CG). Knowledge concerning diabetes at the second evaluation was significantly higher (p less than 0.001) in SG than in CG for D and IT, although an improvement was observed in all items. SG patients showed a significant improvement of knowledge (p less than 0.05) for D, a not significant improvement for HD and IT and no change for E. No change was observed for HbA1, MRI and UG, while a significant decrease (p less than 0.05) was observed for FBG in SG. At the second evaluation, FBG of SG patients was significantly lower (p less than 0.05) than that of CG patients. Our results go to show that individual teaching can improve the level of knowledge of patients without affecting metabolic control. Individual teaching during routine diabetologic counselling represents in our opinion an effective and economic educational model.
Acta diabetologica latina 26(3):225-35.
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ABSTRACT: To evaluate if skin hardness in diabetic neuropathic feet was increased and if its eventual modifications could be correlated to the severity of neuropathy, we studied a group of diabetic outpatients with and without neuropathy. Patients, selected among those who were attending their routine screening for diabetic neuropathy at our diabetologic clinic, were divided into two groups according to the presence (ND+) or absence (ND-) of diabetic neuropathy with the criteria of the S. Antonio Consensus Conference on Diabetic Neuropathy. Patients then underwent an evaluation of vibration perception threshold (VPT) by means of a biotesiometer, measurement of skin hardness (DMT) by means of a durometer, and transcutaneous oxygen tension (TcPO2) determination. VPT was determined at allux (VPT-A) and external malleolus (VPT-M), DMT was measured at heel (DMT-H), at medial (DMT-M) and lateral (DMT-L) midfoot, and at posterior midcalf (DTM-C) as a control site; TcPO2 was evaluated at dorsum (TcPO2-D) and at medial midfoot (TcPO2-M), respectively. All measurements were performed on the nondominant side with the patients supine. Patients were compared with age and gender-matched healthy volunteers (Controls), who underwent the same evaluations in the same order. ND+ patients showed higher values of VPT than ND- and Controls, both at first toe and at malleolus analysis of variance (ANOVA) p<0.01), as well of DMT in all the three sites explored (ANOVA, p<0.01). Moreover, ND+ showed no difference in DMT among the sites, while both in ND- and in controls DMT-M was significantly (p<0.05) lower than DMT-H and DMT-L. No difference among the three groups were observed in TcPO2 measurements, and no difference in DMT-C was observed either. A significant correlation was observed between DMT-H and VPT-M (r2 = 0.516) and between DMT-M and VPT-A (r2 = 0.624) in ND+ patients. Skin hardness was diffusely increased in ND+ patients, and this increase strongly correlates with the severity of neuropathy. Simple, noninvasive determination of skin hardness could identify patient at potential risk to develop neuropathic foot ulcers.
Journal of Diabetes and its Complications 13(3):129-34. · 2.03 Impact Factor
